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There is no magic GP tree

There is no magic GP tree

Jaimie Kaffash says we should not dismiss the idea of hiring SAS doctors in general practice

I’ve always said about GMC Charlie Massey that, whatever you think of his organisation, his frankness is to be admired. I remember when he stood in front of an understandably angry audience at the British Association of Physicians of Indian Origin conference a week after the GMC struck off Dr Hadiza Bawa-Garba and explained the decision with humility. It didn’t excuse the decision, of course. And while not a single delegate left that conference thinking that the GMC had acted correctly, there was a grudging respect.

Yesterday, he spoke to a (slightly) less angry audience at Pulse LIVE, but with equal frankness. He elaborated on his ideas for more staff and associate specialist doctors – those secondary care doctors who are not consultants but are not in training either – to join general practice to help alleviate the workforce crisis. Now, I am still lukewarm on the idea. I understand the problems – we might be creating a two-tier medical workforce, will they need supervision, is this cheap labour, how will secondary care cope with the loss of such doctors.

But I would be a hypocrite if I rejected this out of hand. I have asked for radical solutions, and this is a radical solution.

Because the one thing Mr Massey said that really resonated with me is that there is no magic GP tree; we can’t just go and get GPs off the shelf. There is plenty we can do, of course. Increase funding, improve retention with programmes that actually work, stop the GP bashing in the media and by ministers. But even with the Government starting to treat GPs as they should be treated, the years of neglect of the profession means it will only go so far. It is at least a decade before we will see such measures making a tangible difference.

We need an injection of medical staff now. Other roles, such as physician associates, pharmacists, physiotherapists can help, but they are not the same as having another doctor in the practice.

If we were to change regulations to allow SAS doctors to join general practice, it opens up more options. Because, according to the GMC, this grade is growing rapidly, mainly from doctors trained abroad. Would it involve a dermatologist on site, as one audience member asked? Or, as RCGP chair Professor Kamila Hawthorne mentioned, would it involve a new training pathway for them to enter general practice?

At the moment, we don’t know. NHS England have made positive noises, but so far there doesn’t seem to be any concrete proposals. For the moment, such an idea can’t be dismissed out of hand.

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

Paul Burgess 23 March, 2023 6:24 pm

The ‘manage anything and everything’ type of GP (typically a GP Partner) is a dinosaur. (because of lack of incentivising partnerships). But dinosaurs don’t become extinct -they evolve -into chickens -well battery hens mainly….

Simon Ruffle 23 March, 2023 6:32 pm

Paul Burgess- may I steal that analogy?

There are plenty of GPs. There are not enough that are willing to put up with the onslaught and ever decreasing pay conditions and satisfaction that current partnership offers.

Anonymous 23 March, 2023 7:02 pm

Diabetic specialist nurse asking me today how to manage diabetic patients during Ramadan.

Scary if you think about it.
You have allowed all these noctors to run around like they are God knows who.

David Church 23 March, 2023 10:01 pm

Ah Jaimie – you only don’t believe in the Magic GP Tree because they won’t allow you into the garden of Number 10 to see it with your own eyes!
It will of course be removed and taken to the grounds of a very Private ex-PM’s house should the Conservatives be voted out at the next election, but then, who cares once they have wrecked the NHS anyway?
No, I do not believe this ‘SAS’ doctors to the rescue will help GP-land : significantly because they are hospital doctors and do not know how GP works; would need training on everything from consulting and patient relationships, to correctly consenting, completeing paperwork, and use of clinical IT systems, and let’s not forget that none of them know how to write a referral, they always ask a GP to do it for them.
Secondly, removing them from secondary care would significantly increase difficulties with waiting lists, and shift even more problems onto Primary Care – and to a greater extent than what they would reduce by working in GP surgeries, so the whole system would be a lot worse off, especially the patients.

Paul Burgess 24 March, 2023 9:02 am

Simon Ruffle, I’m chuffed. Be my guest!

David Turner 24 March, 2023 10:17 am

the quickest thing the GMC could do to improve the situation is to improve retention. Boring as it is to repeat these, the below would help immediately.
1) suspend appraisal, or at least make it 3 yearly. It is enormously time consuming and of little or no value
2) Revalidation as above. Could be automatically revalidated, unless any GMC level complaints pending. Would prevent a lot of pointless paperwork
3) CQC. SUSPEND ALL ROUTINE INSPECTIONS. WASTE OF TIME AND MONEY. they should just focus on problem practices

If the above is carried out I guarantee the flow of experienced GPs out of the profession will slow significantly.

Michael Mullineux 24 March, 2023 3:10 pm

As per DT above, a quick calculation demonstrates that even in the shortened form, in excess of 18,000 12 hour days are lost to General Practice annually through appraisal

Jamal Hussain 25 March, 2023 2:40 am

If they paid GPs more maybe more people would want to be GPs. If there were enough GPs then the workload wouldn’t be problematic and retention wouldn’t be a problem. We already have a minimum wage system operating. So that’s not a new concept. Peg the minimum wage to that of the MPs.

Jamal Hussain 25 March, 2023 2:41 am

And also match their pension system.

Jamal Hussain 25 March, 2023 2:47 am

If that doesn’t work give GPs all the same perks of the MPs which is worth a many tens of thousands. If that doesn’t work come back to me and I’ll tell you what to try next.

David Mummery 25 March, 2023 9:45 am

There is if you link GP pay to number of clinical sessions worked for all GPs

Finola ONeill 25 March, 2023 8:43 pm

I am a locum GP. Happy to be partner when;
1. It pays as well as being a locum; that will be full time pay of 125-150,000 per year. The tax and pension set up is better for partnership so is an attraction
2. No personal liability; then they would need to be small limited companies and government needs to pay interest free loans for buy-in/mortgage for premises etc
3. We are out of PCN and qof; non stop top down micromanagement. I don’t mind PCN run and dictated by surgeries; give us the bloody money and foxtrot oscar; we will share staff, etc as works best. (No prescribed roles; good bye social prescriber and wellbeing coach FFS)
4. up funding from 8-9% of NHS budget to around 14% would do it. That would end up cost effective for NHS anyway. Essentially we do as much as we can with time and money we have. And we do 90% of consults; More time and money we could do even more of secondary cares work for them and far cheaper and prevent the massive over investigation of 2 care.
(My friend, in his 40s, severe vertigo, went to ED, MRI, f/u with neuro; probably seen by F2 and discussed with consultant. Got him worried waiting for stroke OP rv. I told him, mate you have labyrinthitis; if he had seen GP he would have got stemetil. This is how secondary care works. You need a filter before they get there and get over investigated. Similarly a patient referred by a rushed GP to cardiology; CT angiogram OP, didn’t prove conclusive. Proper angiogram; no sig disease. Still waiting to see cardiology back at first hospital. I took a history. It wasn’t even cardiac chest pain. None of the cardiologists had taken a history.)

The removal of qof, micromanagement and increase in funding will save masses because if we do our job properly the rest of the system works better.

And until then the government and NHSE can F***off.
And I suggest will we get that increase in funding of 5-6% of NHS budget to 14-15% of total; we work to rule.
I mean literally.
8.30-6; acute stuff triaged, chronic staff as able and the rest; nothing till funding.
I am totally serious. my colleagues are crumbling and expected to work on their bloody goodwill.
Goodwill is 3 year past its sell by date.
Pandemic; government parties; “no cake was had2. Nuff said

Elizabeth Toberty 26 March, 2023 6:38 am

Patients never come with just one thing. Even with the best triage, there are always undifferentiated problems. We also balance risks very differently to secondary care.
If these doctors want to be in GP, get them to fully train up, with a less time in hospital….maybe 2/2.5 years.

Mark Howson 27 March, 2023 9:22 am

You worry how the hospital will cope losing the SAS doctors but I am at a loss as to what the consultants are doing given they have increased in number three fold in the last 15 years while we have gone down and still GP deals with over 90% of consultations.

James Cuthbertson 27 March, 2023 11:40 am

I disagree with this article as well, which is unusual. I am a GP who only does a few locum sessions now because my GPSI work is better paid and hugely less stressful. I would come back to GP if the job was fixed and I know several other GP’s who do many less sessions than they would than if the job was less terrible. Multiply that over the country and their are obviously thousands of fully qualified GPs ready to go. The worst part is that when I see a patient in the big shiny building as a “specialist” I am usually listened to and my opinion holds a degree of respect, whereas in GP land patients have been conditioned to think of the GP as an obstacle or a dogsbody.