Nuclear weapons exist to be not used. Their whole job is to stop others crossing a line. General practice has no equivalent. No serious deterrent when government pushes through contracts. That gap shapes everything that follows.

At lights out my son asked, “Why are you allowed to go on your phone?” The room was quiet. My screen wasn’t. Children copy what we do, not what we say. If I can’t hold the line against the attention economy, how can I expect his developing brain to? typeshare.co/anishkpatel/...

Show me another industry where a contract is agreed, then FAQs and policy footnotes are treated as if binding. Policy by back door. Welcome to general practice. 😔

We now celebrate everything with chocolate: Christmas, Easter, Valentine’s Day, Halloween, [insert celebration here]. 1/3

GLP-1 drugs prove, for many people, food behaves like an addictive substance. If that is true, then it is not enough to focus on individuals. As with tobacco, alcohol and gambling, we have to look at the companies engineering and marketing the product. 1/x

I gave up on perfect balance. I work in seasons. Pick the season, lean into it, and stop punishing yourself. Decide before life decides for you.

You know something has gone badly wrong when your kids’ state primary school starts asking parents for donations. What’s next? McDonald’s sponsoring rulers, Amazon logos on the jumpers, or Tesco buying the naming rights to the school?

Have you ever been on a train where a real person announces the stops, says Charlie in carriage 3 is celebrating his sixth birthday and asks everyone to sing, then throws in a random fact about the next station? 1/6

I speak to retired GPs and the pattern is obvious. They miss the patients, not the job. Not the grind, the tick boxes, or holding a service together on a shoestring. Most stayed as long as they could, then hit eject for their own sanity. There is a warning here for all of us.

I speak with GPs nationwide. Two camps keep coming up: 1) recruit more GPs 2) grow the wider team and protect GP time for complex care. Which camp are you in?

Oct 1 contract changes: online REQUESTS not online BOOKING. Gov says one thing, media go off and writes what they want. When headlines promise booking, GPs get the heat, patients feel misled, and the bar for Wes jumps higher than he intended. 😬

Everyone thinks they are on the side of good.

Doing docs the other day. So many letters addressed to GPs that have not worked at my practice for 10+ years. Would this be accepted in any other profession? 🤔

NHS Trust CEOs aren’t rewarded for collaboration. They’re rewarded for control. Bigger budget = bigger band = bigger pay. Even if that means holding on when they should let go. 1/3

I spoke with someone from the voluntary sector while at an ICB event this week. He saw firsthand the gaps in our health and social fabric. I explained how GP practices in poorer areas actually receive less funding than those in richer ones. His eyes widened. 😳He had no idea.

We talk a lot about what’s going wrong in the NHS. What’s broken. What’s missing. That’s fair. There’s plenty. But the danger is we only ever feel the climb. 1/3

Everyone keeps saying better data will fix the NHS. But after years digging into triage and call stats across practices, I’ve realised the opposite is often true. What gets measured gets misunderstood. 1/3

To the Patient I Had to Turn Away 🧵 I see you on my triage list, staring at me. I see the worry etched across your words. I see the fear. But I also hear the others calling out just as loudly.

It should be the most meaningful job in the world. You help people when they’re scared, broken, or lost. But instead of feeling fulfilled, you feel empty. This is what burnout in the NHS really feels like. And it’s not just happening. It’s being designed into the system.

Don't hold back Doncaster LMC: "The latest changes to the GP contract for 2025/26, as outlined by the BMA, are yet another disappointment for general practice.” www.doncasterlmc.co.uk/the-2025-26-...

Trying something new – creating YouTube videos. Turns out talking to a camera is way harder than it looks, but I’m giving it a go. First up: how NHS GP funding is rigged against poorer areas. Let’s see how this goes… 🎥👇 youtu.be/D-oXS45gIbA

Safety First: The Case for 1 GP per 1,000 Patients GP numbers have not kept up with demand. But what would it take to fix this? The BMA’s "gold standard" for safe general practice is 1 full-time GP per 1,000 patients. Ambitious? Yes. Impossible? Let’s break it down. 🧵

In the age of AI, PCSE can't get a form working on their online portal 🙃 God help us!

We had a good run on here but the bot accounts have arrived 😔 My block button getting a work out 🏋️

I was in full flow during a patient participation meeting, explaining how we’re making the government aware of the crisis in general practice by stopping FREE (unfunded) work. Then a patient stopped me and asked: “What can we do to get you more funding?” 🧵

“Just a GP” – a phrase once wielded to belittle, now one I use with pride in my bio. The debate about the GP title continues. Does it still work? Is it holding us back? 🧵

The 4th shift to add to the NHS 10-Year Plan: From sad, burnt-out staff → to happy, energised ones As James Timpson says: 'At the heart of every successful venture lies a remarkable, happy team.'

Is this the modern-day NHS postcode lottery? Where you live determines your access to General Practice—if not the access itself, then the type of access. Can’t help thinking part of this is driven by inequitable funding via Carr-Hill formula.

What did the 'golden age of general practice' (post-2004 GP Contract) actually feel like? As someone who wasn’t even in med school yet, I’m really curious to know.

Mandatory training has lost its way. Once a tool for learning critical skills, it's now a growing list of endless requirements. If everything is mandatory, is anything truly essential? 🧵

Someone should study whether trainee portfolios actually achieve anything. I’m seriously unconvinced they make better doctors. All I see are trainees drained of the joy of medicine and patients. There has to be a better way than this tick-box rubbish.

At first I felt frustrated. Many of us hoped for more. But I’m choosing to stay hopeful. This looks like a first step—a move to stabilise General Practice. It’s not the huge leap we wanted, but it’s something to build on. This could be the start of meaningful change.

The government has announced £889 million for General Practice. Sounds like a big deal, right? But how far does it actually go? Let’s break it down. 🧵

I’ve always had a complicated relationship with SMART goals. At 1st, they were rigid, self-imposed targets designed so others could tick a box. I’ve come to see their potential. When the person keeping you accountable is yourself, they can be transformative. Here's my journey. 🧵

Taking this at face value: - £20 per A&G - 1 in 2 cases diverted from the waiting list to be managed in primary care = 2 million patients Is £20 sufficient for providing this additional level of care? I'd love to see the costing behind this figure. But we never do.

Before Pharmacy First, we had an experienced clinical pharmacist seeing similar issues—consultations were at least 15 mins. Our current one spends 20 mins per patient minimum. How long are Pharmacy First consultations? Are they even cost-effective for pharmacies to run? 🤔

The Five Dysfunctions of Daily Huddles - A GP’s Perspective Daily huddles: The most powerful change I’ve seen in general practice. Yet, mishandled, they can become a source of dysfunction. Here are five common pitfalls—and how to avoid them. 🧵

Daily huddles have brought the most powerful change I’ve seen in general practice. More than AI or new phone systems could. But when misused, they create problems instead of solving them. Here are five common dysfunctions to avoid. typeshare.co/anishkpatel/...

The Secret to Finding a Better-Funded NHS GP Practice What if I told you it’s possible to find a GP practice with up to 10% more funding than others? No need to analyse complex data. Let me show you how to find them in two simple steps—and why this funding gap exists. 🧵

As a GP, I’m used to seeing illness from the other side. But now, it’s my turn, and the guilt feels worse than the fever. I’m ill. Nothing too serious, just a viral illness causing aches in every joint and muscle, random headaches, and a cough that's stopping me from talking. 🧵

It’s hard to describe what it feels like to be a GP. Sitting in a room alone, with patients rotating in and out, tackling a never-ending list—there’s no space to breathe. It can be relentless. 🧵

I'm genuinely curious about the data sources chosen for this study. Any academic primary care folk, I’d love to hear your thoughts. bjgp.org/content/earl...

Exploring the difference between hope and optimism—and why hope is a more powerful mindset. Calming your inner ‘chimp,’ taking meaningful action, and finding control in overwhelming situations like the NHS. www.linkedin.com/pulse/taming...

I’m worried about the influence on the 10-year health plan. Big players are throwing their weight behind agendas, and while we’re all conflicted, they seem to be taking the biscuit. Hard for the Health Secretary to see the wood for the trees when everyone wants a slice of £25bn.

Finally got around to starting this book. Just from the prologue, I can tell it’s going to be incredibly insightful. Check out a podcast featuring the authors—definitely worth a listen! youtu.be/aluKb3GwrRE

In the #NHS, many specifications are imposed without fully considering the downstream costs for those providing the service. Cost = Time + Money + Stress Is the cost justified? Has anyone even stopped to ask? 🤔

I’ve stepped back from being a GP trainer—not because I didn’t love it, but because the role is unsustainable. The costs don’t add up, and practices are forced to cut corners to make it work. Let me break down my calculations. bsky.app/profile/anis...

Waiting for my GP appointment, feeling nervous. Funny, since I’m a GP myself. Sitting on the other side reminds me how hard it is—booking, waiting, then ten minutes to unpack. A note to my GP self—always be calm, compassionate, and ready to listen.

Stark warnings from some greats about digital services. Don’t be blindsided by the sales pitch. Take the time to critically evaluate how it will genuinely improve patient care and, by extension, benefit your practice. #GeneralPractice #NHS

How often do we see this in the #NHS? When outcomes fall short, the response is more measurement, more control—classic command and control. The grip tightens, the boxes get ticked, but outcomes only get worse.