About this guidance

General practice in Scotland delivers exceptional, relationship-based care and remains one of the most effective and efficient parts of the NHS. Yet the environment in which that care is delivered has changed significantly. Patients are living longer with multiple conditions. Clinical knowledge continues to expand. Treatment options are more numerous and more complex. Expectations from both patients and the wider healthcare system have increased. At the same time, workforce, premises and infrastructure challenges continue to place pressure on practices across the country.

In response, practices have repeatedly adapted. New services have been developed, additional responsibilities absorbed and increasing demand accommodated. However, much of this adaptation has relied on professional goodwill and on work being undertaken outside the formal structures through which practices organise and recognise workload.

The consequence is that many of the activities required to deliver safe, high-quality care remain partially hidden. Clinical consultations are highly visible and easily counted, but much of the work that makes those consultations effective takes place before, after and between appointments. Reviewing results, prescribing safely, managing referrals, supervising colleagues, running the practice, improving services and maintaining professional standards are all essential functions of modern general practice.

The purpose of this guidance is to help practices recognise and value this wider contribution. It seeks to support conversations about how work is distributed, how time is protected and how sustainable models of practice can be developed. It is not intended to define how individual practices should organise themselves, nor to prescribe fixed proportions of clinical and non-clinical work.

Instead, it offers a framework through which practices can examine their current arrangements, identify areas of hidden workload or risk, and consider whether changes might improve sustainability, safety, and fairness to ourselves, our colleagues and patients. By making the full scope of GP work more visible, practices may be better placed to develop working patterns that are resilient, professionally rewarding and capable of supporting high-quality patient care into the future.

We recognise that practices operate in very different circumstances. Rurality, deprivation, health literacy, English literacy, age and many other determinants of health and demand mean all our practices are unique with their own challenges. The intention of this guidance is therefore not to define one model of sustainable working, but to support practices in understanding their own context and making locally appropriate decisions with confidence.