General practice – a crisis of vision?

Richard Pratt is a GP in Cornwall with an interest in health tech & innovation. He is on Twitter: @rich_pratt

More than the 10 minute face-to-face appointment….

The last 18 months have been characterised by challenge and turbulence in much of our lives and General Practice has not been spared. We have been thrown around in a covid storm, the experience unsettling both in its unpredictability and surges.

As we enter the winter and the uncertainty that this brings in terms of direct demand from covid & non-covid illness, taking a moment to pause and reflect now is essential to be as well prepared mentally and practically as we can.

There is value in returning to our core motivations, questioning what we do and why we do it. This then allows us to return to our work with renewed understanding of our underpinnings, more sure footed. Changes in working practices and new requests that are made of us are much easier to rapidly assimilate, assess and respond to if we have a clear vision for what General Practice is & similarly is not.

We have been thrown around in a covid storm.

In recent months there has been a challenge perpetuated in the media that we should be returning to a more face-to-face model of delivery. These calls while understandable are deeply flawed. They arise through conflating what we do and how we do it.

As a GP, I’m here to look after my 1600 people when they are unwell. Adding more colour and broadening this vision of General Practice; providing safe, accessible healthcare, free-at-the-point-of-use, close to home, where possible with a team who know you.

At the start of the pandemic, we had to pivot, shifting our dominant mode of delivery from face-to-face to remote consultations incorporating telephone, video, SMS & online. Face-to-face consultations have remained an option throughout the pandemic & utilised when clinically needed following triage. Failing to adapt would have risked in-practice transmission of Covid-19 & compromised safety of all involved.

A pivot is a change in strategy without a change in vision.1 This we achieved, but failed to adequately explain. This failure to explain has led to fundamental misunderstanding that we have somehow abandoned our core vision, in short, we no longer care.

A pivot is a change in strategy without a change in vision. This we achieved, but failed to adequately explain.

What we do (provide healthcare) & how we do it (face-to-face, online etc) are intertwined but distinct. Our vision has remained intact, or more correctly, has been strengthened through these challenges, as has our commitment to provide high quality healthcare. Our strategy of how we do this has shifted – a new, blended model of delivery, more intelligently tailored to each individual’s specific needs.

The one-size-fits-all 10 minute face-to-face consultation as the only option is no more and as a healthcare system we are better for it. It is only in understanding our vision & sharing this, that it becomes clear that pulling back from face-to-face consultations is not a marker that somehow we no longer care, quite the opposite, it is itself an act of caring. In seeing beyond the 10 minute face-to-face consultation, we are liberated from its confines, creating a service that is more responsive & accessible, better tailored to each individual’s needs and circumstances.


1. Ries E, 2011. The Lean Startup. Pub Crown Publishing Group (Random House)


Featured image by Riccardo Annandale at Unsplash     

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