Newsletter Monday
Hello Reader,
Last week I was driving along listening to the news announce that GPs will now have to guarantee same-day appointments for “urgent” cases in 90% of instances.
I admit to shouting at the radio:
“Define urgent!”
My daughter asked me to calm down.
Then I opened the BBC comments later and discovered half the country was shouting the same thing.
So let’s talk about it calmly.
Because on the surface, this sounds entirely reasonable.
If something is urgent, of course you should be seen the same day.
The difficulty is that urgent isn’t a shared language.
Urgent according to whom?
In everyday life, and in GP surgeries up and down the country, urgent often means:
- It’s my only day off work.
- My tablets are about to run out.
- The hospital hasn’t replied and I want you to chase it.
- I’ve been worrying about this for three weeks and today it feels unbearable.
In medicine, urgent usually means:
- There is a risk of deterioration today.
- Treatment needs to start today.
- Something serious could be missed if it waits.
Those are not the same categories.
And the public instinctively knows this.
The comment sections were full of people pointing out that my urgent won’t be the same as your urgent, and neither will match the GP’s.
That’s not because patients are unreasonable.
It’s because illness feels urgent when it’s happening to you.
At the same time, I’ve seen patients with painless blood in their urine who didn’t think it was urgent at all, or else don't want to bother us because they know we are busy.
Perspective is uneven. That’s human nature.
Capacity is finite
Here’s the bit that rarely makes the headlines.
There are only so many appointment slots in a day.
If practices must guarantee more same-day urgent access, they will protect urgent capacity.
And when you protect one part of the diary, something else shrinks.
That’s routine care.
Routine care is where continuity lives.
Seeing the same GP. Following up properly. Not having to re-tell your story from scratch. Someone spotting a subtle change because they know your baseline.
Continuity isn’t sentimental nostalgia. It improves safety, reduces duplication, and cuts down unnecessary referrals and tests.
But it is the easiest thing to erode when targets focus on speed.
More activity doesn’t always mean better access
You’ll often hear that “more patients are being seen than ever before.”
That can be technically true.
The practice team has diversified because this was also deemed to be a priority by our previous government, thats where new money had to be spent.
There are more roles. More appointment types. More recorded contacts.
But increased activity and improved experience are not the same thing.
If your problem fits neatly into a defined pathway, you may be seen quickly and efficiently.
If it doesn’t, you can end up bouncing between professionals, each operating within a narrower scope, until eventually it circles back to a GP — whose time has not magically expanded.
From a spreadsheet perspective, the numbers look good.
From a patient perspective, it can feel fragmented.
Both can be true at once.
The leaky bucket
There’s another reality that doesn’t fit neatly into announcements.
Experienced GPs are reducing hours.
Some leave altogether.
Many will move abroad.
Currently younger doctors look at full-time general practice and decide it isn’t sustainable.
This weekend I worked with a GP registrar — bright and committed. He has a year left of training. I asked what his plans were.
He said he there's "no way he could see himself working full-time as a GP".
It didn’t feel workable long term.
That isn’t laziness. It’s a rational response to a system under strain.
So when new funding is announced to “recruit more GPs,” it’s worth remembering that workforce capacity isn’t just about headcount.
It’s about retention, morale, supervision time, paperwork, and whether experienced clinicians feel able to do the job properly.
If the bucket has holes, pouring more water in doesn’t solve the problem.
The uncomfortable truth
Everyone wants better access.
GPs do.
Patients do.
Politicians do.
The public already knows the system isn’t working smoothly. You can see that in the comment sections.
The question isn’t whether same-day urgent care is a good idea in principle.
It’s whether setting a target, without structural reform across the system, can deliver what people imagine it will.
Healthcare is not short of good intentions.
It is short of time, continuity, and joined-up design.
And those are harder things to fix than a headline.
