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Independents' Day

Investigation: Are we at risk of running out of GPs?

With trainee numbers barely rising and retention rates collapsing, the GP workforce crisis is growing. Caroline Price reports on what is being done to address the situation

GP density map - large - online

Frinton-on-Sea finds itself at the sharp end of the GP recruitment crisis. According to LMC leaders, the Essex seaside town is experiencing such a dearth of full-time GPs that there is currently just one serving more than 8,000 patients.

The crisis has become so great in north-east Essex that NHS England managers have had to step in to ‘immediately address’ the situation and support practices.

Essex LMCs chief executive Dr Brian Balmer even warns that the future of traditional general practice is at stake.

He says: ‘That area is struggling because several practices are very short on doctors, but they’re not alone. Normal-type general practice is simply going to disappear in some areas.’

Recruitment problems are not confined to Essex. A Pulse investigation suggests some 149 practices in England have more than 4,000 patients for each full-time-equivalent (FTE) GP. Ministers, experts and GP leaders are in rare agreement that the country needs more GPs, even if they are divided over how many.

The RCGP estimates that an additional 10,000 GPs need to be recruited and trained in order to accommodate the workload shift from secondary care, the growing burden of demand from an ageing population and the demands of seven-day opening. The college has based its estimate on roughly one additional GP being needed in every practice across the UK.

The Centre for Workforce Intelligence (CfWI) says its projections show that for deaneries to meet their target for GP registrars to make up 50% of specialty training places from 2015, a yearly intake of 3,250 GP trainees will be needed. If this goal is met, the CfWI predicts there will be an additional 12,800 FTE GPs by 2030, bringing the total workforce up to around 83-84 GPs per 100,000 population.

Ministers have officially adopted the 3,250 GP trainee target, but even these estimates may not go far enough, according to health secretary Jeremy Hunt.

In a speech last year, Mr Hunt said the additional responsibilities he expected GPs to take on were likely to mean more were needed. ‘It may be that we need to increase those numbers still further,’ he said.

Pulse has obtained figures that show a wide disparity in GP numbers across the UK. A Pulse analysis of 2012 data from 8,088 GP practices in England, collected by the Health and Social Care Information Centre, shows that – excluding locum support – 149 practices had more than 4,000 patients per FTE GP  and 75 were coping with more than 5,000 per GP.

There were 67 GPs per 100,000 patients in England in 2012, but this ratio varied considerably, with a continuing trend for more deprived areas to have fewer doctors (see map, above).

Northern Ireland and Wales had similar overall GP densities in 2012, at 67 and 66 GPs per 100,000 patients respectively. Data for Scotland showed a more favourable picture, with around 82 GPs per 100,000. 

Progress on recruiting more GPs has so far been slow. While there was a significant hike in the proportion of trainees going into general practice last year, up from 36% to 41%, this increase was largely down to a sudden drop in specialty training posts.

The actual increase in GP trainee places was just 95 compared with the previous year. The total number recruited – 2,725 – fell far short of the 3,250 needed next year and beyond.

Pulse has learned that Health Education England has commissioned a GP taskforce, led by Dr Simon Plint, postgraduate dean at Wessex Deanery, to develop a more coherent recruitment and retention strategy.

The taskforce is in the process of finalising a report calling for better marketing of general practice as a career to medical students, increased training capacity and capping recruitment into other specialties – as well as devising strategies to improve the retention of existing GPs.

Professor Bill Irish, director of GP education at Health Education South West and chair of the Committee of General Practice Education Directors, says: ‘There are good numbers applying in Northern Ireland, London and the South of England, but a relative paucity of good-quality applicants in the north of England. This is a bit of a “double-whammy” as these tend to be the areas with high healthcare needs.

‘Why that is is difficult to say. But it probably relates to the aspirations of doctors around quality of life and workload, which drives them to the home counties, south coast and similar areas.’

In the meantime, GP leaders are working on various possible solutions to what appears to be an ongoing crisis. Whether any of these will help reverse the trend remains to be seen.

How many more GPs do we need?

10,000 more GPs needed to staff seven-day working: RCGP

12,800 extra full-time-equivalent GPs needed by 2030: Centre for Workforce Intelligence (CfWI)

Readers' comments (26)

  • Bob Hodges

    Close the Golf Courses - that sort us lazy buggers out. We could fit in an extra surgery a day if we tried.

    If you close John Lewis and block the Boden website, some of the lady doctors might suddenly find some time to see some patients too.

    On the other hand, Why on earth they think that more GPs won't simply result in more expensive referral to hospital I'll never know.

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  • I dont think this data shows the real picture in Scotland. Some small rural and island practices only have a very small number of patients per GP( a few hundred in some cases due to large areas covered and practicalities of covering islands).

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  • There is no crisis just alot of hyperbole.Recruitment in any sector of the economy is cyclical and varies geographically.Vacancies in rural and inner city areas have always been the most difficult to fill.That is nothing new.Medicine remains the most popular subject for university graduates and there is only a finite capacity to absorb them all into secondary care posts.Ergo they must side step into general practice.A few may leave or emmigrate but that is proportionately a tiny figure.General practice will do just fine.

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  • sort out the csa and watch the trainee number rise

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  • Anonymous 11.27am
    Just carry on.
    You will be very happy with the new services when the traditional GP has faded into history.
    I don't think.

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  • I am afraid the generalist GP is now obsolete and each GP must be a generalist but have a speciality interest and preferably work in that speciality in Hospital.
    All surgeries will have all the GP's doing as they do now in the mornings but doing their speciality in the afternoons seeing cases referred by their colleagues
    from the morning appts.
    When the NHS started scores of GP surgeons anaesthetists et al had to commit to full time Hospital work ie overnight they were consultants.
    A similar thing will happen with my scheme and 2 things will happen
    1. Job satisfaction will increase enormously
    2.Hospital referrals will drop massively.
    In Germany this system of "office specialists " works very well and many many investigations and treatments are done in General Practice cystoscopies endoscopies exercise ECG's etc etc
    Patients will receive better and faster treatments and the cost to the taxpayer will fall
    It's a "no brainer" as they say those not up to it can retire on special pensions as a one off.

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  • Bob Hodges

    "there is only a finite capacity to absorb them all into secondary care posts.Ergo they must side step into general practice."


    Absolutely NO IDEA about how the NHS works in reality or the status of General Practitioners as a 'specialist generalists' on whom the model of shifting health services to the community utterly depends.

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  • This is frustratingly close to a good article, but it lacks some crucial information.
    To reach a target number of GPs we need to know
    - How many are there now
    - How many per year will leave or retire
    - How many are training
    - How many will drop out of training.

    C'mon pulse - show us the maths.

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  • Not sure why everyone is scratching their heads about this one. GP's are normal people with normal basic human needs such as the need to eat when the day comes, the need to sleep and the need to have some kind of life outside of work. Until these very basic human needs are addressed then there will be very few doctors attracted to the profession.

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  • They may need to think about why a lot of GPs are moving abroad. I personally know large number of GPs moved or in the process if moving to Canada, Australia/ N. Zealand and Middle East with much better package and much less red tape culture out there. I don't see a day when there is no bad/ stressful news about GPs if not from Ministers then from NHS England/ CCGs or GMC.

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