Small team. Big ambition. We innovate with purpose – and we know when to evolve.
The challenge we identified
For many years, General Practice has experienced escalating operational pressure, often without a consistent or credible way to describe that pressure at system level.
Other parts of the health system benefit from established escalation frameworks – such as the Operational Pressures Escalation Levels (OPEL) – supported by dashboards, shared language and agreed responses. General Practice, by contrast, lacked a comparable mechanism through which pressures could be articulated, understood, and acted upon strategically.
In late 2019, Devon LMC identified a clear gap: without a structured way to surface pressure across practices, the realities facing General Practice risked being under-recognised within system decision-making.
A Devon-led response
In February 2020, following an eight-week period of research, design and testing, Devon LMC launched the General Practice Alert State (GPAS).
GPAS was designed as an anonymous, practice-led reporting system, enabling the LMC to build a strategic narrative of the pressures being experienced across General Practice locally. The intention was never to comment on individual practices, but to create a collective system-level picture that could sit alongside other operational intelligence.
From the outset, GPAS was positioned as a strategic tool. Practices were clear that any immediate, tangible benefit would be limited; the longer-term ambition was to influence system awareness, dialogue and ultimately, response.
From local innovation to national adoption
Following its introduction in Devon, GPAS evolved rapidly in response to learning, feedback and system engagement. As awareness of the approach grew, interest from other LMCs – and from NHS England (NHSE) – increased.
With national funding secured through the General Practitioners Defence Fund (GDPF), Devon LMC led the national roll-out of GPAS, supporting other LMCs to operationalise the system within their local areas.
What began as a locally developed response became a nationally adopted framework, supporting wider conversations about pressure, capacity, and resilience in General Practice.
Linking insight to system response
A core ambition of GPAS was always to move beyond visibility alone.
In Devon, this led to the development of a System Response Standard Operating Procedure (SOP), designed to describe how the wider system might respond as GPAS alert states changed. The SOP was accepted by the Integrated Care System in Devon and piloted between September 2022 and January 2023, with the intention of embedding it into routine business.
This work reflected a central principle of GPAS; that shared understanding of pressure should support earlier dialogue, better co-ordination and more proportionate system responses.
Knowing when to evolve
Over time, both the system and the needs of General Practice continued to change.
Following careful reflection, in November 2024 Devon LMC made the decision to stand down GPAS locally, recognising that the tool had served its purpose in Devon and that alternative mechanisms were now better placed to support local conversations. This decision reflects a considered approach – evolving as local need changes, rather than holding on to tools that no longer serve their purpose.
Importantly, GPAS continues to be actively used elsewhere in the country, where it remains a valuable part of how pressure in General Practice is understood and communicated.
Why this matters
GPAS is a clear example of how a small organisation can:
- identify a system gap
- design a practical, credible solution
- influence thinking beyond it’s local footprint
- and adapt as circumstances change
It demonstrates how locally led innovation, grounded in real practice experience, can shape national conversations, even when those innovations later take different forms locally.