2023 in review: Will the NHS workforce plan work?

It is well documented that the GP workforce is on its knees, with too few doctors and too much to do. The Government’s pledge of £2.4bn to tackle a predicted shortfall of 360,000 staff by 2037 ought to do the trick, right?

Pulse analysed the NHS workforce plan earlier this year, looking at what it means for GPs at all stages of their careers, from medical school to retirement. The plan focuses on getting more fresh meat into the profession at the point of entry.

First off, it commits to doubling the number of medical school places in England from 7,500 to 15,000. In addition, funding will be made available to those that offer high-quality placements in general practice and therefore promote it as an attractive career option.

Added to that is a proposal to set up more medical schools in areas where there is greatest need for GPs, and a promise to ensure that by 2031, all foundation stage trainees do a rotation in general practice – only around half currently do.

Lastly, the workforce plan will see a 50% increase in GP speciality training places by 2031, bringing the number to 6,000. Details on who will train them is lacking, though.

But the recruitment of prospective doctors into general practice is fairly successful. The cohort of GPs who earned their CCT in 2022 represents one third of the total 2012 medical school intake (assuming a linear career progression).

So, plenty of trainee doctors become GPs, but not enough of them stay on in the profession full time. A Pulse survey of these mid-career GPs currently working full time found that 45% wanted to reduce their hours.

Many of these are already starting to burn out, and one in five are considering going overseas for a better work-life balance, while others look to private practice as a way forward.

What the workforce plan has to offer to keep these GPs from fleeing the NHS is anyone’s guess. There is no mention of GPs at all in the spiel about how the Government plans to make sure ‘130,000 fewer staff leave the NHS over the next 15 years’.

It’s not just GPs at the height of their career who aren’t sticking around. Those towards the latter stages of their working life want to bring forward their retirement.

Many continued working or came back to the NHS after retiring to muck in during the pandemic, but with that incentive now gone, retiree numbers are returning to pre-Covid levels.

In fact, around half of Pulse’s survey respondents aged 50 and over said they are thinking about leaving general practice.

For some time a sticking point has been pension tax, which has meant it’s costing older GPs money to keep working. Taxation reforms announced in the Spring Budget could well be transformative, according to the BMA, but come too late to tempt some GPs who are set on retiring to change their minds.

A bigger problem, perhaps, is that a long career as GP is simply too much: burnout and stress were the most common reasons GPs answering a GMC survey gave for walking away from the profession early.

NHS England seemed to acknowledge this ahead of the workforce plan’s publication, releasing guidance for late-career doctors to ‘stay well in the NHS’. The 10 recommendations include fewer out-of-hours shifts, more remote working, and job sharing.

The guidance was written primarily for secondary care doctors – perhaps further signalling the tendency for general practice to be considered as afterthought; undervalued and still overstretched.

There is a sting in this particular tale, however. Pulse surveys last month revealed that there has been a 44% reduction in the number of GP vacancies advertised since the previous year while around half of GP locums have reported a decrease in their sessions worked over the same period due to a lack of work available.

Only this Government could pull the trick of having both unfilled roles and GPs out of work.