General Practice After Covid – A future conversation

Pamela Martin retired after 30 years a partner, 10 years a trainer, 3 years on BMA GPC, and is currently trying to support younger GPs. She is on Twitter: @pamarpamela

“Good morning. Are you wishing to apply for a job in our GP Hub or in our GP Plus clinic?
“I see, you have just returned to the country and didn’t know the difference. Well, we do have vacancies in both.

“The GP hub is usually considered entry level. It’s based in the hospital. There are 12 of you on a shift. The shift is for four hours. The patients are booked by 111. Half are telephone slots, one quarter video and one quarter face to face. If you can’t complete the episode you can bring them back to a senior for a face to face within a week.
Patients needing nursing care, physiotherapy, mental health care, contraception or sexual health services will have been booked into the relevant service.

“Children under 10 will be seen by the Paediatric team in the urgent care centre.

“The GP hub is usually considered entry level. It’s based in the hospital. There are 12 of you on a shift.”

“You can request investigations, and abnormal results are handled by a senior.

“You can refer to our hospital, subject to referrals meeting the criteria. If the Consultant feels a tertiary referral will be needed that will be organised later. Your investigation, referral and bring-back rates are audited as part of your performance management process. Contracts are initially for 3 months, potentially renewable then for a year. At this hub we pay the outer London regional rate for GPs within 10 years of completing training. You are entitled to a a week of study leave after 15 months work in the Hub.
“Ah, I see, you feel that is not attractive, and you have over 10 years’ experience.

“Well, our GP plus clinic vacancy is likely to be more competitive. It is a paid-for service, but more like the old-style General Practice you were familiar with in 2015. As the Clinic gains more subscribers, we can recruit more staff.

“Consultations are offered as either 15 or 30 minutes face to face, or by video, or by telephone or e-consult. The subscription costs are set to allow client choice. We have found after two years we can price it appropriately. A shift here is again 4 hours, which may mean 8 half hour slots, sixteen 15 minute slots or a combination of all types of consultation. For every four hours of consultation time you are paid for one hour of administration time as you will be doing all your results, repeat prescribing and referrals to the hospital of the patient’s choice. You are free to arrange follow-up appointments as you see fit.

“Oh, that doesn’t sound like the General Practice you were familiar with in 2015?
“Well I was still at school then, but how could GPs possibly have no cap to the number of patients they were consulting? Didn’t you overrun?
“I did read somewhere that there weren’t enough GPs to do the work, as it had become impossible when there wasn’t enough funding for practices, so the Government decided in 2022 that they couldn’t afford “gold-standard” primary care for everyone. They brought in the Hubs and the separate clinic system is not part of the NHS.
“They say the NHS is still free at the point of delivery, but the delivery method has changed.

“No, the Hubs are not like you get to know patients or patients get to know you, that isn’t the idea.”

“No, the Hubs are not like you get to know patients or patients get to know you, that isn’t the idea. Most doctors move into the Clinic system as soon as they have done the 5 years needed to get an Independent Licence, then they can have a regular clientele.
“Sorry, I don’t know about prevention work and public health work and health inequalities, I just work for The Organisation.
“Sorry, I don’t know anything about Scotland, except it’s very different up there
“Thank you, I hope you got the information you needed. All the best……”


Featured photo by Drew Beamer on Unsplash


  1. This is prescient and dystopian. Pam outlines extremely well the risks of not standing up for traditional General Practice as a holistic service with continuity of care, embedded in communities allowing the GP to see the patient in the context of their lives and not just their symptoms. We lose this at the peril of our patients, ourselves and the NHS we need to stand up and fight for the jewel in the crown of the NHS!

  2. The really scary bit about Pam’s piece is that we can actually see it happening in England as we sit here now. The value of universal coverage is being lost as we sit back and let it : the neglected ones will drag down not just ‘average health’, but civilisation loses it’s soul too and becomes callous, corrupt, and unhealthy. It will not be long before the young remember nothing better!

  3. Is this really where we are heading, or is this here already with more practices being bought up by US multinationals

  4. Indeed very dystopian and very scary.
    The union Doctors in Unite (Medical Practitioners Union) have written a very different future scenario outlining a much more community based vision of Primary Care with a return to continuity of care, practitioners really getting to know their patients and their families, team-working and a real change to a public health model of general practice with dual training for clinicians, democratic accountability and an emphasis on the use of technology to support such a model rather than leading it.

  5. The younger doctors I speak to feel alienated by too much emphasis on remote consultations and a polyclinic approach-older GPs lament the loss of continuity of care-so who is driving this forward? Are health professionals helpless when facing unseen forces or a White paper full of traps?

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