The number of GP practices in Scotland has fallen by 3% in the past five years while the average list size has risen by 6%, figures from Audit Scotland show.
There were 963 practices in Scotland in 2016 compared with 991 in 2012 with the average list size increasing from 5,586 to 5,881.
At the same time, the number of GPs only increased by 1%, the report on the state of the NHS in 2016/17 said.
General practice is ‘central to the changes that are needed to the healthcare system’ but there are many difficulties in achieving that including recruiting and retaining GPs and low morale, Audit Scotland said.
A lack of data is preventing a clear picture of workload pressures in general practice but there is evidence that GPs are struggling to meet demand, the report said.
The best guess is that GPs dealt with 17 million consultations in 2016/17 – a figure which could well be underestimated.
Signs the profession is overwhelmed include a GP practice vacancy rate of 26% and a third of GPs planning to retire in the next five years.
Audit Scotland said gaining GP agreement to the new GP contract ‘is critical to changing how primary care works’.
And it said while there was a long-term government strategy to move care into the community it was still not clear how that would be funded.
Caroline Gardner, auditor general for Scotland, said: ‘The NHS in Scotland marks its 70th anniversary next year, and there is widespread agreement that healthcare must be delivered differently if it is to withstand growing pressure on services.’
Dr Miles Mack, RCGP Scotland chair said it was frustrating that the same messages had to be delivered by Audit Scotland year after year.
‘Underfunding general practice is the root cause of so many of the issues the NHS now faces.
‘We are pleased that a professional consensus is coalescing around that fact,’ he added
‘We have had over a decade of consistent cuts to the percentage share of NHS Scotland budgets going directly to general practice services.
‘We see serving GPs leaving their profession and record numbers of practices handing back their contracts.’
The RCGP is calling for 11% of NHS Scotland funding to be allocated specifically to general practice.