A practice manager has responded to a letter of thanks from the Health Secretary sent to all GP practices in England, highlighting what she sees as a disconnect between government ambitions and the realities faced by general practice.
In his letter, Wes Streeting thanked practices for their ‘tireless efforts’ and ‘for the contribution you are making to improve access to, and experience of, general practice for the public’.
But Caitlin Clarke, business manager at Castle Partnership in Norwich and managing partner at Fleggburgh Surgery in Great Yarmouth, used a LinkedIn post to deliver a pointed critique of short-term cost-cutting that she says overlooks wider health outcomes and patient needs.
Ms Clarke, named Practice Manager of the Year in 2023, acknowledged Mr Streeting’s thanks for ‘our hard work on improving access to general practice for our patients – a desired outcome you share with Practice Managers across England’.
But she said there was a contradiction between government messaging and operational constraints, bureaucracy and funding decisions that hinder service delivery.
Ms Clarke said that while ‘we hear one thing… in reality, the constraints, bureaucracy and decisions do not reflect what we hear’.
She pointed to integrated care boards (ICBs) being ‘forced to make huge financial savings’ that result in decisions ‘entirely contradictory to what the Government says it is seeking to achieve – in improving access, reducing health inequalities and on preventative healthcare’.
The problem, she said, was that it is easier to quantify the cost of running a service than it is to measure the long-term health benefits.
Mr Streeting’s letter of thanks referred to recent Office of National Statistics data showing improvement in patient satisfaction as well as the 2025 GP patient survey showing an increase in satisfaction over the last year.
While stressing that practice managers share the goal of improving access and services, Ms Clarke said they needed proper support and resources to achieve it.
‘We all want to deliver improved access, improved services, more appointments, but we need to be enabled to do so,’ she said.
A number of people commented on Ms Clarke’s post to express agreement and share her frustration.
One talked about the importance of ‘looking at the whole picture over a number of years as opposed to silo decision-making to balance one set of books in-year’. Another said ‘The holistic value and pathways need to always be considered. It’s not about just acquisition costs or silo net savings but he wider impact of any pathway changes’.
In 2023, Ms Clarke was named Practice Manager of the Year for several initiatives in general practice. She overhauled the appointment system, which resulted in telephone queues reducing from 30 minutes to four minutes and introduced an urgent care team model that utilised the skills of a multi-disciplinary team for signposting, support and supervision.
She also introduced a new approach to recruitment, offering flexible working and protected learning time, boosted staff hiring so the surgery became less reliant on GP locums.
