Primary Care should lead the shift to prevention. It's set up to fail.

The gap between ambition and Monday morning.

The NHS 10 Year Plan sets out the most ambitious strategic opportunity in a generation for primary care: the shift from sickness to prevention. GPs, who are the most trusted and accessed part of the health system, are explicitly positioned at the heart of it: identifying at-risk patients earlier, managing complex care closer to home, and preventing the escalations that cost the NHS millions of hours downstream.

We started Asterix to enable proactive, preventative care at scale. That ambition is right. And we started with GPs on purpose: They are the people to deliver it.

But ambition requires structural conditions. And right now, there is a painful gap between what the system asks primary care to do, and what it has designed to make possible.

The structural mismatch

Step into a GP practice on a Monday morning and you'll see the gap in real time. The diary shows 25–30 appointments already scheduled before the phones open. The inbox contains over 100 items. Abnormal test results came in over the weekend. Somewhere in that torrent of reactive work is the time that is supposed to be protected for proactive, preventative care.

These are structural challenges that prevent GPs from delivering proactive care.

This is not a problem of individual effort or clinical motivation. With falling numbers of GP Partners, the workforce is being asked to absorb more with less. Partners under 40 now make up just 10.5% of the workforce, down from 19.2% a decade ago.

Hidden capacity, recoverable time

One of the most important things to understand about this problem is that the time isn't gone. It's consumed by growing clinical admin work that never appears on the appointment book:  and actioning abnormal test results, processing discharge summaries, reading referral letters and dealing with the EPR. Each task is individually reasonable. Collectively, they form a substantial but invisible administrative layer that sits on top of the scheduled day, absorbing valuable in-practice GP time..

We recently met a GP that quit his practice job and went full-time private after spending 3 hours on clinical admin daily. This is the reality of the primary care today.

The good news is that whilst a lot of these tasks require GP-level clinical judgement, there are ways to recover that valuable time.

The prevention agenda is a values alignment, not a stretch goal

GPs go into medicine to keep people well: to catch the diabetes before it becomes a crisis, to manage the hypertension before the stroke, to support the patient with early frailty before they fall. The prevention agenda isn't something being imposed on them from outside. It's what many of them want to spend their time on.

The frustration isn't lack of motivation. It's that the current allocation of clinical time doesn't allow them to act on it. The at-risk patients are known. The funded pathways (Local Enhanced Services for structured diabetes management, cardiovascular risk, mental health support) often exist. What's missing is the capacity to execute.

When that capacity gap is closed, the results are significant in both directions: for patients who get proactive care before crisis, and for practices that can access the LES funding that currently sits unclaimed because clinical bandwidth won't stretch to deliver it.

‍The NHS 10 Year Plan is not going away. The ambition is right, and primary care is the right place to deliver it. The question is how to create the structural conditions that make it possible. That's what this series is about.

At Asterix, we support GP Practices in clinical admin and patient consultation work streams with highly-qualified, GMC-registered GPs, at a fraction of the cost. Reach out at julian@asterix.health to learn more.