Secret Diary: PMs Unite - Enough is Enough

My hopes for a better 2024 for primary care have been dashed by recent announcements and events, and it’s only early February!


The financial state of our sector continues to be challenging to say the least, with pressures coming from all sides, and unless we do something about it now, we will see practices going to the wall. Let’s look at just a few issues:

GMS Income

Faced with a 9.8% rise in the minimum wage from April 2024, the offer of a 1.9% increase in the GMS payment is derisory. 

Are they serious? Or is this a repeat of last year’s fiasco when the GMS was increased in April and then increased again later in the year, backdated to April?  Even then the increase did not cover the full increase for the minimum wage, and the increase for salaried clinicians.

How can we set our budgets in-house for the year starting April 2024 when we have little idea of the final figure being given, and whether it is likely to match the full staff cost increases in running a surgery? 

Heat and Light 

A lot of surgeries are coming out of fixed-term energy contracts this year and will be faced with large increases in heat and light on their premises. For many practices already on the brink financially, this could push them over the edge.


Last year it was stipulated that surgeries had to update their telephone systems to cloud-based ones. The cost of this again is to be borne by the practices at many thousands of pounds.

The rollout has been chaotic, with promises being made of financial and organisational assistance in the project falling far short of any help and now leading to a last-minute scramble to beat the deadline. 

In some areas, pressure was put on practices to sign up before 15th December 2023 with a new provider. There was then an announcement that financial help was available, but only to those practices that had not signed up before 15th December.

My practice did not sign up purely because we could not get the contract from the procurement hub and so we may get some money, but even at the end of January, we have no idea of the amount. Is it right that practices do not get any funding for signing up early?


The millions of pounds of waste within the government and the NHS are eye-watering. I have repeatedly said that I feel we are being governed by people with no idea of reality. If it were their money, they would be more prudent and have more sensible ideas - but it is our money, and they should be more responsible.

We should expect better, and before anyone says I am blaming the current government, I am referring to all governments over the last 50 years of failing in their duty to conduct all matters of finance properly. 

What Can We Do? 

We should not just stand by and take whatever is thrown at us. There must be a point that we say, “Enough is Enough” and we need to take some action, now, before it is too late. I hear the usual groans that we are powerless, as morally it would be wrong for primary care to go on strike, and I understand that. But there should be a campaign across the country to put our case forward:

  • We should all publish our statistics showing how many appointments we offer on our websites, and we should show how our funding has been reduced in real terms over many years, and it is just not this government’s fault but successive governments.
  • We can highlight how many GP practice closures have happened over the years, and the fact that for each closure, local practices must pick up those patients, and that adds extra pressure.
  • We need to disprove the inaccurate claims made by the government as to how many new doctors and nurses there are, and how the waiting lists are coming down.
  • We need to say that most surgeries worked through COVID-19 and are performing better now than before COVID-19.
  • We need to explain how our Econsults work, how they benefit patients, and explain all the new types of clinicians being used and how they work and are supervised.
  • We must emphasise that these are all NHS initiatives, and that the NHS must change. Patient should also be told about all the red tape that exists, taking GPs away from the day job.

As practices we need to get publicity when events happen, as the press and TV are always interested in a story. The recent case of a surgery having to take a seriously ill patient to hospital after a 3-hour wait for an ambulance that did not turn up, did attract the news, and attracted feedback and support.

Finally, we need to get the message across that all these financial pressures are put on partners of GP practices that take all the risk, and either benefit or are penalised by all these events.

I am not saying that this will be a magic cure, but we need to bring our patients into the issue, as many will support us as most surgeries do offer good service.

Created by Secret Diarist
Secret Diarist
FPM's Secret Diarist and Anonymous Practice Manager gives us their views throughout the year on the latest developments in primary care, what they think of the powers that be, and any other bugbears they need to get off their chest...


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