Patients are being asked to navigate increasingly complex healthcare decisions alone, dressed up as “empowerment.” It sounds progressive. In reality, it often means expert support has been stripped away, leaving them to figure it out themselves. 🧵

“The best doctors, clinically, are NOT the ones with the highest reviews,” said my friend who started in the world of private healthcare. 1/n

NHSE put out how they are going to measure if urgent cases are being seen on the day. TLDR: Objective-Measure Mismatch. The Objective: >90% of urgent cases presenting to general practice are seen on the same day. Urgent being defined by the clinical team at the practice. 1/n

“Your back pain is due to your job” I say. “I know this is not easy but I would consider reducing how much you work”. A little smirk that I know too well comes across his face. The one that says: “What world are you living in.” 1/n

His name appears on the triage list again. A feeling of failing this man on some level comes over me. The contracts push me in a direction that goes against the family GP I want to be. There is no tick box for continuity of care. 1/n

One of the most misunderstood parts of medicine: Why health professionals ask you to repeat your story. When we take a history, we’re recognising patterns and testing possibilities. What is causing this? How serious might it be? What can I do to help? 1/n

I can’t help think that the traditional GP appointment book has set us up for a shitty day by default. 1/2

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-...

The 2025/26 GP Contract: Another Blow to General Practice – Doncaster LMC

The latest changes to the GP contract for 2025/26, as outlined by the BMA, are yet another disappointment for general practice.

doncasterlmc.co.uk

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

Richer Areas Get MORE Funding – Why It Matters & How It Happened

YouTube video by Dr Anish K Patel

youtu.be

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!