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Building a better general practice

Building a better general practice

The Mail on Sunday’s campaign for GPs to ‘open up’ led, in part, to NHS England’s infamous letter on GPs seeing patients face to face. This week, it did an op-ed piece on the GP ‘refuseniks’, led by ‘rabble-rousing’ Pulse.

As much as we will wear that as a badge of honour, something concerns me about this. Some sections of the media and politicians have cast themselves as the voice of patients, with GPs on the other side.

And their message is compelling: ‘why won’t GPs see us?’ (Telegraph columnists and Mail on Sunday); ‘patients want to be able to get in touch with their GPs through an app’ (Matt Hancock); ‘patients want to access their GP seven days a week’ (Jeremy Hunt). These are easy messages to sell when you strip away all the context.

Of course, GPs know the context. But regardless of truth being on GPs’ side, the negative message is harder to sell. People don’t want to hear that there are not enough GPs to provide all the services you want, or that opening up surgeries would lead to worse outcomes overall, or that seven-day access simply spreads non-existing resources even more thinly. Therefore, GPs become the lazy moaners who refuse to change.

This is a ridiculous situation. Because objectively, GPs are far more qualified to speak about what patients both want and need. They have the relationships with patients and they speak to more patients than anyone. They also understand what is possible on the resources available. Yet they are being usurped by people far less qualified to discuss these things.

As I argued in my editorial for the June issue of the magazine, GPs need to start winning hearts and minds with a positive message. The fact is, GPs are being dictated to because there is a lack of a viable alternative. I understand why the likes of the BMA and the RCGP have been unable to provide such a vision. While the profession is in this state of permanent crisis, they are constantly fire-fighting, while having to take into account the political pressures they are under.

So Pulse is taking the opportunity to live up to the reputation the Mail has bestowed on us – to rouse, if not a rabble, then some very tired, disaffected and disenfranchised GPs. And that is why we are launching our new campaign for the summer: ‘Building a better general practice’.

The campaign will aim to develop principles around general practice: the purpose of general practice; what services should be provided in general practice; what the relationship should be with patients; how to ensure safety; what contractual model should be in place; and how to ensure GPs’ work satisfaction, among other things.

We will then, alongside readers, mould a new system that implements these principles. How it will look, we don’t know. It might involve a fully salaried service, it might involve hour-long consultations, it might involve total remote triage – this will be up to our readers. 

We will start from scratch. This won’t be a case of picking out the parts of the current system that we don’t like: CQC inspections will not be mentioned (unless readers actually believe CQC inspections would be part of the perfect model of general practice – which is, shall we say, unlikely).

The only parameters we will put in place is we will work with the current number of people in the UK, and the current number of GPs. This is because these are not something that can be changed by policymakers; by the same token, our model will allow increased budgets, because that is within the power of policymakers.

There will be two elements to this: the first will be a panel of GPs representing the breadth of general practice – not just in terms of contract types, age, ethnicity, gender, but also their interests within general practice; the second will be a series of four weekly surveys to Pulse readers, asking you to agree or disagree with statements of principle devised by the panel.

Once we have formulated our model of general practice, we will feature this in the September issue of Pulse.

We will send this to policymakers, ministers, MPs, mainstream media organisations, the BMA, the RCGP and other general practice groups. We will provide updates in the monthly magazine on the response.

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Most importantly, this will become Pulse’s de facto ‘manifesto’ and will inform our editorial line in the future.

Below are some dates for the diary. And I would urge you to get involved. If you want to receive surveys, or are interested in being involved in the panel, or – most importantly – have suggestions around how we can do this better, please contact me at

We know how ambitious this might seem. But I feel this work will be worthwhile. Let’s provide a positive vision of general practice and show the power us ‘rabbles’ can do together.

Dates for the diary:

30 June – Panel meets to discuss initial statements of principle around general practice

1 July – First survey sent out to Pulse readers with list of statements

7 July – Second panel meeting to discuss next stage

9 July – Second survey sent out to Pulse readers with list of statements

21 July – Third panel meeting to discuss next stage

23 July – Third survey sent out to Pulse readers with list of statements

28 July – Fourth panel meeting to discuss next stage

30 July – Fourth survey sent out to Pulse readers with list of statements

1 September – Publication of campaign in Pulse print and online

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at



Please note, only GPs are permitted to add comments to articles

Simon Gilbert 9 June, 2021 12:53 pm

In a centrally planned service the customer – government – has to guess how much service to provide to meet demand whose only cost is the time to receive the good (waiting times, telephone lotteries etc).
Even if blessed with the wisdom of Solomon they could never have enough information as to the millions of individual decision that make up an patient deciding to seek a doctor’s advice, and a doctor offering a service to meet that need at that time.
Each extra patient would be an opportunity in a free market, not a burden.
Contrast the press coverage of queues before the Boxing Day sales vs the coverage of queues to get access to a GP practice!

Decorum Est 9 June, 2021 1:04 pm

Adequate resources for reasonable demand!

John Graham Munro 9 June, 2021 2:25 pm

Yeh, yeh——the public, I’m sure would like to know why we get a never ending stream of Television Doctors who should be in their surgeries

Patrufini Duffy 9 June, 2021 2:58 pm

The model involves a payment levy. Period. Not to a GP. Take them COMPLETELY out of the payment argument. To the Government or DoH. To reinvest. Currently, the Gov is cleverly using cheap General Practice to cover social, mental, maternal, child, end of life and every other societal woe for fixed payment. Limitless.
Imagine if you could self-refer to mole clinic, podiatry, paediatrics, geriatrics or gynaecology. Exactly. You CAN’T. But, you CAN self refer to a GP, online, via emails, post-it notes and apps. For any part of the body. For free. And demand it all same day. The walk-ins crashed and so did A+E. Even GUM. They all have the same thread. Limitless free demand. Over-promises. This is great for private companies, create anarchy, trivial complaints and anxiety, and complete disarray and then create a business model for a 1 year procurement. I called the council today, for sharps bin disposal information. Their reception is closed, as stated on the answerphone, and only taking phone and pre-arranged appointments. Funny that. I didn’t complain. You’ve become the local council too now. Surprised you don’t fight fires. Oh, you do that too.

Guy Wilkinson 9 June, 2021 3:51 pm

Great work Jamie / the Pulse team.

However it’s ridiculous that journalists have to a role that should be done by BMA /clinicians in NHSE.

We need to abolish FATPOA and move to a hybrid system like AUS/GER.

Turn out The Lights 9 June, 2021 4:54 pm

Block contract doesn’t work,free at the point of delivery doesn’t work.Any changes are probably too late.In the next few years a third of the workforce is gone.Nothing Will change this.The penance served on us since 2004 has a price to pay,the UK and it’s citizens are going to pay.A faceless non caring lack of continuity omnishambles where some true blue profits from it.Dido at the helm what can go wrong.Look at the success of Talk Talk and track and trace,coming to primary care in the very near future.

terry sullivan 15 July, 2021 9:00 pm

copayments with insurance–no exceptions at all–all must pay

no more IHS