Analysis: The workforce data behind the 3.5% GP pay rise recommendation

Emma Wilkinson analyses the in-depth workforce data underpinning the pay review body’s recommendation for a 3.5% pay uplift this year.

A recommendation from the Doctors’ and Dentists’ Remuneration (DDRB) body that GPs should receive a 3.5% pay uplift for 2026/27 has been accepted by the Government.

Applying to contractor and salaried GPs across the four devolved UK nations, health secretary Wes Streeting said it represented a ‘real terms’ pay rise.

But the BMA said the figure would be a ‘crushing blow’ to doctors with the award failing to meet the cost of living or restore levels of pay that had been eroded.

Here Pulse goes through the data that informed the DDRB review.

Workforce and recruitment

The GP workforce has seen growth but concentrated among salaried GPs, the DDRB found.

Qualified GP numbers have increased across all UK nations over the last year, reflecting a longer-term trend of growth since 2016/17.

But the composition of the workforce has shifted with rising numbers of salaried GPs at the same time as GP partners or performers have declined or flatlined. Locum numbers have also fallen.

Yet the DDRB also noted that partners work longer hours with 36% working seven or more sessions, compared to just 11% of salaried GPs. With changes to working patterns as well as the shift to a more salaried workforce means it takes more GPs by headcount to generate the same number of FTE positions, it added.

Overall in 2024/25, the number of GPs per 100,000 registered patients was 75.0 in Scotland, 71.0 in Northern Ireland, 64.5 in Wales, and 57.0 in England.

GPs (headcount) per 100,000 registered patients, by nation, in 2024/25

A substantial section of the review looked at the issue of underemployment in GPs with the DDRB concluding that workforce planning needs more careful consideration.

While the overall workforce may have grown and training numbers expanded, concerns remain across the UK about the recruitment and retention of GPs in rural, remote and deprived areas.

A more recent development within evidence collected by the DDRB is the analysis of GP job adverts. Figures from NHS England show an increase of 47.9% over the past year albeit still well below the record number reported in 2022/23.

Giving evidence to the DDRB, the BMA said that unemployment and under-employment were increasingly prevalent among sessional GPs. A survey at the start of 2025 found 15% of respondents said they could not find any GP work and another 56% would like to work more hours as a GP in the NHS than they currently were.

In some areas an ‘over-reliance on non-GP roles’ through the ARRS scheme after years of GP recruitment issues had led to displacement of investment in substantive posts, the BMA had told the review.

Whether there were not enough GPs to hire was questioned by evidence to the review from the Nuffield Trust, but it noted there was a ‘significant risk that allowing employment of GPs under the ARRS was worsening the GP recruitment crisis’ because there was ‘little incentive for GP partnerships to employ salaried GPs directly at practice level’.

In the 2025 General Practice Workforce Survey in Scotland, 14.4% of GP practices reported that they had vacant GP sessions down from 22.1% the previous year with an overall vacancy rate of 3.8% compared with 7.6% in 2023/24. But wide variation was apparent between health boards with 0.8 % in Forth Valley to 15.5% in Highland.

Practices reporting GP vacancies in Scotland

Wales, Scotland and Northern Ireland had introduced various schemes to support the development of GP partners, the DDRB heard.

A strong growth in GP trainees had been seen over the medium term although saw a small fall of 6.4% in the past year, figures showed.

But an RCGP survey found that 66% of 156 final year GP registrars who had looked for work had found it difficult.

Of those who had not been able to find work yet, 70% had warned there were not enough suitable jobs anywhere in the country.

The RCGP said it was essential that GPs were supported to move into under-served or hard-to-recruit areas, for example, through the reintroduction of a targeted enhanced recruitment scheme (TERS) or a similar initiative.

Earnings

The earnings and expenses of GPs ‘varies significantly across the nations’, the DDRB found. In the most recent year, to 2023/24, GP contractors saw increases in average pre-tax incomes of between 3.9% in Wales and 13.2% in England.

GP contractors’ changes to average pre-tax income compared with DDRB recommendations, by nation, 2016/17 to 2023/24

Variation can be explained by contract funding, costs, service provision, and practice population with a trend towards larger practices.

The DDRB pay uplift recommendation is only one small part of this equation. Average earnings growth for salaried GPs in 2023/24 also showed a wide range, the review body found.

In 2023/24 – the latest figures available – median pre-tax incomes in Scotland, Wales and Northern Ireland were between £108,100 and £121,200, compared with £141,700 in England.

Figures also show that in England, 31.4% of contractor GPs had pre-tax income above £175,000 in 2023/24, compared to 11.8% in Scotland and 6.6% Northern Ireland.

But the DDRB stressed, pre-tax income estimates are on a headcount basis and take no account of hours worked.

They estimate that the FTE mean pre-tax income for contractor GPs in England in 2023/24 was £185,300 rather than £158,700 when looked at on a headcount basis – a 13.3% increase from 2022/23.

Applying the same adjustments to Scotland and Wales gives incomes of £156,000 and £158,400 respectively in 2023/24. A growth of 6.7% in Scotland and 6.2% in Wales.

Income over the past decade was looked at in both nominal terms and real-terms.

Since 2012/13, when adjusted for the consumer prices index, contractor GP income has grown by 10.9% in England and 6.1% in Scotland but fallen by 3.3% in Wales and by 9.3% in Northern Ireland.

The Welsh Government said that the fall in real terms average earnings for GP partners, for the third consecutive year, reflected ‘sustainability challenges’ and a ‘growing disparity between employed and risk-bearing GPs’.

But the BMA warned that underfunded contract uplifts in Wales meant that the DDRB recommendation for GP partner pay ‘could not be realised’.

Giving oral evidence to the DDRB, the Department of Health and Social care said the increase in partner earnings seen in 2023/24 was ‘unexpectedly high’.

This was caused by a combination of factors including growth in unconditional income streams, such as capacity and access funding, increase in practice list size boosting global sum payments, and fewer partners with which to share funding.

But DHSC also pointed to a ‘discrepancy between partner and salaried earnings growth’, with practices only passing on 4.3% of the recommended 6% uplift.

Practices say insufficient funding uplifts prevent them from doing so.

But the BMA sessional doctors committee said that there needed to be greater accountability on behalf of practices in passing on the DDRB uplift to their salaried GPs.

Failure to pass on the uplift in full meant that salaried GPs fell further behind their secondary care colleagues, it added.

When it comes to salaried GPs, earnings across the four nations showed less variation. In 2023/24 average pre-tax income grew by 4.3% in England, 2.3% in Scotland, 8.7% in Wales, and 9.3% in Northern Ireland.

Again, adjusting for hours worked gives an estimated FTE mean pre-tax income for salaried GPs in England of £114,400, rather than £72,200 on a headcount basis, a 5.5% increase, the DDRB said.

Unadjusted and FTE-adjusted average pre-tax income for salaried GPs and
annual growth, England, Scotland, Wales, 2023/24

Salaried GPs in Wales showed the largest differential following FTE adjustment, reflecting a higher prevalence of part‑time working than in England or Scotland.

Overall, 53.2% of all doctors are satisfied with their level of pay, the DDRB heard.

Patient access, sustainability and contracts

More patients are being seen with 1.47 million appointments with general practices in England every working weekday in December 2025, up by 4.0 per cent from December 2024 and by 22.8% since 2021.

There was also a 3.1% increase in the number of patients seen specifically by a GP every working day, the DDRB review said.

A drop in face-to-face appointments form to 64% to 61.5% in the year to December 2025 was countered by an increase in the proportion of online/video appointments, which now accounted for 10.1% up from 5.9% the previous year.

There have been modest improvements in patient satisfaction and access to GPs in England.

The Welsh Government said access to GP services remained a ‘key public concern’ but practices were doing 1.5 million every month, representing almost half the population of Wales.

Long-term sustainability of general practice was raised as an issue throughout the UK but with Wales and Northern Ireland facing particularly severe pressures.

With the proposed move to care in the community under the 10 Year Health Plan in England, and the introduction of large-scale neighbourhood contracts, there may be a need for a ‘different type of pay structure, with more direct employment of GPs, and with GPs and consultants working together’ in the future, the DDRB said.

Last year, review body had ‘highlighted the urgent need for an effective uplift mechanism in primary care contracts to reflect the actual cost of providing care.’

The latest review concluded that while UK and Northern Ireland governments have made some progress on this, in terms of undertaking work to better understand the costs of providing care ‘the issue has not been resolved and remains critical in ensuring the sustainability of primary care’.