Call for Action to Address Declining Number of GPs

Peter Russell

December 03, 2019

The Royal College of GPs (RCGP) called for urgent action to reverse a trend in declining GP numbers.

The British Medical Association (BMA) said that latest figures showed "significant holes" in the health workforce particularly across acute medicine and mental health.

Figures published by NHS Digital showed that while more GPs than ever were being trained, GP numbers continued to decrease. There was a 2% drop in the number of permanent, full-time equivalent GPs in the past year, and 6.2% fewer in September 2019 than in 2015.

Also, in October this year there were 6 million GP appointments – out of 31 million – for which patients faced a wait of more than 2 weeks.      

The statistics come as a new survey by The King's Fund confirmed that although the number of doctors entering GP training was higher than ever, the number of full-time GPs continued to fall.

The reduction was identified as a key reason behind patient dissatisfaction.

"If we don't put energy into retaining the GPs we've got, it doesn't matter how many are trained, we still need more," Beccy Baird, senior fellow at The King's Fund told Medscape News UK. "And that's clear in the numbers at the moment."

NHS Vacancies

Among key findings from the NHS workforce survey were that:

  • In September 2019 there were 28,488 advertised vacancy full-time equivalents in England published, compared with 28,623 in 2018

  • Between 1st July 2019 to 30th September 2019 there were 92,149 advertised vacancy full-time equivalents in England, of which 84% were permanent and 16% fixed-term

  • The number of advertised vacancy full-time equivalents were highest registered nurses and midwives, who accounted for 40% of vacancies

Responding to the latest quarterly NHS vacancy data, Dr Chaand Nagpaul, BMA council chair, said: "Despite promises to fix the workforce crisis in the NHS, there are still almost 10,000 medical vacancies, and these figures confirm this is a far cry from the full complement of staff that is so desperately required to deliver the care patients need.

"Recent weeks have seen pledges from politicians about increasing GP numbers, but given that we’ve lost 1000 GPs since we were promised 5000 more back in 2015, much more needs to be done to make this happen.

Prof Martin Marshall, chair of the RCGP, said: "We have 340 fewer full-time equivalent GPs than we did a year ago, and more than 1000 fewer than we did in 2015.

"These numbers are going in the wrong direction – this is disappointing, it is serious and we need to see drastic action taken to reverse this trend.

"We do have more people training to be GPs than ever before, which is encouraging news for the future, but we need to see detailed plans as to how we're going to retain our existing workforce. For too many GPs, escalating workload means that the job is not do-able and as a result highly-trained and experienced GPs are burning out and leaving earlier in their career than they planned."

Workload Intensity

This risk of work overload and burnout was highlighted in the survey by The King's Fund.

It found that out of 840 responses from GP trainees across England, only 27% intended to work full-time in general practice 1 year after qualifying, down from 31% in 2016.

Also, only 5% said they thought they would be working in general practice after 10 years, down from 10% 3 years ago.

The main reasons they gave for choosing part-time or portfolio work were:

  • Intensity of the working day (69%)

  • Family commitments (66%)

  • Interest in other work such as emergency medicine or palliative care (50%)

Beccy Baird, an expert on primary care, said it was clear that the pressures of GP life were weighing heavily on trainees. "It's a really attractive career but I think there's a recognition that to do it well or to do it safely, it's not possible to do it for 10 clinical sessions a week. And maybe not even eight – maybe more like six.

"I think it's troublesome because we talk about GPs working half day sessions, but they're not really half days. On average, they're about 6 hours. So, two half-day sessions is about a 12 hour day."

She said there were a number of areas that needed addressing in primary care, such as "investing in more GPs" and "making sure we put lots of effort into reducing GP workload, whether that's investment in staff, or investment in helping them put new IT systems in".

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