The General Practice Podcast

GP list cleansing is having a significant impact on general practice, with practices across England reporting falling patient numbers, reduced funding and growing concerns about staffing and financial sustainability.

In this week's episode, brought to you in partnership with Practice Index, we welcome back Robyn Clark and Alison Daff to discuss why list cleansing has intensified, the challenges practices face and the potential consequences for PCNs and patients.

They explore the administrative burden of validating patient registrations, the risks to vulnerable patients and the knock-on effects for practice funding, workforce capacity and neighbourhood working.

The conversation also covers practical steps practices can take to attract new patients, improve online registration processes, strengthen community engagement and prepare for the financial impact.

What is GP list cleansing? (01:15)

Why list cleansing is increasing (02:02)

The impact on practice funding and workload (04:48)

Patient concerns and risks for vulnerable groups (05:53)

The administrative burden of validating patient registrations (06:08)

The implications for PCN funding and neighbourhood working (08:34)

Practical ways to attract new patients (10:22)

Financial planning and staffing pressures (11:53)

Why some practices are more affected than others (13:31)

How long could list cleansing continue? (14:57)

Patient safety and preventative care (15:43)

Raising concerns with NHS England (16:36)

Will the money saved return to primary care? (19:34)

The Carr-Hill formula and GP funding (20:49)

Practice Index resources and practical support (23:57)

Explore the resources below for further information and practical support:

Lunchtime Learning with the Learning Package in the Practice Index HUB, including a session on building your list size.

Learning Package

How much will the National Minimum Wage rise cost your practice?

Finance Package

To visit the Practice Index website, click here, or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

This week, Ben is joined by Dr Jane Harvey, GP and Clinical Director of Healthy Hyde PCN in Greater Manchester, to explore how eight practices have come together to deliver proactive, community-centred care.

Jane explains how the PCN has developed services around the needs of its local population, from proactive care for care home residents and people living with dementia to urgent action clinics, learning disability support, social prescribing and wellbeing services for refugees, children and other disadvantaged groups.

The conversation explores the challenges of measuring the value of preventative care when savings benefit the wider health system rather than the PCN itself.

What does Healthy Hyde PCN look like, and who does it serve? (00:25)

How did the PCN develop its focus on prevention and proactive care? (01:25)

How does working across a larger population create opportunities for proactive care? (03:39)

How has the PCN expanded its services for people with dementia, learning disabilities and urgent care needs? (04:50)

How does Healthy Hyde support wider determinants of health and community wellbeing? (06:15)

How does the PCN identify what services its population needs? (07:44)

What impact has preventative care had on hospital admissions and A&E attendances? (10:19)

Why is it so difficult for PCNs to sustain services that benefit the wider system? (11:33)

What is stopping integrated neighbourhood working from becoming a reality? (13:28)

How has Jane kept the PCN's community-centred approach going? (14:36)

What needs to change to make integrated neighbourhoods work? (16:43)

Could enhanced PCNs provide a stronger foundation for neighbourhood working? (18:16)

How can PCNs balance proactive community services with the pressure on core general practice? (21:04)

Where can listeners find out more about Healthy Hyde PCN? (22:08)

Visit the Healthy Hyde website here, and access the Healthy Hyde Annual Report for 2026 here.

Contact Jane via email here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

This week, Ben is joined by Dr Hannan Chaudery, CTO & Co-founder of GP Triage, for an update on how autonomous AI triage and booking is being used across primary care.

Returning to the podcast nine months after his previous appearance, Hannan explains how GP Triage has evolved and how practices are using AI to reduce the burden of manual triage, increase appointment capacity and improve patient access. They explore how practices can customise their triage pathways around their workforce, patient population and local services, as well as the role of data in continually refining these systems.

The conversation also covers AI governance and regulation, patient experiences, the impact of changing GP contract requirements, and the potential role of AI in supporting neighbourhood working. Hannan also shares what's next for GP Triage, including new integrations, secondary care applications, dermatology and voice-enabled triage.

How does GP Triage work, and what's changed over the last nine months? (00:26)

How can AI triage help protect appointment capacity? (02:26)

Do practices typically move from a hybrid to a fully automated model? (05:09)

How much does risk tolerance influence how practices use AI? (06:02)

What lessons has GP Triage learned over the last year? (11:31)

How are AI governance and regulation evolving? (12:38)

Have patients been receptive to AI-enabled triage? (14:31)

What impact is GP Triage having on phone call volumes? (15:46)

What new results have emerged from using the system? (16:39)

What's changed with GP Triage Version 2? (17:09)

How are new GP contract access requirements affecting practices? (18:11)

Could AI triage support the development of neighbourhoods and community-based care? (19:34)

Can the data identify gaps in local services? (20:45)

How can PCNs benefit from using GP Triage across multiple practices? (21:53)

What funding is available for PCNs? (22:31)

What's next for GP Triage? (23:29)

Could voice technology become part of the primary care front door? (24:33)

Listen to Hannan's previous episode, 'How GP Triage Is Transforming Patient Access in the NHS', here.

Visit the GP Triage website here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

Flu clinics are a familiar part of the general practice calendar, but are they becoming increasingly difficult for practices to deliver?

In this week's episode, brought to you in partnership with Practice Index, we welcome back Claire Houston from Practice Index and new guest Nicki Walker, Practice Manager in Rhyl, to discuss the challenges facing practices during this year's flu vaccination campaign.

They explore vaccine supply, consent requirements, the changing role of community pharmacies and, importantly, whether the current funding makes delivering flu vaccinations financially sustainable for general practice.

They also share practical advice for making this year's clinics run as smoothly as possible.

The challenges facing flu clinics this year (02:07)

Vaccine supply and the impact of recent changes (04:05)

Confusion around consent and vaccination guidance (07:05)

Where practice managers can find clearer guidance (11:39)

The changing role of community pharmacies (12:31)

Is delivering flu vaccinations still financially viable? (15:55)

Why practices are considering opting out of flu vaccinations (18:56)

Could general practice be pushed out of delivering flu vaccinations? (22:48)

Top tips for running successful flu clinics (24:24)

Prior planning, preparation and keeping the team positive (24:36)

To visit the Practice Index website, click here or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

Where are neighbourhoods taking general practice, and what does this mean for Primary Care Networks?

In this episode, Ben is joined by Ceri Chaplin, Managing Partner at Hereford Medical Group, and Robert McCartney, Partner at Hempsons, to discuss the latest NHS England neighbourhood proposals and what they could mean for practices.

They explore the changing role of PCNs, funding and locally enhanced services, governance, relationships between practices, and why now is the time for practices to prepare for what comes next.

What exactly is a neighbourhood? (00:27)

How different areas are approaching neighbourhoods (02:13)

What does the NHS England consultation tell us? (04:14)

Funding, contracts and potential risks for practices (05:15)

Are neighbourhoods simply the next stage of PCNs? (07:05)

What could changes mean for practices and PCN funding? (09:07)

What should practices be doing now? (15:20)

Governance, incorporation and preparing for new contracts (16:33)

The challenge of difficult PCN relationships (18:00)

Why practices need to act now (20:20)

Should practices respond to the consultation? (20:43)

The opportunities neighbourhood working could bring (21:32)

Shifting care into primary and community care (23:02)

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

This week, Ben is joined by Katie Collin, Partner at Ramsay Brown, to discuss NHS England's consultation on Single Neighbourhood Provider contracts and Multi-Neighbourhood Provider contracts.

They explore what the proposed contracts could mean for GP practices, PCNs and federations, including the potential impact on funding, governance and locally commissioned services.

Katie explains the different contract options, whether PCNs should consider incorporation, and the potential role of federations and collaboratives as MNPs.

The discussion also looks at the opportunities and risks of shifting more services into primary care, and why strong governance, transparency and financial planning will be essential as neighbourhood working develops.

With the consultation still underway, Katie shares her thoughts on what practices and PCNs should be considering now.

Introduction (00:08)

The NHS England consultation on neighbourhood provider contracts (00:30)

Why the consultation is a positive step for general practice (00:51)

Single Neighbourhood Provider contracts: what do they mean for GPs? (03:57)

PCN DES vs a local variation: understanding the options (05:47)

Could locally commissioned services move through PCNs? (08:39)

The financial implications for GP practices (09:00)

What the IIF taught us about collective funding (11:01)

Why PCN governance could become more important than ever (13:40)

Should PCNs consider incorporation? (15:29)

The benefits of incorporation and stronger governance (15:57)

What are Multi-Neighbourhood Providers (MNPs)? (18:16)

Could MNPs create new opportunities for general practice? (20:18)

The risks of following the funding into primary care (21:38)

How can federations and collaboratives fit into the new model? (23:37)

Why governance and transparency will be critical (25:06)

What should PCNs and practices do next? (26:03)

Visit Katie on Linkedin here, or email Katie directly here.

Visit the Ramsay Brown website here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

Integrated neighbourhood working has been talked about for years, but what does it actually look like when it's put into practice?

In this episode, Ben Gowland is joined by Bobby Pozzoni-Child, Director of Partnerships and Transformation for the Buckinghamshire Primary Care Provider Collaborative. Bobby explains how Buckinghamshire has evolved from a GP Provider Alliance into a truly integrated primary care collaborative, bringing together general practice, community pharmacy, dentistry and optometry to create a stronger collective voice and deliver better care.

If you're interested in neighbourhood health, integration, system leadership or the future role of primary care, this episode offers practical lessons from a system that's already making it happen.

Introduction (00:08)

Why Buckinghamshire expanded beyond general practice (01:29)

Bringing GPs, pharmacies, dentists and optometrists together (02:41)

Creating a stronger voice for primary care across the system (04:31)

Why neighbourhood working needs relationships and delivery (06:05)

How Buckinghamshire is turning collaboration into action (08:01)

Building neighbourhood teams and local leadership (10:23)

Keeping practices engaged as neighbourhoods grow (11:45)

Delivering measurable results through integrated working (14:27)

How attitudes towards primary care are changing (16:49)

From planning neighbourhoods to delivering care (18:51)

Why Bucks isn't waiting for national contracts (20:57)

Lessons learned from leading system-wide integration (22:40)

Why expanding to wider primary care was the right move (25:59)

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, brought to you in partnership with Practice Index, we welcome back Robyn Clark and Ed Kennedy to discuss the new "return to good" inspections, how they differ from previous CQC visits, and why many practice managers feel these are now effectively practice manager inspections.

Ed shares his first-hand experience of being among the first practices inspected under the new approach, while Robyn discusses the wider concerns being raised by practice managers across the country. Together they explore the benefits, challenges and practical steps practices can take to prepare, as well as the growing recognition of practice managers as leaders within the NHS.

The new CQC inspection model explained (02:31)

Ed's experience of being one of the first practices inspected (04:27)

Why these are becoming "practice manager inspections" (05:43)

The benefits and limitations of the new approach (07:07)

Can practices improve their CQC rating? (07:52)

Why inspector consistency remains a major concern (11:45)

The increasing pressure on practice managers (14:23)

Practical advice to prepare for a CQC inspection (16:18)

Key compliance areas inspectors are focusing on (17:08)

What to do if you disagree with your inspection report (21:45)

Practice managers influencing national NHS policy (22:41)

How the role of practice manager is gaining national recognition (24:18)

Listen back to a Practice Index – Navigating CQC Inspections with Confidence feating Kay Keane here.

To visit the Practice Index website, click here or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

What does it take for general practice to lead system transformation rather than simply respond to it?

In this episode, Ben Gowland is joined by Dr Sunaina Khanna and Dr Imran Zaman to discuss how they have built a unified leadership model that is helping shape neighbourhood health across one of England's largest Integrated Care Systems.

Starting with a collaborative response to winter pressures, they explain how GP leaders came together to create the GP Partnership Board, giving general practice a stronger voice in system decision-making while developing services at scale. They share the practical lessons they've learnt about building trust, securing buy-in from practices, working alongside community providers, and creating leadership that is focused on delivery rather than representation alone.

The conversation also explores how general practice can prepare for the future NHS landscape, why working at scale matters, and the importance of demonstrating value through action.

Whether you're a GP Partner, PCN Clinical Director, practice manager or system leader, this episode offers valuable insights into building collaboration, influencing change and strengthening the role of general practice within neighbourhood health.

Introduction (00:09)

How winter pressures sparked a new model of GP collaboration (01:26)

Using population health to redesign services at scale (03:20)

Building multidisciplinary teams around neighbourhood health (05:59)

Why Birmingham & Solihull created the GP Partnership Board (08:25)

Winning practice buy-in through delivery, not persuasion (11:39)

Balancing uncertainty with opportunity in the changing NHS (13:10)

Evolving towards a 24/7 general practice leadership model (16:22)

Making general practice easier for the system to work with (17:33)

Building stronger partnerships across community services (19:30)

Why every area needs a unified GP leadership voice (22:19)

Practical advice for creating collaboration at scale (25:30)

Learning by doing and proving what works (28:30)

Final reflections (29:36)

Contact Sunaina directly via email here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

The Carr-Hill formula sits at the heart of GP funding, yet few people fully understand how it works, or the impact it can have on individual practices. In this episode, Ben is joined by Dr Matt Jones, GP Partner in Cardiff, who has spent years investigating the formula after discovering significant funding differences between seemingly similar practices. Drawing on Freedom of Information requests, published papers, and detailed analysis, Matt explains why Carr-Hill remains such a controversial issue and why a long-awaited review could have major implications for general practice.

Together they explore how the formula's different indices interact, why some practices can lose out by hundreds of thousands of pounds each year, the role of deprivation and fixed costs, and how funding inequalities can affect workforce capacity, patient access, and sustainability. Matt also shares his thoughts on what meaningful reform could look like and why greater transparency is essential if practices are to understand the challenges they face.

Introduction (0:09)

How did you become interested in the Carr-Hill formula? (0:19)

What prompted your research and submissions to the Welsh inquiry? (1:05)

Why is understanding Carr-Hill so important ahead of the current review? (1:54)

Is the problem really about deprivation, or is it more complex than that? (2:45)

Which parts of the formula have the biggest impact on funding? (3:18)

Why are some of the formula's deprivation measures now outdated? (4:12)

How do the different Carr-Hill indices compound to create large funding gaps? (6:14)

Do practices actually know their Carr-Hill scores? (7:49)

How large can the funding differences between practices be? (8:43)

Why do funding inequalities become harder to fix over time? (10:17)

What happens if the formula is adjusted to better reflect current deprivation? (11:31)

Does Carr-Hill underestimate the fixed costs of running a GP practice? (12:42)

Why does the age and sex index potentially exaggerate funding differences? (13:24)

How do fixed costs reduce clinical capacity in lower-funded practices? (14:27)

What changes could make the funding model fairer? (15:50)

Should national pay uplifts be separated from the Carr-Hill formula? (16:59)

Why are funding inequalities continuing to grow? (17:57)

What does this mean for access targets and patient care? (19:18)

Could funding be based on workload instead? (20:24)

What would Matt like to see from the Carr-Hill review? (22:11)

Why transparency around funding matters for practices and patients (22:50)

Closing thoughts (24:11)

Read Matt Jones' paper here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.