A GP is, by definition, a general practitioner, namely someone who is not a specialist and treats all common medical conditions and provides general healthcare services. They are a primary care doctor who often serves as the first port of contact and then makes referrals to secondary care doctors who are more specialised.

Their key responsibilities are:

• Diagnosing and treating illnesses
• Preventative healthcare
• Referrals to specialists
• Managing long term conditions
• Mental health support
• Health education

The NHS relies on GPs to keep patients well and reduce the burden on secondary care. This however is not always the case and mistakes and oversights can result in avoidable harm to patients. Our Clinical Negligence Team frequently deal with claims concerning GP care and common themes are overlooked persistent or recurrent symptoms, failing to heed red flag symptoms for serious conditions, failing to provide appropriate safety netting advice and poor documentation.

What is clear however is that there are record levels of public dissatisfaction with GPs. This article is aiming to provide information as to how GP surgeries work and how this can impact care. The way in which GP surgeries typically operate has certainly changed in recent years, due to increased patient demand, staffing pressures and a shift towards digital and team based care and there has been much discussion as to whether these changes are for the better.

Surgeries vary from single-handed practices to large multi-partner and “super” practices. In recent years, there has been a move away from the ‘one man band’ surgeries that were more common historically, with the formation of primary care networks and integrated care systems, which encourages collaboration between practices. This has led to GP care being seen as less personal, with it being less common to always see the same GP and less continuity of care.

GP surgeries are structured as independent businesses contracted by the NHS and face the same financial pressures as are well documented throughout the NHS. Every Practice operates under a contract with the NHS which sets out the essential services it must provide and they will have a budget for the same, which can be restrictive of the services that can be offered.

The structure of a GP practice is of course underpinned by the presence of GPs. As of August 2025, there were approximately 39,116 fully qualified GPs in England, not including Trainee GPs. This is a slight increase compared to September 2020, although still 957 fewer than in 2015 and this growth has not kept pace with the growth of the population. The average number of patients care for by each fully qualified full time equivalent GP has risen to 2,247, respecting an increase of 15.9% and an additional 309 patients per GP. This will inevitably place strain on the GPs as they face the pressure of escalating workloads.

The historic typical GP practice tended to involve GP partners who had a strong inventive to run an efficient service given that the partners were business owners as well as non-partner GPs but there has been a move away from this, with increasing numbers of salaried GP’s, who are employed by the practice rather than be a partner.

Since 2015, the number of GP partners has dropped by around 25%, with there being a particularly steep fall in the number of young GP partners. This has given rise to concern as to the future of GP surgeries, with relatively few early career GPs now aspiring to become partners and with the fall in the number of GP partners, so have the number of GP practices (although this may be influenced by merging of practices as well).

There are also more non-GP roles, such as pharmacists, advanced nurse practitioners, direct patient care such as physician assistants and support roles such as administrative staff and receptionists. Although such involvement can have advantages, it is vital that there is a good level of communication between the different roles involved in care, so that vital information does not slip through the net.

It is also crucial that there is clarity for patients as to who they are seeing and whether they are the right person to be assessing. There have been well documented issues with physician assistants, as set out in our recent article Concern grows over the role of Physician Associates – Williamsons Solicitors.

As a result of COVID-19, GPs have generally had to change the way they worked. There was a greater reliance on remote consultations such as telephone and video calls. There was an increased demand for GPs as other healthcare services were cancelled. Practices had to quickly reorganise their services, often with limited resources, staff shortages and shortages of PPE. There was poor coordination and communication among healthcare services.

At the peak of the pandemic, around 70% of patients accessed their GP remotely and 30% face to face. Before the pandemic, 80% of patients saw their GP in person. As of August 2025, 69.5% of appointments are face to face and 27.2% are remote.

With remote assessments, there come challenges, ranging from technology (such as poor signal or people lacking the necessary technology), communication difficulties and

lack of physician examination. These challenges in turn increase the risk of missed or inaccurate diagnoses and general erosion of the relationship of trust and confidence between patient and GP which flows from an in-person assessment.

The NHS and medical regulators have issued guidance that Practices must offer face to face appointments and should not refuse them without good clinical reason but there is often difficulty securing face to face appointments in a timely manner.

When it comes to children, a GP should see a child patient face to face, especially for a first consultation or when a physical examination is needed. This will allow a more thorough assessment.

From the above, it is clear that GP practices are under significant pressure and this in turn has a negative effect on the service provided to patients. This will not always equate to negligence but in circumstances where the care has fallen below an acceptable standard and it has resulted in harm to the patient which would have otherwise been avoided, a claim for clinical negligence may be able to be brought. If you feel that you or a loved one have suffered such avoidable harm, please do not hesitate to contact us on 01482 323697 to discuss whether we can help.