Sustainability is about the whole practice, not only consultations

A sustainable practice is not created simply by increasing appointment numbers. Safe, effective care depends on having sufficient capacity for the full range of work required to support patients, staff and the organisation itself. This includes indirect clinical work, supervision, leadership, governance, business management and service development.

When all available capacity is consumed by direct patient contact, these functions are often displaced into evenings, weekends or unrecognised effort. Over time, this creates risk for patients, leads to burnout for clinicians, places considerable stresses on outside commitments such as family, and creates fragility within the practice.

There is no single template for every practice

Practices across Scotland serve populations with very different needs and operate within very different local contexts. Workforce availability, geography, deprivation, infrastructure, service configuration and partnership arrangements all influence how work is organised.

For that reason, this guidance does not prescribe fixed percentages, sessional models or workforce configurations. Instead, it aims to support practices in considering whether their current arrangements remain safe and sustainable and makes recommendations on how to make improvements where this is not currently the case.

Invisible work is still real work

Direct clinical contact is often the most visible part of general practice, but it represents only one element of the role. Reviewing results, managing referrals, responding to correspondence, prescribing safely, supervising colleagues, supporting staff, handling complaints, investigating learning events and leading organisational change are all legitimate and necessary aspects of GP work.

Building these responsibilities into contracted work allows practices to have more realistic conversations about workload, capacity and sustainability.

Sustainable change requires permission to think differently

Many practices have responded to increasing pressure by stretching further, often at considerable personal and organisational cost. While that response has reflected professionalism and commitment, it is not always sustainable.

Developing safer ways of working may require practices to challenge longstanding assumptions, make different choices about how time is used and openly discuss responsibilities that have previously been taken for granted. Sustainable change is more likely when practices feel supported to have those conversations and to test alternative approaches without fear that they are somehow working less. In reality, sustainable working is about creating the conditions in which high-quality care can continue to be delivered over the long term.