GP for Non-GPs - More than Coughs and Bumholes

There’s an entire world behind your “refer to GP” discharge note — and chances are, if you’ve never worked in primary care, you don’t fully understand how it works.

And I get it. Most hospital-based clinicians think they do:

“GPs just see coughs and UTIs, right?”“I sent them back for follow-up. That’s normal.”“Surely their GP can sort it.”

Sound familiar?

If you’ve ever wondered why your referral bounced, why a patient wasn’t followed up like you expected, or why your lovely discharge plan didn’t quite land — this one’s for you.

What Even Is General Practice?

Let’s be blunt: we’re the front line, the filter, and the sponge of the NHS.

General Practice isn’t “basic” — it’s broad. It's about balancing uncertainty, juggling complex multi-morbidity, and catching zebras with less time, fewer tools, and no hospital-grade safety net.

We’re expected to:

• Spot the cancer in a sea of back pain and tiredness.

• Manage the polypharmacy, psychosocial chaos, and fallout from disjointed secondary care.

• Translate consultant speak into real-world plans for a worried single mum with three kids and a 10-minute window.

We're also:

• Counsellors, medics, social workers, and data processors, all in one.

• Often running the building, employing staff, managing the rota, meeting QOF targets, and fielding complaints — sometimes on the same day.

The Structure: Who’s Actually in Charge?

GP Land comes in 3 flavours:

1. Partnerships: These are the most common. Think of them as small, independent businesses. The GPs are both clinicians and owners. They:

   • Hold the contract with the NHS.

   • Employ their own staff (reception, admin, nurses).

   • Pay for their own buildings, equipment, and some IT.

   • Handle complaints, HR, rotas, and governance — on top of clinics.

2. Salaried GPs: Employed by partnerships or health boards, depending on the model. Less business responsibility, but also less say in how things run.

3. Health Board–run Practices (aka 2C contracts in Scotland): Often used when no-one else wants to run the practice — underfunded, underdoctored, and usually serving deprived areas.

This mix means massive variation in:

• Appointment availability

• Who sees what

• Access to investigations

• On-call demand

• Follow-up expectations

How Are GPs Paid? (Spoiler: Not Like You Think)

Here’s the part no one outside GP seems to understand — we’re not salaried by the state like hospital consultants. Our funding is a patchwork quilt of multiple streams:

Core funding (Global Sum)

• Based on number of registered patients.

• Adjusted by things like age, sex, deprivation, and mortality via the Carr-Hill formula.

• Still doesn’t account for actual workload.

QOF (Quality and Outcomes Framework)

• Paid points for hitting targets (e.g. BP control in diabetics).

• Incentivises chronic disease management.

• Requires robust data entry, recall systems, audits.

Enhanced Services

• Extra cash to take on services beyond core GP (e.g. minor surgery, contraception).

• Optional, and not always funded well.

Premises/IT Reimbursement

• Partial coverage for buildings and IT — but not everything.

What it doesn’t pay for:

• Chasing hospital departments.

• “Just do the bloods and check my ECG again.”

• Unfunded follow-up.

• Fixing the messes others create.

In short: if you say “GP to chase,” “GP to repeat,” “GP to monitor,” without handing us the budget, staff, or protocol — you’re not delegating. You’re dumping.

A Typical Day (If You Can Call Anything Typical)

10-minute appointments. 30–50 contacts a day. Add-on extras. Results. Labs. Referrals. Notes. Letters. Complaints. Med requests. Death certificates. DVLA forms. Med3s. Work sick notes. Care plans. MDTs. Safeguarding calls. And that's before lunchtime.

Real talk:

• Most “10-minute” slots last 15–20 mins.

• Demand is infinite. Our time is not.

• Complex patients need more time — but the system doesn’t flex.

Add in:

• Business meetings

• Appraisal prep

• Staff absences

• Trainee supervision

And yes — we still get patients asking “Is the doctor even in today?”

GP Training: It’s Not a Cop-Out

Contrary to what some hospital folk think, becoming a GP is not the “easy route.”

• 3 years minimum

• 18 months in hospital specialties

• 18 months in General Practice

• Pass:

  • AKT (Applied Knowledge Test)

  • SCA (Simulated Consultation Assessment, or previously CSA)

• Fill out an endless ePortfolio and complete regular workplace-based assessments (WPBAs)

We are trained generalists. We do more breadth, more uncertainty, and more real-world negotiation in eight minutes than many see in an afternoon ward round.

So Where’s the Friction?

Glad you asked.

This isn’t laziness or “lack of knowledge.” This is structural fragmentation, misaligned incentives, and a system that runs on goodwill and guesswork.

What Can You Do?

You don’t need to love GP. But if you want better care for patients (and fewer shouty phone calls), try this:

ASK before you bounce

• Not sure what’s expected of GP? Check first. Don’t assume.

Handover clearly

• If you want us to repeat bloods or review — tell us what, when, why, and how urgent.

Shared care? Actually share it.

• Don’t recommend drugs we can’t monitor. If you start it, own it — or send a formal shared care protocol.

Respect capacity

• “Just check with GP” may sound small — but multiplied over 10 patients/day, it's a tsunami.

Remember: we're not the dumping ground

• GP manages 90% of NHS care with just 8% of the budget (King’s Fund, 2023). We’re already beyond breaking.

TL;DR

GPs aren't lazy.

We’re not clueless.

We are overworked, under-resourced generalists holding the system together with duct tape, sarcasm, and a half-charged laptop.

If you're outside GP, try and understand what we can do — and what we can't. If we all stopped working in silos, we might actually get somewhere.

Stay positive

- DW