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Et tu, NHS England?

There’s only one issue to discuss this week – that letter.

The letter from NHS England ‘reminded’ GPs that they should be seeing patients face to face. You don’t need me to tell you that this is already happening. But the insight I can provide is on why NHS England decided to send this out.

I don’t think there is any question that the letter made no positive difference to GPs. There is not a single one in England who would have read it and said ‘damn, I completely forgot about the face-to-face part of the job, I’d better rectify that ASAP’. All it did was infuriate and demoralise GPs who have been performing under immense pressure and are now facing more demand than ever.

But, despite being addressed to practices, it wasn’t designed for GPs. And I strongly suspect – just as the addressees were a red herring – this did not come from the primary care team, who would know there is no good to be gained from this letter.

No, this letter was a comms exercise, designed for the likes of Allison Pearson, those columnists with huge followings who are claiming that general practice is closed.

We received an embargoed press release on Friday, alerting us and the other media to the letter. This was deliberate, telling primarily the reactionary elements of the media (and, only tangentially, patients) ‘we are on your side’ – even if your side’s argument has no basis whatsoever.

The ramifications of this will be long lasting. This has effectively sacrificed the goodwill of GPs for some easy headlines. And NHS England may come to regret this when they are appealing to GPs this winter.

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

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Anonymous 16 September, 2020 2:52 pm





Anonymous 16 September, 2020 3:46 pm

Unfortunately this whole episode does show that Dr Kanani is in an unenviably weak position , treated as mere window dressing by NHSE to provide a veneer of professional input.

Anonymous 16 September, 2020 4:59 pm

Phenomenal and unique sign of the times :
(1) At any other point of time in history, this row would simply represent either a storm in a teacup or a story of penance( remember who famously used this word?) GP usually ‘deserved’ . I totally take the argument that some patients suffered finding it really difficult to access our services during last 6 months . There were clearly circumstantial reasons , strongly related to Covid 19, behind these difficulties . But the fact some patients having such difficulties is never the same as ‘GP surgeries are closed ‘ . In fact , closure is equating to a breach of GP contract which is always punishable. But having an alternative arrangement due to circumstantial obstacles needs to be accommodated by the system and its hierarchy . In fact , it has the responsibility to help struggling practices ,especially during the peak of Covid 19 ,to communicate properly with patients so that they understand and know how to access the alternative arrangement. Each individual case should be supported after discerning the facts . I did not see that from the government and NHS England .
(2) Of course , patients then complained as well as spreading ‘rumours’ . The top down technocratic recommendation was providing us an one-size-fits-all ‘communication toolkit’ . This is much far from supporting GPs .
(3) NHSE also ‘reminded’ us that face to face consultation remains available when clinically appropriate. This is fine at any other time and circumstances although ,to me ,it is just telling me that my mother is a woman and my father is a man !
Problem is the current relationship between GPs and the government, hence NHSE , is bottom low . There is very little trust left between . The plight of all frontline clinical staff working with least amount of protection undercut loyalty and faith towards the system . What was left to drive them forward was purely primal professional code . I am not so sure that NHS England recognised that .
Ultimately , yes , this reminder is an ‘insult’ against this backdrop (it is rare that even pro-establishment body like the Royal College of GPs would use word like that ).

Nikita , during the first painful 3 months of the pandemic, my simple message to my colleagues(particularly PCN) in practices was :(1) Cut the red tape (2) Improvise with full flexibility (3) Last certainly not the least , listen carefully to the feelings of all frontline colleagues.
I don’t think NHS England showed any sign of these .
While I never condone any personal attacks on yourself , politics is perhaps not something you are cut out for ( just like many doctors and nurses) . I think you are the one being ‘hurt’ in here .
After all , politics is merely a medium to expose the dark side of human nature . Every time you ‘signed’ something , you might have become the no-man of the no-man’s land.
Live long and prosper……….

Anonymous 16 September, 2020 8:15 pm

Thank you. This blog sums up my feelings on this subject perfectly. It is a complete own goal with no positive outcome for patients or GP’s & has caused genuine distress to many. After working face to face throughout the pandemic in shoddy PPE knowing my colleagues have died this is the last straw. If I didn’t have bills to pay I’d be gone in the morning.

Anonymous 16 September, 2020 9:26 pm

You might want to put a link on the front page (the one that appears on the site when you cannot log in) to restring your password. I tried, repeatedly, to put in my details on the ‘register’ page, and it just freezes and doesn’t indicate why. Only when later checking email did I see I had a link from earlier today inviting me to reset password. Many will hit the brick wall I did, and give up on registering as they won’t notice the ‘reset password’ email in their inboxes

Anonymous 16 September, 2020 9:29 pm

P.S. agree – own goal, demoralising, insulting, indicates that NK has either no backbone, no decency, or no awareness of the pressures that many GPs labour under. A great loss of confidence in NHSE (but confidence is exceedingly low, and has been for some time). I’d be gone in the morning too- in fact I have been looking on job sites this week. Life is too short to spend it doing a thankless task and receiving grief daily.

Anonymous 16 September, 2020 9:50 pm

Ha ha ha. I am sick to the back teeth of being criticised by NHSE. They do not deserve us. Well I have buggered off as of yesterday and retired. They do not deserve us. GPs should leave the NHS ASAP.

Anonymous 17 September, 2020 8:32 am

Quite agree 9.50, NHSE has no insight and no respect for what we have been doing to keep primary going over the last 6months. This letter is so damaging in so many ways, it makes you wonder was it intentional and ‘ordered’ from above?
Forget balloting on pay, we just need to leave NHS behind and go private aka the dentists.

Anonymous 17 September, 2020 9:39 am

I didn’t think that (a) with the second wave looming earlier and fiercer than predicted, making full GP support the only chance of the NHS/population getting through this reasonably, and (b) given the amount of disrespect, abuse, bullying and PR bashing we have already suffered with increasing intensity over the past few years, that there was anything lower that could be found, let alone that it would be from someone who is supposed to be supporting GPs. It might help if Dr Kanani climbed out of her ivory tower, walked into a surgery to see what is going on or saw patients face-to-face herself – at least that would be useful.
The damage caused by this letter, I fear, is irreparable. The pandemic has shown clearly that the only effective part pf primary care, the bit that has carried on regardless of the level of adversity and personal sacrifice, is the bit where NHSE had no influence. Primary care would have ground to a halt had we all sat back and waited for NHSE to tell us what to do. The amount of red tape and interference, patronising and political game playing is only hindering GPs in doing their work. I have yet to find out what they really do for us that we couldn’t do better.
So yes, why not leave the NHS and set up like the dentists, we all know how to run a business.

Anonymous 17 September, 2020 10:06 am

Thank you for outing this. I hope they don’t freeze you out of the journalistic loop in punishment.

Apart from the tabloid ‘journalists’ I’m concerned there is a significant portion of commissioners who also believe GPs can’t be trusted.

It is strange that the answer to all the NHS ills is always ‘give it to the GPs’ but that giving GPs extra resources to do work is a no no in the NHS.

Anonymous 17 September, 2020 9:31 pm


Anonymous 18 September, 2020 8:43 am

We are seeing patients after triage. The only people not seeing any patient face to face are those hiding in NHSE. Show some leadership by example NHSE. How many face 2 face have you seen? The hypocrisy makes me sick.

Anonymous 18 September, 2020 12:01 pm

It’s not surprising – after the dust settles, there will be a storm of observations that cancer diagnoses have been missed, people have suffered from long waits for interventions, minor ailments have degenerated into severe disease, conditions in which early intervention has long term ramifications such as rheumatoid will have been delayed etc., etc.
NHSE and the govt. need a scapegoat for the inevitable shitstorm, and, as per usual, Primary Care is the perfect foil.

Anonymous 18 September, 2020 1:05 pm

is NHSE going to be investigated and fined accordingly for the abuse of innocent staff members that has occurred as a consequence of that letter. Its inaccurate and inflammatory. Serious Damage has been done.

Lester Russell 19 September, 2020 10:57 am

What a dreadful, awful, horrendous job it must be, working for NHSE, CQC, GMC or any of the other multitude of institutions bearing down and simultaneously undermining general practice.
Why on earth do these doctors voluntarily throw themselves into that pit? I have no idea.
What a truly odious and pitiful legacy to reflect upon at the end of their careers. I certainly would not want to reflect on THAT.

T F 23 September, 2020 9:24 am

Can we have the old look pulse please with the boxes Jamie. The grey writing is very difficult to read.