Anuj Sean Chathley is a UK-based GP with an extended role in medical and surgical dermatology.
I qualified as a General Practitioner in 2012, beginning my career at a well-regarded training practice in a coastal town in the North of England—an organisation consistently rated among the best in the country. I started with high hopes and a strong desire to make a meaningful impact. I pursued additional qualifications in dermatology, sexual health and contraception, vasectomy surgery, joint injections, and point-of-care ultrasonography. Like my colleagues, I believed in bringing as many services as possible into the community. We saw this as not only good for patients but good for the local NHS economy—delivering quality care, reducing pressure on secondary services, and saving money.
But the reality that has followed in this country has haunted me.
Despite our dedication and the measurable benefits of our model, the NHS began to systematically defund primary care.
Despite our dedication and the measurable benefits of our model, the NHS began to systematically defund primary care. Funding previously available for service development was stripped away. I remember how many similarly sized or smaller practices lost a substantial portion of income shortly after I joined. Many GP partners at the time chose to absorb the losses, valuing patient care over personal financial gain.
Life events and financial pressures lead to partner departures. Recruitment becomes increasingly difficult. The partnership model itself begins to be seen as unsustainable.1 Practices, once proud of their role in training future doctors, are forced to scale back educational commitments.2 Today, many partners take home less personal pay than salaried doctors. I fear that his trend will only worsen as they inch closer to retirement.
And yet, practices may rate highly for patient satisfaction, take time to avoid unnecessary prescribing and secondary care referrals, and continues to offer services —such as ear-microsuction— that are no longer NHS-funded. But this is sustained only through the sacrifice of the partners’ incomes and well-being.
How is this fair?
Here is a group of GPs who have given their all for their patients, and the reward has been disillusionment and financial decimation. Many practices will not survive once the current partners retire. This is not just a personal tragedy; it is a warning about the future of primary care in the NHS.
The wider issue is a systemic one. We are trapped in a cycle of short-term cost-cutting that undermines long-term sustainability. In the name of savings, funding is pulled from primary care—one of the most efficient and patient-friendly arms of the NHS—resulting in fragmentation, inefficiency, and rising costs elsewhere.
The NHS claims to want: cost-effective, patient-centred, low-referral, high-quality care. Yet it is precisely practices that adopt this model that are being punished. Why?
This erosion is not only financial. It is moral. There has been a marked shift in GP attitudes over the years. Increasingly, I hear colleagues say words to this effect: “Why should I go the extra mile—challenge inappropriate prescribing or resist unnecessary referrals—when I am unsupported and overstretched?” And who can blame them? The incentives to do the harder, more principled thing are vanishing. In this climate, taking the easy route—referring, prescribing, avoiding conflict—has become a survival mechanism.
In the name of savings, funding is pulled from primary care—one of the most efficient and patient-friendly arms of the NHS—resulting in fragmentation, inefficiency, and rising costs elsewhere.
This disengagement is dangerous. It undermines the very efficiencies the NHS claims to seek. Primary care has repeatedly proven its value in doing more with less. But it is being squeezed to the point of collapse.
A recent example is the minor surgery DES. This national contract sets tariffs for procedures like joint injections and skin surgeries—tariffs that have not changed in 15–20 years. Why would any GP commit to this work at a rate that bears no relation to current costs or effort? And why would those already doing it not simply opt out and refer everything to secondary care?3 That would mean longer waits, higher costs, and potentially poorer outcomes for patients. Yet this is where policy decisions are steering us. A short-sighted attempt to save money ends up costing more and delivering less.
In conclusion, we are burning out the very engine of the NHS—primary care—by treating it as a cost centre rather than a foundation for health.
Unless we urgently recalibrate the value we place on community care, we will lose more than money. We will lose trust, continuity, and a generation of doctors who once believed, like I did, that we could make a difference.
References
- https://www.nuffieldtrust.org.uk/news-item/withering-gp-partnership-model-threatens-provision-of-general-practice-experts-warn [accessed 19/6/25]
- https://www.pulsetoday.co.uk/news/education-and-training/bma-increasingly-seeing-non-gps-appointed-as-training-programme-supervisors/ [accessed 19/6/25]
- https://www.pulsetoday.co.uk/news/practice-personal-finance/gps-told-to-stop-subsidising-minor-surgery-as-part-of-collective-action/ [accessed 19/6/25]
Featured photo by Jason Blackeye on Unsplash
All true and unbelievable.