In Perfect World, we’d all agree with the Government’s demands

Pulse editor-in-chief Jaimie Kaffash agrees with the Government’s ideals for same-day access and patient choice, but says real-world general practice cannot deliver without major reinvestment

I know I am risking the ire of readers here, so apologies in advance. But here goes. I agree that 90% (ideally 100%) of urgent cases who need to be seen on the day should be seen on the day, as the Government/NHS England suggest.

And I will go further. Should patients be able to contact their practice through whichever method is most convenient throughout routine hours? Absolutely!

But this is small fry. I would like all patients who need one being given a home visit, ideally on the same day. I would like to see GP appointments being at least 15 minutes – ideally more when necessary. I would like patients to be able to see their preferred GP more often than not. I could go on. 

Unfortunately, however, we don’t live in Perfect World. Because we live in 2025 UK, GP practices are already struggling to meet demand. This is not because they are lazy, but because of deep structural problems caused by funding being steadily reduced in real terms for the past two decades, the number of GPs continuously falling while the number of patients – and their complexity – is increasing, and you know the rest.

I know what the Government will say. They will talk about the success of GPs in the additional roles reimbursement scheme and the funding increase in this year’s contract, with the unspoken (though sometimes spoken) message that you don’t get something for nothing.

But these initiatives barely touch the surface of the problems in general practice. Until we turn the tide of decades of underinvestment, then trying to maintain even current levels of access will be impossible.

It is no longer enough to create a new target, increase funding by the precise penny how much practices could – with the right prevailing winds and nothing going wrong – meet the target, and expect them to get on with it. Because each new target upsets what is already a delicate balancing act being performed by every practice. There is no slack in the system. As a result, new demands simply mean that another part of general practice has to be deprioritised – which ultimately leads to potential patient harm.

Which appointments will be devoted to urgent cases when this target is made compulsory? Will it be the routine appointments, which will lengthen waits to months rather than weeks? Or will it mean GPs will devote a little less time to checking through the deluge of online consults and, if a case of severe vomiting, acute abdominal and chest pain, or rectal bleeding goes unnoticed in the free text option, then so be it? Or do we just get physician assistants – or maybe ChatGPT – to see these additional urgent cases?

I would go as far to say that – despite my apologies in the first line – all GPs would agree with me, and would love to provide the level of service that the Government promises. Furthermore, there would be no need for targets because of-course-that-is-what-we-are-doing-because-we-understand-medicine-and-our-patients-ffs.

But achieving this will require hard work. Fix general practice from the bottom, starting off with huge injections of cash to hire the right staff and improve premises. Do this, and I guarantee you patients will be the ones to benefit.

However, for ministers, it is a lot easier to simply demand perfection and expect general practice to deliver. Which might be a Perfect World for them, but is very imperfect for GPs and patients.

Jaimie Kaffash is editor-in-chief of Pulse