Jonathan Sunkersing is a GP and sleep medicine expert dedicated to transforming primary care by tackling the systemic “sleep tax” on both patients and the workforce.
She couldn’t sleep because of her duvet.* Not anxiety. Not racing thoughts. She had multiple sclerosis, and with it, allodynia. The weight of bedding against her skin at night did not evoke comfort. It was a signal her nervous system could not ignore to tell her to stay awake.
The solution, once the mechanism was understood, was relatively straightforward. She was already prescribed amitriptyline for neuropathic pain. The problem was timing: taken late in the evening, its sedative window consistently missed the period of neurological hyperarousal that was preventing sleep. Taken two hours earlier, it could do two things simultaneously, both quiet the aberrant signalling and ease her nervous system toward the rest it had been unable to reach alone. One GP consultation and one adjustment resulted in a meaningful change in her nights.
The GP consultation is the only place in the NHS where everything about a patient exists in the same room simultaneously. We are being stripped of the time to use it.
She had been seen by a neurologist, a pain team, and an MS nurse specialist. Each excellent. Each working, with expertise, within what their system was designed to see. None of them, by design rather than by failure, were positioned to hold sleep, pain, her social context and pharmacological timing in a single encounter. The GP consultation was where those threads finally met.
This is not an exceptional case. General practice is uniquely designed for convergence and is the only clinical setting in which a patient’s full complexity and life story is held by a single clinician over time. Sleep lives inside that complexity in almost every surgery, expressed as fatigue attributed to depression, hypertension resistant to medication, or weight gain without metabolic explanation. We are ideally positioned to recognise the pattern and make a difference.
Which is why the RCGP’s findings in April 2026 should give us concern. Their new report, surveying over 2,300 GPs, found that fewer than 30% feel they have enough time in consultations to provide high-quality care. 73% say patient safety is being compromised. The average GP is losing the equivalent of £410 a day to system inefficiencies that have nothing to do with direct patient need.1
What we lose when we lose the thinking space of the consultation is not administrative efficiency.
We tend to frame this as a workload crisis, which it is. It is also a diagnostic one. What we lose when we lose the thinking space of the consultation is not administrative efficiency. It is a form of clinical knowledge that cannot be generated any other way: the knowledge that emerges when a clinician holds the whole patient in mind and asks the questions the system was not designed to ask. The GP consultation is the only place in the NHS where everything about a patient exists in the same room simultaneously. We are being stripped of the time to use it.
Sleep is one of those questions. It always has been. The woman with MS and allodynia was not unlucky. She was, in a precise and pharmacological sense, predictable. Her story illustrates a system where the consultation is no longer given the space to provide what it should.
We must stop treating the ordinary elements of a patient’s life as peripheral. Sleep affects us all, and it is often dismissed as background noise, yet it sits at the heart of our biopsychosocial reality. Protecting the time to notice it is not a luxury. It is the core of our clinical duty.
*Author’s note: This is fictional case based on my clinical experience and not specific to any particular patient alive or deceased, in order to illustrate system-wide lessons.
References:
Royal College of General Practitioners. Tackling the GP workload crisis [Internet]. London: RCGP; 2026 Apr. Available from: https://www.rcgp.org.uk/getmedia/38760b50-f2a2-43f0-9d1f-8986edb811e6/RCGP-Tackling-the-GP-workload-crisis-April-2026.pdf. [Accessed 5 May 2026.]
Featured Photo by Rehina Sultanova on Unsplash
