Intended for healthcare professionals

Rapid response to:


GPs are at “breaking point” and in need of respite, leaders warn

BMJ 2021; 373 doi: (Published 04 May 2021) Cite this as: BMJ 2021;373:n1139

Rapid Response:

Re: GPs are at “breaking point” and in need of respite, leaders warn

Dear Editor,

In the last week, the BMA and RCGP have both come forward to acknowledge the increasing pressures on General Practice. Many notable doctors, including Professor Trisha Greenhalgh, Dame Clare Gerada, Dr Richard Vautrey and Professor Martin Marshall have all publicly expressed concerns about rising GP workloads and the essential need for further support.

Whilst recognising the workload issues at hand, it is most disappointing that no central interventions have taken place to immediately help reduce the unprecedented demand on General Practice. At a time when practices are being shut down at record rates, GP resignations are widely being reported, and tales of professional burnout are rising, it cannot be more important to roll out potential solutions to the GP crisis that can quickly be applied.

I believe that literally every single frontline GP would be able to propose some ideas, and solutions may include the following:

1. As a matter of urgency, all CCGs should formally write to hospital trusts and instruct them that GPs will no longer be performing non-contracted work with immediate effect. This includes (but should not be limited to) the provision of medical certificates on discharge, inter-department referrals, additional investigations requested by hospital teams, and hospital prescriptions. GPs are highly trained and experienced healthcare professionals who should not be treated as community house officers for hospital specialists.

2. Simplify the referral process. Rejected referrals on account of failed box-ticking exercises are an insult to our vast knowledge and experience. A GP referral should serve as a clear message to the relevant provider that our patient’s needs can no longer be entirely met within the community according to our professional judgement. This message should be respected and acted upon in good faith.

3. Adopt a better communications strategy which not only highlights the remarkable work that GP teams perform every single day, but also demonstrates how attractive the role can be for new doctors. Appoint regional representatives to act as local GP champions to help support media enquiries and quickly address false narratives that are constantly being propagated, causing much harm to our professional morale and public opinion.

4. It is vital to recognise that GP teams cannot be everything to everyone, and our resources are indeed finite. Whilst patient demand may also be finite, there is clearly a mismatch between these two theoretical figures and we must determine how to close this gap. This would at least require modifications to existing consultation models, and appropriate funding to recruit, retain and support more health care professionals. There is no escaping that fact that our NHS presently has around 100,000 vacancies, and every effort must be made to fill these positions without delay.

5. Stop all non-essential CQC inspections, and allow GP leaders to agree a simple, uniform, evidence-based approach to inspections that is collaborative, non-threatening, and does not adversely impact patient care and staff wellbeing.

6. Cease appraisals and revalidation as there remains no evidence to support these protracted exercises in futility. As doctors, we are all expected to practise evidence-based medicine, yet the irony of unilaterally enforcing these unscientific impositions clearly is lost on NHS England. Whilst regulation of GPs is essential, it should also aim to be straightforward, supportive, collaborative, scientific, and respectful.

7. Invest further into work streams that help to promote population health through education and support at a community level, helping to tackle the many lifestyle elements that can contribute to chronic diseases. Smoking cessation services are an excellent example of how effective these measures can be. Similar approaches towards (for example) exercise, diet, and stress reduction could potentially have equally powerful results.

8. Place staff wellbeing at the heart of healthcare delivery. The World Health Organisation defines a healthy working environment as “one in which there is not only an absence of harmful conditions, but an abundance of health-promoting ones”. Presenteeism is rife within the NHS, and we must recognise that an exhausted, overworked health care professional cannot perform at their optimum capability. It is therefore vital that appropriate measures are taken to create a healthy workplace environment that enables our healthcare professionals to both survive and thrive during these extraordinary times.

If General Practice were to fail, the entire NHS would collapse. The current GP crisis predates COVID-19 by many years, but has been highlighted and worsened by the pandemic, and more work continues to be transferred to primary care without the associated funding or resources. Many potential solutions are easily achievable with political will, and could make significant impact on the workload and morale in General Practice.

Competing interests: No competing interests

05 May 2021
Shan Hussain
General Practitioner