Still holding it together: what NHS administration really looks like from general practice

When we talk about NHS administration, it often gets described as systems, processes, inefficiencies. That’s not how it feels in general practice. From where I sit as a practice manager, administration is the bit that either helps a patient get care – or quietly stops them from getting it at all. 

The recent report from The King's Fund talks about patients feeling ‘lost in the system’. I don’t think anyone working in a GP practice would find that surprising. What is less visible is the amount of work happening every single day to stop that from happening.  

‘Can you just help me log in?’ – the reality of a digital NHS 

We talk a lot about digital access as a solution, and sometimes it is. But a big part of our day now is helping people just get through the front door of those systems. That looks like: 

• talking someone through downloading the NHS App  

• resetting passwords (again, and again)  

• explaining what an online form is actually asking for 

• helping someone find a test result they’ve been told is ‘there’.  

My GP assistant Aimee regularly spends half an hour with patients helping them access their hospital appointment email, complete a self-referral or find information on the NHS App. 

The systems can be confusing even when you are in good health. When you are frightened, anxious and unwell, they become much harder to navigate. So many times we hear, ‘why can’t I just talk to someone?’ 

Without this work – and let’s face it, it’s not an efficient use of our time – those patients wouldn’t be accessing care at all. We don’t really talk about administrative support as part of care, but it is. It’s support, it’s teaching, it’s compassionate, it’s general practice. 

Where the system doesn’t fit, general practice bends 

The patients who struggle most with NHS administration are often the ones who need care the most. They tend to be people who don’t have a fixed address, are moving between services, don’t always pick up calls or open letters, or are managing multiple, complicated health issues.  

The system assumes stability – and a lot of our patients don’t have that. So general practice adapts. That might mean registering someone without the usual documentation. It might mean working with a local charity to keep track of someone. It might just mean taking a bit more time to understand what’s actually going on. 

Every day, practices make systems work for those with the highest need. We act as their home address for correspondence. We know where they are staying. We know that they might not pick up the phone first time, but if they hear it’s us leaving a message, they will call in and see us. They trust us but that takes time. And it takes relationships with administrative teams as well as clinicians. We are part of their community. 

I often overhear, ‘I knew you would be able to help me’, about something totally unrelated to medical care, but absolutely related to health and wellbeing. 

None of that is particularly visible. It’s not always counted but it’s happening all the time. 

What people don’t see: carrying the frustration 

When administration doesn’t work, patients quite understandably get frustrated. But they don’t direct that frustration at ‘the system’. They direct it at the person who answers the phone. Our teams spend a lot of their day apologising for things they didn’t cause, trying to explain processes they didn’t design, and finding solutions inside systems that don’t quite work.  

Our teams care and that’s the bit people often miss. They choose to work in general practice because they care, they want to make a difference and they themselves have seen first-hand what happens when the NHS is at its best. Even so, carrying frustration from patients can take its toll. We’re seeing more burnout, more stress, and more abuse directed at admin teams.  

High responsibility, low recognition 

There’s a mismatch that’s becoming harder to ignore. Administrative teams in general practice are managing risk, coordinating care, making judgement calls about urgency and access, holding huge amounts of system knowledge, and providing continuity to patients. But the pay, investment and recognition haven’t kept up with that reality. 

We lose good people because they can earn similar or more elsewhere with far less pressure. And when experienced staff leave, you don’t just lose a person, you lose everything they know about how to make the system work. 

A conversation with one of my receptionists has stayed with me: 

This isn’t unique. Our administrative teams are advocates for our patients’ care every day. They signpost, they direct, but most of all they listen and care.  

What needs to change? 

If we’re going to improve NHS administration in a meaningful way, we have to start with the reality on the ground. That means: 

• recognising admin as part of care  

• investing in the workforce  

• designing systems around real patient journeys  

• giving teams time to improve.  

Because right now, general practice administration staff are doing a huge amount of unseen work to make the system function. Quietly. Consistently. And without much recognition.