Expert analysis: Why are we not retaining GPs?

Following their recent study, Drs Victoria Tzortziou Brown, William Palmer, Lucina Rolewicz, and Giuliano Russo explore the retention patterns of recently qualified GPs

Earlier this year, it was revealed that over 40% of GP registrars who qualified in 2022 and 2023 have yet to take up substantive roles in UK general practice. This troubling figure highlights persistent difficulties in transitioning newly qualified GPs into permanent positions within the NHS.

We recently published a study in Human Resources for Health that complements this and offers a deeper dive into the retention patterns of recently qualified GPs in England. The analysis is based on data from 14,302 doctors who completed their third year of GP specialty training (GP ST3s) between 2018 and 2023, and it paints a concerning picture.

Just 34.3% of these GPs had taken on a fully qualified role in NHS general practice six months after training. That number rose to 47.5% within a year and 62.2% by the two-year mark.

Participation rates may mask true workload

Interestingly, the study found that average estimated participation rates for joiners remained relatively stable, between 65% and 69% of a full-time contract, across the 2017 to 2023 period. However, this definition of ‘full-time’ equates to nine sessions a week, with each session lasting four hours and ten minutes. In practice, many sessions extend far longer, meaning that GPs working fewer than nine sessions may still be operating at, or above, full-time capacity.

Disparities by gender and training background

The study also revealed significant variation in retention based on gender and training origin:

• Male UK-trained GPs were less likely to remain in NHS general practice two years after qualifying compared to their female peers;
• International medical graduates (IMGs) were less likely than UK-trained doctors to join NHS general practice;
• Among IMGs, male doctors had lower retention rates.

The study did not investigate the reasons behind these disparities. Potential contributing factors may include visa restrictions, a limited number of GP positions, and the appeal of alternative career paths.

Gaps in the data

Notably, the available data does not include GPs working exclusively as ad hoc locums and GPs working in non-clinical roles such as education, research, or leadership. These roles are critical to the wider NHS ecosystem, yet they remain invisible in official workforce data.

Why better data matters

To gain a full understanding of the GP retention challenge, the NHS needs more granular workforce data. Current systems do not track GPs as they move between roles, take career breaks, or leave general practice entirely. The absence of comprehensive vacancy data also makes it difficult to assess how market dynamics, such as supply and demand for GP roles, regional disparities, and changes in employment models, influence workforce trends. Without insight into where vacancies exist or whether demand aligns with the distribution of new GPs, it becomes challenging to gauge how economic pressures are shaping retention patterns.

A system at risk

The NHS is not retaining enough of its newly trained GPs. For every ten who complete training, just four full-time equivalent (FTE) GPs are joining the workforce. Retention is particularly low among male GPs and IMGs. And while many new GPs are reported to be working part-time, the current definition of ‘full-time’ may significantly underestimate their actual workload.

Urgent need for policy action

To address these issues, there must be a concerted policy focus on supporting the retention of newly qualified GPs. Without targeted action, the NHS risks continually pouring resources into training new doctors only to lose them through a growing hole in the bucket. Efforts to expand the workforce will have limited impact unless more is done to understand and stem the steady outflow from general practice.

Dr Victoria Tzortziou Brown is a GP in east London and GP Academic in Primary Care and Health Policy, at the Wolfson Institute of Population Health, QMUL

Dr William Palmer is a senior fellow at the Nuffield Trust

Lucina Rolewicz is a researcher at the Nuffield Trust

Dr Giuliano Russo is senior lecturer of Global Public Health at the Wolfson Institute of Population Health, QMUL