It’s not the operating model that’s at fault, it’s the resource model

3 September 2021

'Impasse' might be the right word to describe some of my conversations with critics of general practice. They say current ways of working in general practice are broken and rebuilding is the only option. I say of course general practice needs to flex, and it does, but the biggest issue by a long way is that general practice is inadequately resourced to do what it’s being asked to do.  

The more I speak to colleagues around the country, the more practices I visit, the more I think the College view is vindicated. I speak to single-handed colleagues in East London where I work and to GPs working in practices serving 30,000 patients. I speak to practices which still revel in glorious isolation and ones that are fully engaged in their local networks. I speak to clinicians working in practices run by their local acute trusts and to ones working for multi-national providers. I speak to conservative clinicians and innovative clinicians. And they all say the same: however hard they work, however much they improve their ways of working, the job remains undoable. 

It’s not the operating model that’s at fault, it’s the resource model.


Latest updates from your College

Defending the profession

The ongoing denigration of GPs by certain sections of the media is offensive, inaccurate and downright irresponsible. The criticism in the Telegraph in particular has been relentless.

I hope you’re seeing the efforts we are making to defend the profession - via media statements, letters to editors and on social media. Thank you also to our members who have written their own letters challenging and calling out these insults.

As I have said many times, particularly over the past few days, GPs and patients are on the same side but we need the four governments of the UK to urgently and properly invest in and support general practice.

We will continue to fight the corner of hardworking GPs and our profession against this undeserved onslaught. Please keep an eye on the news section of our website and social media for latest updates. You can read our latest riposte to the Telegraph.

It would be fantastic if a newspaper such as the Telegraph got behind us and ran a campaign to support general practice, rather than using its pages to condemn us for trying to do our jobs in exceptionally difficult circumstances.

GP Action Plan

Our GP Action Plan outlines the workforce, workload and wider challenges facing general practice and includes a set of recommendations for the government to implement now. You can help us by sharing our action plan with your MP. All you need to do is enter your postcode and a few details, the rest of the work is already done for you.

AKT update

Apologies again to those trainees who’ve had problems trying to book for the October sitting of the Applied Knowledge Test.

The situation originated from technical issues with Pearson Vue who run the test centres. While we were able to resolve these yesterday afternoon, the high volume of concurrent bookings then caused further difficulties.

Following extensive testing this morning, we now seem to have resolved the issue and all trainees should be able to continue the booking process by following the instructions on their booking email.

Candidates are still able to apply for the AKT via the application page which will remain open until 17:00 on Tuesday 7 September.

Please accept our sincere apologies for the inconvenience and delay caused. We understand that this disruption will have added to what is already a stressful situation and we’re extremely grateful to you for your patience and understanding while this was resolved.

Blood tubes

The blood tubes shortage continues to cause a major headache for general practice, not least in trying to reassure patients who are already concerned about long backlogs for treatment as a result of the pandemic. I made these points while doing the media rounds, including BBC News, on Tuesday.

We understand that the English government is seeking alternative sources for bottles, and it is crucial these are urgently put into action to enable GPs to plan and reschedule delayed tests. We also need assurances that any alternatives are fully calibrated against UK laboratory standards and that they are compatible with existing equipment. Today, the BMA has written a letter to the Health Secretary on behalf of all doctors (134 KB PDF), calling for clear plans for resolving the issue and an investigation into how it happened.

Health and climate change

This Monday, 6 September, the UK Health Alliance on Climate Change - of which the College is a founder member - will be publishing a groundbreaking editorial on health and climate change in over 220 health journals across the world, including our own BJGP.

It’s the first time so many journals have combined to work in this way. The editorial calls for world leaders to take emergency action to transform societies and limit the global temperature rise to below 1.5°C, restore biodiversity, and protect health. 

It makes two main points: the current strategy of encouraging markets to swap dirty for cleaner technologies is not enough, and global cooperation hinges on wealthy nations doing far more to reduce their own emissions, and to financially support low-income and vulnerable countries to do so.

We’ll be promoting the message on social media and elsewhere on Monday, using the hashtag #HealthyClimate

Thanks as always to former College President Terry Kemple and Sheffield GP Aarti Bansal, co-chairs of our Climate Emergency Advisory group, who have taken up the sustainability baton on behalf of the College and are doing a superb job to ensure the green agenda gets the attention it deserves.

GP role in Surveillance of Respiratory Illness

Join us on Thursday 9 September when Professor Simon De Lusignan, Director of the RCGP Research and Surveillance Centre, talks through recent data on respiratory illness collected via England's oldest sentinel network, including surveillance of COVID-19. He is joined by a representative from Public Health England on how this data can been used in research and what GPs can do to get involved, as well as a frontline GP already involved in virology and serology sampling.

New guidance on suicide prevention

As GPs, we regularly make difficult and challenging decisions regarding information sharing around patients’ mental health, so we welcome the Department of Health and Social Care’s updated consensus statement on suicide prevention. The Zero Suicide Alliance (ZSA) has produced guidance for frontline staff to read alongside the consensus statement on how to engage with patients when discussing confidentiality and consent to share information. We hope it will produce better patient outcomes and save lives. Thank you to Elizabeth England who has led the College’s involvement in this important work.

OLE upgrade

Our online learning environment (OLE) will be offline from 00:00 on Saturday 4 September to 20:00 on Sunday 5 September due to planned technical work. We apologise that there will be no access to eLearning during this time. Our main website, including clinical toolkits, will be available and members can also continue to book online events.


Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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