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The challenges facing health care are well known. They include an ageing population, increasing expectations, and shrinking budgets. GPs remain key in the provision of primary care in the current model and report that they are failing to cope with rising demand. Increasing concern that the 10-minute GP appointment is obsolete in the face of increasing comorbidity adds to these pressures. NHS England’s Five Year Forward View nevertheless emphasises that ‘The foundation of NHS care will remain list-based primary care.’It also reiterates the concept of redeploying care from secondary to primary, so-called ‘shift left’.

This article presents an alternative model for delivering GP services. No single element of the model is new but the overall concept is revolutionary. The model’s integrity is key. It seeks to improve productivity through using the skills and knowledge of the GP to maximum effect while introducing a range of healthcare professionals to relieve the pressure of less complex care.