In GPs we (should) trust

Pulse editor Jaimie Kaffash argues that the Government and the NHS have a lot to gain by simply trusting GPs instead of weighing them down with bureaucracy

Our exclusive interview with NHS England primary care director Amanda Doyle confirms what many of us knew – that the 2024 GP contract won’t be revolutionary. But it will set the direction of travel for what looks likely to be the seminal contract in 2025.

Dr Doyle indicates that the ‘future of QOF and incentives in general practice’ (which have a huge influence on how GPs work) will be up for debate. 

Obviously, much of the negotiation will focus on the nitty-gritty. But, if I were a GP negotiator, I’d send one overarching message to NHS England and the Government: trust GPs. 

That should be a given but it is not. And the failure of NHS leaders to do so is having serious repercussions for GPs, the wider NHS and ultimately patients. 

What does trusting GPs mean? It means believing in their knowledge and professionalism and that they are always working in their patients’ best interests. 

To me, this doesn’t seem too much of a stretch. Maybe I’m a hopeless optimist, but I think it applies to most professionals. And more so for GPs, who have undergone a decade of gruelling education and training, with qualifications that would earn them a lot more elsewhere and clear ethical codes. 

Once you start trusting GPs, the benefits are overwhelming. First, you save the time wasted ticking boxes for CQC inspections and appraisals. This is already game changing. 

Next, you can get rid of the QOF. You can trust that GPs are acting in their patients’ best interests – keeping disease registers where necessary, taking blood pressure readings where necessary, prescribing the right medication where necessary, etc. No more valuable time lost achieving targets and – even worse – having to record that they are achieving targets. 

Then you can end strings-attached funding. Practices can join networks if it is right for their patients. They can appoint the staff they need, at the right salary. They can offer vaccinations or enhanced services if appropriate. 

There will be a tiny minority of GPs and practices that don’t warrant trust; those that are underperforming or providing poor care. But I’d argue that the mechanisms to identify them far outweigh their prevalence. There are plenty of ways to pinpoint bad apples without swamping the whole profession in box-ticking bureaucracy. 

We have many metrics that raise flags, and are recorded as part of practices’ day-to-day working: volume of appointments, prescribing and referral rates, patient surveys, complaints and peer pressure. Local commissioners can work with these practices, discuss what is causing problems and take action if absolutely necessary.

Of course, the awful shadows of Harold Shipman and now Lucy Letby hang over this debate. But both were identified by clinicians raising concerns about discrepancies in data. The current inspections and regulatory processes were no help in the case of Letby. 

This isn’t an argument for deregulation. That has caused disaster in many sectors when industry cuts corners or behaves aggressively so as to make more money. But trusting GPs won’t free up time to increase their income – it will free up time for patient care. 

Saying this out loud might make me sound naïve. But this approach is best for commissioners and politicians too, as it will improve the quality of care. Trust me.

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