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Who dares wins

Who dares wins

It will take radical solutions to solve the GP workforce crisis and the GMC has taken a bold step in the right direction, says editor Jaimie Kaffash

I die a little inside every time I see someone suggest ‘recruiting more GPs’ as the solution to the crisis in general practice, or even worse, as a means to implement their latest populist policy (hi Wes Streeting!). It’s a bit like advising someone who has financial problems to ‘get more money’.

The shadow health secretary’s vow to ‘train more GPs’ is a policy that is only designed to elicit favourable headlines with little thought behind it. I’ve argued countless times that only radical solutions will bring about any changes – the likes of golden hellos, diplomas and a few thousand pounds for returners will have little to no impact.

These radical solutions won’t be popular with everyone, and it’ll take brave people to implement them. So well done to the GMC for putting their head above the parapet and proposing something that I think is potentially radical – allowing secondary care doctors, and specifically staff and associate specialists, to join the GP register.

I say ‘potentially’ here deliberately. Presuming this is approved, there are a number of issues that will determine whether it will actually help general practice in the immediate crisis. The numbers look enticing – there are currently 60,000 associate specialist (SAS) doctors already on the specialist register, and the GMC predicts there will be 50,000 more staff and SAS doctors practising in the UK by 2030. It would only take a fraction of these to decide to join general practice to make a real difference.

But whether it will help practices will come down to the framing. If they will be heralded by ministers as ‘10,000 new GPs’ (as I suspect they will), then this would be disastrous for general practice. They are not equivalent to GPs – they would require GP supervision and support. Yet their presence will hugely increase expectations of GPs and may leave us in a worse position.

But with leadership from health authorities, this might actually provide a great short- and medium-term boost to general practice, providing a workforce of doctors who may not be GPs, but bring their own skills. This leadership would involve campaigns in making the role attractive to SAS doctors and avoid the perception that they’re a subclass; it would help GPs explain these new medical roles to patients; it would provide support and guidance on the inevitable supervision; and it would extol the benefits of fully trained GPs, to avoid resentment in younger GPs who have gone through rigorous training.

However, my half-glass-empty outlook worries about any lasting effect. SAS doctors do not usually have the longevity of GPs, according to the GMC. This may in part be due to the contracts they are given, but we don’t know. More importantly, this doesn’t on its own address the structural problems within primary care of rising demand and a secondary care system that is under-resourced itself.

So, in the longer term, this might just be the first step to a revolution. This move provides the workforce ‘fluidity’ – as Mr Massey puts in – to really look at how healthcare services can be provided. This might be general practice expanding to provide more services, potentially employing consultants, and removing the need for referrals for anything but the most specialist cases. Although radical, this would probably not be my choice.

But what it could also do is allow us to cut general practice workload by, for example, siphoning off all urgent, on-the-day care, managed by separate organisations and in many cases utilising SAS doctors’ particular skills.

For me, a revolution remains the only thing that will rescue general practice, not just platitudes about ‘training more GPs’. If the GMC’s recommendations are approved, and policymakers use it to its full potential, this daring manoeuvre could provide a win for general practice.

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

David Jarvis 20 October, 2022 12:42 pm

If they just binned appraisal and revalidation how much impact would that have?

Patrufini Duffy 21 October, 2022 4:12 pm

Don’t get me wrong on this note.
But, Jaimie and Pulse need to have a look at their headlines, and click-bait approach. The “must”, “should” and “warn” and “told” littered on the headers is being construed as winding professionals up, and bleak – not sure if it is intended or not or wanting of a response, but it is seeding with negative energy and needs a constructive look at and ownership and consideration of tact.

David Banner 22 October, 2022 7:22 pm

What’s been happening over recent years, with the paucity of GPs versus the influx of PAs/ANPs/Pharmacists et al, is a relentless watering down of a once noble profession, and the SAS brigade is merely the next chapter in this tragedy.

But since we can’t turn back the tide, we GPs need to sink or swim.

The pyramid of a Practice stuffed with doctors supported by a nurse or 2 has been inverted, and those of us left need to embrace the “Consultant GP” role if we wish to survive and (possibly) thrive.

Already we are busy supporting and debriefing our various noctors. SAS doctors will need similar supervision. This is time consuming, but actually highly rewarding and enjoyable.

But most of us haven’t felt able to reduce our own number of appointments to accommodate this extra work, leading inevitably to overworked burnt out GPs. Many self styled Consultant GPs have halved their appointments, usually seeing patients already triaged by non-GP clinicians.

Of course, patients won’t like it. They want to see “their own GP” just like in the Good Ol’ Days. But that model is dead or dying, and increasingly the public are waking up to reality.

So the SAS surge could well be the shot in the arm we need………..but only if we free ourselves up from (say) 15 down to 8 appointments.

Of course, it isn’t perfect, and a deluge of fully qualified GPs ready to take on Partnerships would always be preferable, but it ain’t gonna happen. With proper planning, though, the Consultant GP model could be a fulfilling second prize.

It certainly beats oblivion.

A Non 25 October, 2022 8:45 pm

Its the job that needs to change..not the people doing it

A Non 25 October, 2022 8:59 pm which i mean secondary care Drs wont find the job any more palatable on account of the fact they have less training. The primary care workforce meat grinder will continue to mince the staff its fed. Better to replace the grinder than tweak what your feeding in.