GPs are consistently being asked to work even harder than we already are. We see endless news stories about falling GP appointment numbers and suboptimal patient care due to lack of GP availability. We hear it from our patients, sometimes in gentle coded language (‘I know you are busy, but surely you can squeeze me in tomorrow?’) and sometimes in more explicit terms (‘I never used to wait so long for an appointment, things have really changed … ’). And as a profession we all too often tell each other we need to work harder, with GP partners and practice managers, understandably, trying to maximise the number of appointments offered to satisfy a seemingly infinite clinical demand.

As the data show, general practice clinicians are, in fact, working very hard indeed. Record numbers of general practice appointments are now being provided in England (34 199 547 in October 2023 compared to 30 297 111 in October 20211), and GP responders to the 2021 GP Worklife Survey reported working faster and more intensely than in previous years.2 However, to fully understand our increasing workload, we need to not only assess the numbers of appointments we provide, but also carefully examine the full spectrum of work carried out in general practice.

The paradigm that our specialty, as well as the government and wider public, has unfortunately come to accept when assessing …