The human toll of the employment crisis on newly qualified GPs

The nightmare scenario of GPs finishing training and unable to find work has come to pass. But it is not just the latest cohort who are struggling. Allie Anderson reports

Pre-2023, the idea of GPs being out of work was unimaginable. Yet in autumn that year, Pulse started receiving a trickle of reports of locums being unable to find work. Soon, this trickle became a flood. These locums were then forced to take on permanent roles, which led to fewer roles overall.

The reasons for this were varied, but boiled down to three main factors – the funding squeeze on practices, the lack of space in premises and the additional roles reimbursement scheme, which incentivised practices to hire non-GP staff.

The Government is aware of this. In one of his first acts as health secretary, Wes Streeting included GPs in the ARRS for the first time – but limited this to those within two years of qualification. This partly allayed the crisis for those qualifying in autumn 2024.

Yet this year, the pressure on newly qualified GPs seems even more acute. Figures around unemployment and under-employment among GPs are not collected, let alone those finishing training specifically. Pulse has learned of young, promising GPs deliberately extending their training due to fears of not getting a job. Others have had to supplement the few weekly sessions they’ve secured with income from a completely different job. And for many, the prospect of abandoning the profession altogether, having worked so hard to qualify, looms large.

So, what exactly has the human toll of the unemployment crisis been?

The employment situation

Last year, NHS England data revealed that for every 4,096 GP ST1 posts, there were more than 15,000 applicants. That’s 3.67 people applying for every training post.

According to the BMA, this trend looks set to continue in what it dubbed a ‘looming’ crisis. Its own survey of 4,000-plus doctors finishing their foundation training in July found that 52% of them had not secured regular or substantive specialty training posts for the following month when they were due to start, although they did not break this down into those wanting to enter GP training.

Figures around unemployment for those who have finished training are hard to find. The BMA points out that past data from NHS England shows that in recent years, around 50% of GP registrars were still not employed by GP practices in fully qualified roles a year later. With the greater numbers of trainees receiving their CCTs this year, they say this figure could be higher this year. Meanwhile, the RCGP have warned about an impending crisis.

With twice as many GPs qualifying in 2025 than did six years ago, the prospect of even more competition for jobs is ‘daunting’, one GP says. ‘I’m terrified I won’t have a permanent job in a few months, and I will have to start looking elsewhere away from the NHS or rely on family to help me and my partner with the house and childcare costs.’

This newly qualified GP admits she is incredibly fortunate to have temporary work, covering while a salaried GP is on maternity leave. And yet, despite a proactive job search beginning in earnest when she started her current role, it’s slim pickings.

‘I’ve applied for five jobs in the last five months. One interviewer said they had 35 applicants, and another bragged that it’s a “buyers’ market”,’ she adds. ‘It is frustrating because I have a very good CV and I interview well, and I genuinely don’t know what more I can do to bag a job.’

The experience is echoed by many others who are at a loss, including an ST3 GP who is due to qualify in January.

‘I’m currently very worried about the job situation. In my area, there is one GP job being advertised. In the whole region, there were six – the nearest being two hours away,’ she reports. ‘This isn’t sustainable when there are experienced and newly qualified GPs looking for jobs.

‘I’m in my 30s, having done medicine as a graduate, and I’ve worked hard to get here. It doesn’t seem fair that we desperately need more GPs in the country, but the funding to employ us just isn’t there.’

Funding squeeze

Funding is one part of the puzzle. Practices saw a real-terms increase in funding until 2021/22, but the trend reversed from 2022/23 – the uplift for general practice plateauing at 2% a year in the face of soaring inflation and the cost-of-living crisis. The situation left many practices in need of doctors but unable to pay for them.

A September 2024 survey by Pulse’s sister title, Management in Practice, polled 387 practice managers on the general practice paradox that is a shortage of GPs and a shortage of GP jobs. Nearly half (45%) said they had been unable to hire GPs due to a lack of funding.

The Government’s ‘emergency measure’ of pledging an extra £82m for practices to employ newly qualified GPs as part of the ARRS was couched as a solution to the unemployment crisis. Yet, one year on, the move feels more like a shot in the dark than a silver bullet, according to GPs.  

‘The ARRS funding GPs is a short-term thing but more than that, it doesn’t pay well enough,’ says one. ‘They are paying about 80% of market rate. That’s a bit insulting.’

Another GP, who qualified in February, is currently working one day a week in an ARRS GP role in Sunderland alongside a part-time salaried job in Hartlepool. He believes the Government’s plan is short-sighted.

‘The ARRS roles are not ideal without a clear idea of their longevity and without a fixed place of practice,’ he says. ‘Those roles are generally part of a PCN where you could be asked to work at multiple sites, which affects continuity and integration with a team.’ 

The experience of navigating the job market left this GP in anguish. ‘It has caused me considerable mental distress and affected by self-esteem as I had put so much personal effort into GP training,’ he comments. As an international medical graduate (IMG) – a cohort that makes up more than 50% of GP trainees – he faces greater difficulty than his British peers.  

‘I was searching for months but many practices are not able to offer jobs to those on a visa, stating they do not have a licence to sponsor visas. I had one interview invitation revoked and, frustratingly, one written job offer withdrawn for that reason.

‘With the current job market being more challenging than it has been in recent years, I feel that as a doctor in need of a work visa, I am part of a group that is being discriminated against and put at an unfair disadvantage, widening the gap in differential attainment.’

Jobs filled

Even in practices where IMGs were once prime candidates for a job, they no longer get a look in – now these employers find themselves able to pick and choose without needing to apply for visas. A GP who works in an ‘undesirable’ area of north London recalls a time when he ‘couldn’t give a job away for two years’.

‘The area is very poor, very deprived – there are a lot of health and social problems, so it’s very challenging,’ he explains. ‘We were always chronically understaffed and usually had to take IMGs and offer them visa sponsorship. And as soon as those IMGs got to two years they would generally move to a less demanding practice.’

But out of nowhere, things changed. Whispers of job shortages frightened many newly qualified GPs away from locuming and into salaried roles.

‘It felt a bit like that petrol crisis: there was plenty of petrol, but not if you all fill up your cars at the same time,’ the GP says. ‘There were a lot of people locuming, who suddenly thought, “Oh, my God, there’s going to be no jobs”. Then suddenly all the jobs get taken.’

The result in this ‘undesirable’ practice that would always be ‘at least 20-25% short’ of GPs? ‘As of last week, for the first time ever, we are fully staffed,’ the GP reports. ‘We always had vacancies. We always had locums. We always had to fill gaps. Not anymore.’

Returners unable to find work

Across in east London, another GP also remembers the halcyon days where jobs were ten-a-penny. ‘When I qualified in 2021, there were multiple options: offers for salaried work, agency work, locum work. In fact, GPs held the advantage because we could pick and choose and dictate terms,’ she comments.

In 2023 she and her partner decided to take time out to travel, returning last summer to an unrecognisable employment market.

‘I started looking around last September and it’s been really difficult getting back into work. Now on [shift-booking platform] Lantum, there are about 20 people applying for one shift, so it’s impossible.

‘I was doing ad-hoc locum shifts – about one or two days a week – but I got to the point where I was using up my savings. It’s completely unsustainable.’

With her non-medic husband also out of work, the strain has been immense for this GP. ‘I’ve been very worried, very, very stressed. I am the sole provider and having to pay bills, a mortgage and everything is really tough.’

The prospect of borrowing money to stay afloat or even leaving the profession altogether became real. It took around eight months to secure a salaried position in a practice she had worked at before – a stroke of luck since the GP that replaced her when she went traveling was leaving.

‘We don’t have a job to offer an ST3 GP who’s just qualified so he is going to be locuming,’ she says. ‘But [he] has to be OK with lower rates because everybody is so desperate. I’ve even heard about GPs who are working as taxi drivers after qualifying, which is really upsetting.’

According to the BMA, an additional 1.26 million appointments could be created every month if every newly qualified GP was employed. It has taken the step of encouraging GP to write to their MPs to ask for support, and in a template letter the union urges MPs and Wes Streeting to ‘retain and to maximise the working ability of those [GPs] we already have’.

If the Government fails to act, GPs will inevitably vote with their feet. ‘There’s not enough money to fund core general practice, so we can’t afford the doctors we need. Now you’ve got more than half of appointments in primary care not done by GPs,’ says one GP trainer.

‘We need GPs to feel valued. It’s really hard to get here – you have to jump through a lot of hoops for years, and then at the end you’re told “You are not worth the money”. People are going to say, “hang on a minute – why am I hanging around and working in this system?” If they are mobile, they’ll leave. I would.’