How the GP system works

Lesley Dobson / 15 November 2016

Find out how your local GP surgery works and the team that help keep you healthy.



We rely on our GP surgeries for the first layer of our health care – from flu jabs to the first diagnosis that can help stop a serious illness going from bad to worse. But what goes on behind those closed doors, and who makes it all happen?

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GPs or General Practitioners

Most practices have a number of GPs working in them. Many of these are likely to be GP partners. This means that they own part (or all) of the practice and are self-employed independent contractors. The number of GPs who are owners or part-owners of a surgery will vary from practice to practice, but the British Medical Association (the BMA) puts this figure at around 75%.

For these GPs their surgery is a business. This means that they are responsible for making sure that it runs smoothly and has the facilities and staff to run efficiently and to provide good healthcare for their patients.

GP Partners in a surgery are paid by Clinical commissioning groups (CCGs). These bodies replaced primary care trusts (PCTs) in 2013. CCGs commission service providers – like GPs – as long as they meet the required NHS standards, and meet the budgets and costs set by the NHS. CCGs also commission most local community health services, mental health services and planned hospital care.

Some GPs are employed by the practice they work in, rather than owning any part of it. These GPs are paid by the practice, but aren’t responsible for the running of the business. They are often known as Salaried GPs.

Freelance locum GPs are GPs who aren’t attached to a particular practice. They can cover for other GPs who are off work because of illness, holidays, or for other reasons. Freelance locum GPs often work in a number of different practices, depending on where and when they are needed.

Both Salaried GPs and Freelance locum GPs are paid by the practice (or practices) they work for.

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From GP to blood tests, inoculations and more

Your GP is often your first point of contact when you have a health problem. If you are feeling unwell, and over the counter medicines haven’t helped, or you have a symptom that is worrying you and won’t go away – a mole that is growing for instance, or blood in your stools – you need to see your GP.

At your first appointment for a particular health problem, know what you want to say, and the symptoms that you need to tell your GP about. It might be a good idea to write all the symptoms down, and make a note of what they are, and how long you’ve been having them. Don’t worry if you forget to do this, your GP will ask why you have come to see him or her, and your answers to their questions should help them make a diagnosis.

Your GP may examine you, take your blood pressure, listen to your chest, ask for a urine sample, and suggest any other checks that may help them diagnose your health problem. 

Depending on what they decide, your GP may write you a prescription for medication, or say you should have a blood test, and give you a form with the specific tests ticked. They may refer you to a hospital department – for an x-ray for instance – and give you an appropriate form for that, too.

Other health professionals also work within the GP Practice or Health Centre. These may include Nurse Practitioners (you can make an appointment to see them for a whole range of illnesses and problems), the practice nurses (who usually specialize in family planning, menopause , diabetes, and cardiac and elderly care), District Nurses, health visitors, counsellors and others such as smoking cessation services.

Additionally, some GP’s provide hospital consultant services i.e. the consultant comes to the surgery to see patients. Or some of the GPs at the surgery you go to may themselves be specialists in a particular branch of medicine such as paediatrics or dermatology.

Depending on your health problem your GP may refer you to a physiotherapist, an optometrist, or other qualified health professional. If there is a long wait, and you can afford it, you could pay for an appointment privately.

Who is on your health team? A guide to other health professionals in the UK

Asking your GP for a referral to hospital

If you have been diagnosed with a condition that needs specialist treatment, you can ask your GP for a referral to a specialist through the NHS. Your GP’s practice holds your medical records, which a health specialist would need to see before treating you.

If you’ve been with your current GP for some time they will be familiar with the health issues you’ve been through, and the medicines and other treatments you’ve been prescribed. Having this information you may find that your GP won’t agree to referring you for specialist treatment just yet. They may want to try other treatments or carry out more tests before taking that step.

NHS specialists need a letter of referral (containing vital information about your health history) from your GP before they see you. You can try talking to your GP again about being referred. Or you can try any new treatment your GP offers, and if that doesn’t help, you can ask again about a referral.

If you can afford it, you can see a private specialist, but it would still be a very good idea to have a letter from your GP to give them. And bear in mind that your GP does not have to agree with, or follow, a specialist’s recommendations.

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GP Practice Managers

These people are vital to the smooth running of your GP’s surgery, the paying of bills, and recruiting and training staff who are important in keeping everything on track, such as medical receptionists and secretaries.

Practice managers need to have a wide range of skills, and the ability to stay calm in all situations. The role will vary, from one GP's surgery to another, but as a general rule, they are responsible for choosing and training the non-medical staff, including medical receptionists - the first people you talk to when you go to your GP - and the medical secretaries, who make sure that any referrals, requests for information and other correspondence are processed efficiently and arrive on the right desks.

Keeping on top of business planning, and improvements to areas such as appointment systems, accurate record-keeping and computer systems are all important to a successful GP’s surgery. Added to this, practice managers also have to keep in close contact with clinical commissioning groups and other local and national health organisations.

Other vital tasks include paying the staff, making sure that the duty rota for all staff, including doctors, and the medical records systems are up to date. The practice manager also oversees a great deal of the every-day organization, such as making sure that the surgery has enough stocks of drugs, stationery and other equipment. GP surgeries need to be kept clean, and it’s the practice manager who makes sure that the offices and public places are hygienic, clean and well maintained.  

Some GP surgeries split the practice manager’s role, by appointing a business manager who is often responsible for giving the GP partners advice and information on business matters, to keep the practice financially healthy. Another relatively recent addition to some practices is an IT manager. They can make sure that the computer systems run smoothly, and that programmes such as Choose & Book (C&B) make contacting your GP easier and faster. 

How to use GP online services

Unlimited access to a qualified GP with Saga Health Insurance - you'll have access 24 hours a day, 365 days a year to a GP consultation service. Find out more about our GP phone service.

The opinions expressed are those of the author and are not held by Saga unless specifically stated.

The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.