Anish K Patel
@anishkpatel.bsky.social
‘Just a GP’ posting about general practice and healthcare
Until then, every “negotiation” is really an announcement.
Government decides. We are consulted. The contract arrives. We stretch a bit further to keep something we can still be proud of for our patients.
Full blog here: typeshare.co/anishkpatel/...
Government decides. We are consulted. The contract arrives. We stretch a bit further to keep something we can still be proud of for our patients.
Full blog here: typeshare.co/anishkpatel/...
What is General Practice’s nuclear deterrent?
Nuclear weapons are built never to be used. They sit in submarines, bunkers and lorries, costing bil
typeshare.co
November 26, 2025 at 10:59 AM
Until then, every “negotiation” is really an announcement.
Government decides. We are consulted. The contract arrives. We stretch a bit further to keep something we can still be proud of for our patients.
Full blog here: typeshare.co/anishkpatel/...
Government decides. We are consulted. The contract arrives. We stretch a bit further to keep something we can still be proud of for our patients.
Full blog here: typeshare.co/anishkpatel/...
A credible Plan B is not there so we can burn the house down.
It exists so that, when we sit at the table, everyone knows there is a line that cannot be crossed.
We need an option that proves general practice could walk, so that it does not have to.
It exists so that, when we sit at the table, everyone knows there is a line that cannot be crossed.
We need an option that proves general practice could walk, so that it does not have to.
November 26, 2025 at 10:59 AM
A credible Plan B is not there so we can burn the house down.
It exists so that, when we sit at the table, everyone knows there is a line that cannot be crossed.
We need an option that proves general practice could walk, so that it does not have to.
It exists so that, when we sit at the table, everyone knows there is a line that cannot be crossed.
We need an option that proves general practice could walk, so that it does not have to.
Undated contract hand-back letters without a serious plan are not a deterrent. They are a bluff.
A real option needs:
• A transition away from NHS income
• A workable operating model
• Protection for those patient most in need
• Honest communication with the public.
A real option needs:
• A transition away from NHS income
• A workable operating model
• Protection for those patient most in need
• Honest communication with the public.
November 26, 2025 at 10:59 AM
Undated contract hand-back letters without a serious plan are not a deterrent. They are a bluff.
A real option needs:
• A transition away from NHS income
• A workable operating model
• Protection for those patient most in need
• Honest communication with the public.
A real option needs:
• A transition away from NHS income
• A workable operating model
• Protection for those patient most in need
• Honest communication with the public.
But that is exactly why deterrence matters.
When government dropped the latest online consultation changes, it showed how weak our position is.
When government dropped the latest online consultation changes, it showed how weak our position is.
November 26, 2025 at 10:59 AM
But that is exactly why deterrence matters.
When government dropped the latest online consultation changes, it showed how weak our position is.
When government dropped the latest online consultation changes, it showed how weak our position is.
I still do not want general practice to leave the NHS.
The joy of the job is acting on need, not what someone can afford. A publicly funded service, free at the point of use, is still the best way to do primary care.
The joy of the job is acting on need, not what someone can afford. A publicly funded service, free at the point of use, is still the best way to do primary care.
November 26, 2025 at 10:59 AM
I still do not want general practice to leave the NHS.
The joy of the job is acting on need, not what someone can afford. A publicly funded service, free at the point of use, is still the best way to do primary care.
The joy of the job is acting on need, not what someone can afford. A publicly funded service, free at the point of use, is still the best way to do primary care.
So you get a lopsided relationship:
• Self employed small business owners
• A single dominant payer
• A contract that can be imposed
• Personal financial risk
• No realistic escape route
Dependency under pressure, not partnership.
• Self employed small business owners
• A single dominant payer
• A contract that can be imposed
• Personal financial risk
• No realistic escape route
Dependency under pressure, not partnership.
November 26, 2025 at 10:59 AM
So you get a lopsided relationship:
• Self employed small business owners
• A single dominant payer
• A contract that can be imposed
• Personal financial risk
• No realistic escape route
Dependency under pressure, not partnership.
• Self employed small business owners
• A single dominant payer
• A contract that can be imposed
• Personal financial risk
• No realistic escape route
Dependency under pressure, not partnership.
There used to be at least a theoretical soft landing.
A practice could run an NHS list and a private list from the same site and build an exit route over time.
That is now a breach of contract. You can leave, but you jump without a parachute.
A practice could run an NHS list and a private list from the same site and build an exit route over time.
That is now a breach of contract. You can leave, but you jump without a parachute.
November 26, 2025 at 10:59 AM
There used to be at least a theoretical soft landing.
A practice could run an NHS list and a private list from the same site and build an exit route over time.
That is now a breach of contract. You can leave, but you jump without a parachute.
A practice could run an NHS list and a private list from the same site and build an exit route over time.
That is now a breach of contract. You can leave, but you jump without a parachute.
GP partners are “independent contractors” with one dominant customer: the NHS.
If you refuse the core contract, your income stops. Staff lose jobs. Partners’ personal assets are on the line. House, car, savings, the lot.
If you refuse the core contract, your income stops. Staff lose jobs. Partners’ personal assets are on the line. House, car, savings, the lot.
November 26, 2025 at 10:59 AM
GP partners are “independent contractors” with one dominant customer: the NHS.
If you refuse the core contract, your income stops. Staff lose jobs. Partners’ personal assets are on the line. House, car, savings, the lot.
If you refuse the core contract, your income stops. Staff lose jobs. Partners’ personal assets are on the line. House, car, savings, the lot.
We have already seen imposed contracts.
GPC opposed. The profession protested. The contracts landed anyway.
If one side can simply impose, it is not a negotiation. It is notification.
We've even seen this year an agreed contract that ultimately doesn't align with the original intent.
GPC opposed. The profession protested. The contracts landed anyway.
If one side can simply impose, it is not a negotiation. It is notification.
We've even seen this year an agreed contract that ultimately doesn't align with the original intent.
November 26, 2025 at 10:59 AM
We have already seen imposed contracts.
GPC opposed. The profession protested. The contracts landed anyway.
If one side can simply impose, it is not a negotiation. It is notification.
We've even seen this year an agreed contract that ultimately doesn't align with the original intent.
GPC opposed. The profession protested. The contracts landed anyway.
If one side can simply impose, it is not a negotiation. It is notification.
We've even seen this year an agreed contract that ultimately doesn't align with the original intent.
On paper, GPs have a voice.
The BMA’s GPC “must” be consulted on pay and contracts.
But consultation is not power. You can argue, warn and plead. Government can listen politely and do what it planned anyway.
The BMA’s GPC “must” be consulted on pay and contracts.
But consultation is not power. You can argue, warn and plead. Government can listen politely and do what it planned anyway.
November 26, 2025 at 10:59 AM
On paper, GPs have a voice.
The BMA’s GPC “must” be consulted on pay and contracts.
But consultation is not power. You can argue, warn and plead. Government can listen politely and do what it planned anyway.
The BMA’s GPC “must” be consulted on pay and contracts.
But consultation is not power. You can argue, warn and plead. Government can listen politely and do what it planned anyway.
“downgraded to merely “chocolate flavour”.”
Wow. 😮 😔
Wow. 😮 😔
October 22, 2025 at 8:16 AM
“downgraded to merely “chocolate flavour”.”
Wow. 😮 😔
Wow. 😮 😔
That is what big marketing budgets do: change our social norms to serve the bottom line. So what is next for chocolate? Toothbrushes?
3/3
3/3
October 22, 2025 at 6:31 AM
That is what big marketing budgets do: change our social norms to serve the bottom line. So what is next for chocolate? Toothbrushes?
3/3
3/3
It goes further. We have normalised chocolate in daily life. It shows up at breakfast, slips into afternoon snacks, and coats any half-decent biscuit. It is everywhere, and we barely notice.
2/3
2/3
October 22, 2025 at 6:31 AM
It goes further. We have normalised chocolate in daily life. It shows up at breakfast, slips into afternoon snacks, and coats any half-decent biscuit. It is everywhere, and we barely notice.
2/3
2/3
It has to include tougher rules on marketing, placement and promotion, reformulation targets, and, crucially, making healthier options affordable enough that people have a real choose. 7/end
October 21, 2025 at 12:14 PM
It has to include tougher rules on marketing, placement and promotion, reformulation targets, and, crucially, making healthier options affordable enough that people have a real choose. 7/end
GLP-1 works. It transforms lives. But stopping there lets the producers of calorie-dense, nutrient-poor products off the hook. If we are serious about treating food as an addictive driver of obesity, then accountability cannot stop at the clinic or the individual. 6/x
October 21, 2025 at 12:14 PM
GLP-1 works. It transforms lives. But stopping there lets the producers of calorie-dense, nutrient-poor products off the hook. If we are serious about treating food as an addictive driver of obesity, then accountability cannot stop at the clinic or the individual. 6/x
Our collective answer is to spend large sums on a drug and the staff to prescribe and monitor it. In effect, we are medicating the consequences of letting the market run unchecked. 5/x
October 21, 2025 at 12:14 PM
Our collective answer is to spend large sums on a drug and the staff to prescribe and monitor it. In effect, we are medicating the consequences of letting the market run unchecked. 5/x
We expect people to resist firms with million-pound brand budgets, feeding an industry that spends billions a year on ads. These companies hire teams of psychologists to design products, packaging and placement that maximise consumption. 4/x
October 21, 2025 at 12:14 PM
We expect people to resist firms with million-pound brand budgets, feeding an industry that spends billions a year on ads. These companies hire teams of psychologists to design products, packaging and placement that maximise consumption. 4/x
That food noise is not accidental; it is exactly what the food industry exploits. Their products are sold as treats but packaged, priced and promoted as daily staples. 3/x
October 21, 2025 at 12:14 PM
That food noise is not accidental; it is exactly what the food industry exploits. Their products are sold as treats but packaged, priced and promoted as daily staples. 3/x
Patients who start GLP-1 tell the same story. Before, the food noise was constant. Cravings, bargaining, relentless mental chatter. On treatment, the noise fades. 2/x
October 21, 2025 at 12:14 PM
Patients who start GLP-1 tell the same story. Before, the food noise was constant. Cravings, bargaining, relentless mental chatter. On treatment, the noise fades. 2/x