This site is intended for health professionals only

Workforce problems need more than workforce solutions

Workforce problems need more than workforce solutions

Editor Jaimie Kaffash warns that the new workforce plan falls dangerously short on GP retention and workload

It all boils down to workforce. Almost every problem facing GPs and the profession stems from GP numbers – we have lost more than 2,000 full-time equivalents since 2015 in England. I must have quoted that number more than any other as Pulse editor.

Everyone recognises this. The Government, NHS England, the BMA, the RCGP, the GMC and every other stakeholder. The same applies in the devolved nations. 

The Government’s response – its workforce plan – finally landed on 30 June. Although it was due in 2022, I hesitate to describe it as ‘long awaited’ as no GP really expected it to solve the issues in general practice. 

It is easy to say the plan disappoints but our investigation into the ‘five stages of recruitment and retention’ shows exactly why this is true. 

The headlines revolve around education and training and, on this, there are truly positive developments. The increase of GP training places to 6,000 and the doubling of medical school places are vital.  

However, training and education isn’t the problem area. Health Education England has actually done a great job on this already. It has improved GP training take-up, met all its recent targets and helped reduce the ridiculous stigma around primary care in some of the more stuffy medical schools. As our figures show, around a third of those entering UK medical schools become fully trained GPs

But there aren’t enough qualified GPs to train them. This, of course, is a symptom of the underlying problem: we are failing in terms of retention

GPs are, on average, working fewer sessions than in 2015. Some of this is generational – these figures are most stark in the 30-50 age range, and workers of this age in all sectors are reducing time in work in favour of childcare or other caring responsibilities (and this should not only be factored in but encouraged). 

But that is not the whole story. The main reasons for GPs reducing hours, going to private practice, moving abroad or leaving the profession altogether are burnout and unmanageable workload. Indeed, many GPs who officially work ‘less than full time’ in reality still do what other professions would consider full-time hours.

On this, the workforce plan draws a blank. The section on retention focuses on secondary care, and how to build a culture where everyone feels welcome and valued (I’d venture that proper pay might help with this). 

I don’t blame the authors for overlooking GP retention; this is simply not in the remit of workforce planning. The only relevant point in the whole plan is this: ‘We must recognise the influence staff shortages have on organisational culture, and an individual’s experience at work and decision to leave.’

The solution is straightforward but difficult: make the job more manageable. This is not a workforce issue – I’ve long argued that improving recruitment is not enough. It requires a radical change in demand, such as that produced by removing out-of-hours work in 2004. 

I’m still unsure what this should be (luckily, editors can point out problems with no accountability for solutions). But I fear any reduction in demand on GPs will entail an increase in wider public service funding, which seems unlikely regardless of who is in power next year. 

Increasing the number of new GPs is essential. But unless the intense workload faced by today’s GPs is addressed, they will continue to leave the profession. And that is the real challenge.

A version of this column originally appeared in the July/August 2023 issue of Pulse

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at



Please note, only GPs are permitted to add comments to articles

David Church 6 July, 2023 6:56 pm

I don’t know Jaimie, I think we could use workforce solution.
Back in school (High School, upper school, big school, depending where you lived), we used to grow copper sulphate crystals out of copper sulphate solution.
I don’t see why the dissolved nations cannot grow workforce out of workforce solution – it’s just that we might need quite a lot of solution to grow enough workforce! but in a dissolved nation there ought to be plenty of that, eh?

Barry Sullman 7 July, 2023 8:36 am

Another insightful and intelligent piece. How do we get this accross to the political parties? They dont seem to have a clue.

James Bissett 7 July, 2023 9:29 am

The solution is easy but nearly impossible to implement and nobody is willing to talk about it
Traditional General Practice is dead but not yet buried We are undergoing a slow lingering death for probably 15 years. The answer is a salaried service with defined T Cs run by somebody elseBuy up all remaining doctor owned premises and start again Not impossible but will the GPS let go?

Centreground Centreground 7 July, 2023 5:39 pm

If a salaried service was introduced with all the allied roles that are now being introduced, then there would need to be robust managers able to manage them which is not the case and management systems in place. Many current managers are former receptionists with no outside business experience or business qualifications and most certainly do not have accounting or business degrees, Practice management is sheltered as lead GPs who often stay short periods if salaried or otherwise GP partners make the final or difficult decisions. Managers in NHS primary care have little accountability as poor performance is often masked by other highly performing/qualified staff within the practice. It is a taboo subject to discuss PMs in this way as all practices rely to some extent on the manager so do not wish to upset them but the age of admin staff of insufficient calibre being promoted on the basis of being in the right place at the right time is no longer fit for purpose.

Barry Sullman 8 July, 2023 8:43 am

Dear James
A salaried service will be second class. There are 3 types of GP’s – locums, salaried and partners. It is only the partners that keep this service together. I am a partner and as such I work 7 days a week to keep all the processes together at my practice. All partners are the same. Salaried on the other hand are quite different. It matters not a jot to a salaried doctor whether the practice reaches any performance targets or not. They come on time and they leave on time. They do NO additional work beyond their defined job plan.
I came number 1 in London for same day access. If I was a salaried GP, firstly I would not have given a damn; and secondly would have followed my workplan and only done a set number of cases. The massive behind the scenes work that delivered this result would not have been done and we would not have achieved this.
The current model is fine. We need to invest in it.

James Bissett 8 July, 2023 11:19 pm

Alas Barry that’s the whole point
Today’s GP will work themselves to death and take on all the responsibility for everything If salaried you do what you are paid for and what’s wrong with that. It doesn’t make you a second class doc who doesn’t care A tad patronising Barry

Dr No 13 July, 2023 9:00 pm

The absence of a retention ls is intentional. They want us to leave. The direction of travel is obvious if not explicit, with the only extra monies being for various species of Noctor. They want a salaried service substantially staffed by Noctors, as it will be unaffordable with GPs. They believe we are over qualified for the job, and that it can be done cheaper. When the workforce plan bears fruit it will be in the form of biddable salaried doctors. The GP partnership model is dying by design, and with it goes the General Practice we and the public recognise.