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GP workforce ‘stagnant’ despite rising training numbers, DDRB warns

pre-pandemic appointments

Greater increases in newly trained GPs are needed to fix an effectively ‘stagnant’ workforce because of an increase in part-time working, the independent pay review body has warned.

While trainee numbers are rising it has not kept pace with the falling numbers of contractor GPs and a drop in average working hours among salaried GPs, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) found.

Retention in general practice was a clear issue laid out by the DDRB which also noted that the increasing proportion of international medical graduates entering GP training will present a challenge for workforce retention in coming years.

The DDRB also raised concerns about increasing rates of early retirement among senior doctors. It specifically urged UK governments to explain how they will ensure retention is not further hampered by the recently-announced freezing of the Lifetime Allowance in the NHS Pension Scheme.

The DDRB said: ‘We welcome the continued increase in the number of doctors who are entering general practice training.

‘This shows that it remains an attractive option for newly-qualified doctors when making their career choices.

But while the ‘headcount is growing’, its effective size in England is stagnant as the number working part-time increases, it said.

‘We would expect this dynamic to apply also in Scotland, Wales and Northern Ireland.

‘It is therefore crucial that in the coming years, the increases in the number of general practice trainees translates into an effectively larger workforce which can, alongside developments in the introduction of multidisciplinary teams, maintain and improve access to [GP] services.’

The review, which fed into the Government’s announcement for a 3% pay rise for salaried GPs for 2021/22, also urged ministers to recognise the contribution of NHS staff outside the DDRB remit, including GP partners.

It said GPs had played ‘an important part in the pandemic response, including through assisting those who were shielding and the national vaccination programme’.

‘This has underlined the critical importance of general practice and primary care more generally.’

The report said: ‘For those that we have not been asked to make recommendations for, we would stress that recognising their contribution during this period, as well as responding to the impact of the pandemic on them personally and on recruitment, retention and motivation, is as important as it is for other groups.’

The BMA said this represented ‘clear’ advice that doctors on multi-year deals, including GP partners, should also receive equivalent financial recognition for their efforts.

BMA council chair Dr Chaand Nagpaul said: ‘Yesterday the Government said it had accepted the [DDRB] recommendations in full this year and that this was in recognition of the extraordinary efforts of NHS workers. What they didn’t say was that it was in recognition of just some of them.

‘The Government has chosen to ignore the Review Body’s strongly worded advice that all doctors should be recognised and rewarded.’

He added that the BMA would now be pushing the Government to ‘do the right thing’ by honouring the review body’s recommendations in full.

The BMA had already pointed out that the 3% pay rise for salaried GPs in England comes with no extra funding for practices to pay for it.

Fair pay for salaried GPs is also a critical part of addressing the gender pay gap in medicine, the DDRB said, and as part of this, it is important that pay uplifts reach salaried GPs.

Dr John Hughes, chair of GP Survival, said the profession had been warning about workforce shortages for more than a decade.

He added that anecdotally it feels like the problem of retention has got worse over the pandemic.

‘There are quite a number of GPs that with the rise in workload and constant denigration from Government and NHS England have decided to pack it in and retire early,’ he said.

‘First of all we need recognition that GPs are open and working and a clear apology from NHS England for what they were implying otherwise.

‘As far as other steps go, we need a proper and adequate change in funding.’

The number of doctors accepting GP trainee places in England has risen again this year – by 7% – following initial recruitment rounds. 

This is the fourth year in a row that the number of trainees has risen and already exceeds the Government-mandated target for 3,250 GP trainees to be in place every year.


Valerie Jane Philip 23 July, 2021 10:04 am

Newly trained GPs increasingly and rightly looking to work life balance. The job is now so burdened with excessive micromanagement from NHSE, increasing box ticking ES DRS etc. Work dump from secondary care and increasing workload catching up on much patient genuine need and some less genuine ‘want’
Many of these doctors only want 6 sessions even though they are at the beginning of their GP careers.
Great for new partners to get ‘golden hellos’
Not so great for this who have worked at the coal face for 30+ years! We have lost seniority payments and have the pension whammy.
Thanks NHSE for showing how you value GPs less than judges.
And how is the 3% pay rise for salaried GPs and Practice nurses etc to be funded? Silence on that so far!

Turn out The Lights 23 July, 2021 10:55 am

Stagnant is a result for now give it a year or so will be in retreat.Especially when the chancellor shrinks the lifetime allowance.Which will make it not worth staying on in a substantive role.Life is too short the youngsters have the right idea.GP is not doable full time anymore.

Karl Jones 23 July, 2021 11:02 am

The way NHSE treats its primary care doctors might have something to do with the retention problem.

Dermot Ryan 23 July, 2021 11:48 am

Simple; Fire the NHSE, CQC and Nice and use that funding to cover salary increases that do the work, taking it away from those who impede the work!

A non 23 July, 2021 11:55 am

its not just about pay..the role is impossible
there is literally nothing somebody somewhere doesn’t think we are responsible for
we are regularly routinely blamed for any failure of the NHS more generally and we are totally over run by people seeking help for utter trivia or stuff we simply have nothing to do with
just the other day I listened as some hollow eyed, weary looking but sadly blinkered and bubble inhabiting ambulance service manager implied the central reason why the ambulance service is too busy is simply because people ‘cant get an appointment in primary care’ ..that kind of short sighted superficial stupidity is everywhere
every day i do clinics in which there are significant numbers who’ve booked multiple appointments for trivial issues over short periods of time, there are people who’ve booked urgent appointments for vague minor symptoms present for just a few hours that are almost impossible to comment on, there are people who’ve been up to a&e but couldn’t be bothered to wait so they left safe in the knowledge their GP would sort it all, there are loads and loads of people who want to complain about some aspect of their hospital care or the long wait to be seen, they have no way of contacting the hospital but know they can contact us and they do and there’s nothing we can do. Then there’s all the people with serious problems NOT being seen in hospital because they are ‘too busy’ who we are somehow magically expected to look after, and there are people who even though they are supposedly being cared for in hospital aren’t being because their out patient appointments have been cancelled or delayed , and there are people discharged way too early from hospital because there aren’t enough beds who depressingly end up going back in just a few days later, then there are the people who should be followed up by hospital but who aren’t and get discharged even though a five year old could see they are going to get the same thing again in 3 months because their condition is chronic and 9/10 typically recurs. Oh yeah then theres the stuff we actually are supposed to be doing like 8 week checks, vaccinations and urrr primary care. And that half wit in the ambulance service thinks all his woes are caused by a lack of appointments in primary care?..there will NEVER be enough capacity in primary care as long as it’s responsible for providing everything to everyone for free. there is so much you dont know you dont know Mr ambulance service manager..believe me

John Graham Munro 23 July, 2021 12:25 pm

A non——–patients are patients——-no matter how stupid they might be

A non 23 July, 2021 5:50 pm

John Graham Munro – thanks but what’s your point exactly?

John Graham Munro 24 July, 2021 12:06 am

A non ——-your piece explains my point quite beautifully

Nicholas Chiappe 24 July, 2021 7:50 pm

I sincerely doubt that someone who has so much time to comment negatively about GPs and GP partners can currently be a partner him or herself (JGM). The job of a partner has increased beyond recognition in recent years, which he may not realise. Our salaried colleagues also have more complex work than in the past.

Anon has described the problem which I think is making GP partnership much less desirable than it used to be. The evidence is that GPs are voting with their feet, and I hope that this loss of workforce will not continue. While being sure that I will not be able to survive beyond 60 in today’s general practice, I am not sure that I could cope with any additional work in the 3 years I have until that date. If funding is not changed and our colleagues get a pay rise, this will mean partners get a pay cut.

We do need some solutions, and I suspect that given the unlimited demands on general practice, this will have to be a salaried service for almost all. Unfortunately, this will make explicit the need for demand management, as far more doctors will be required when all work has to be paid for.
Work normally done in secondary care brought to primary care will come with a training and workforce implication, which might well cost MORE than doing the same work in secondary care. Every extra hoop or form to complete to get a referral accepted, every rejected referral uses clinical time, Every blood result or X ray to consider, costs time and energy which is not factored in to the clinician hours available . The phlebotomy cost is not the cost of providing the service, though it helps. Every extra organisation or change requiring GP input takes trained doctors away from clinical work, so should be only considered when really necessary.

John Graham Munro 25 July, 2021 12:22 pm

Nicholas Chiappe———the clue to my gender is in the name——-and whilst you’re there, I cannot think of a favorable adjective to attach to G.P.

Andrew Jackson 26 July, 2021 4:42 pm

my son is a recent graduate in a non medical field and has a job where he has a great work life balance and he works 5 days a week and has fantastic continuity in his role
he would find it ridiculous to think of working part time as do all his colleagues
it is possible in GP but only with a controlled workload and a desire to do what it takes to achieve this amongst the profession
as others have said once the available GP time has been burned up then no more is available will quickly focus minds on what they want us to do
you shouldn’t have to be part time or locum to achieve this