NHS England’s baffling incompetence in dealing with the GP workforce crisis
Dr Katie Musgrave on how NHS England’s failure to act is exacerbating the damage of the already pronounced GP workforce crisis
It can be hard to believe that those responsible for huge budgets and large government departments could be hopelessly incompetent. Sometimes one’s default reaction is to defer to their greater wisdom: ‘They must know what they are doing, they wouldn’t have such power and influence otherwise…’.
But working in the NHS must surely disabuse us of this notion.
Currently, the most stunning display of incompetence can be seen in the recruitment and retention crisis amongst NHS GPs. I struggle to write on this topic without grimacing internally with disbelief. Let’s spell it out.
Supposedly, the UK currently has a shortage of GPs, and GP appointments. GPs in post report concerning levels stress and overwork. A report published by the Health Foundation in 2023 found that general practitioners in the UK were experiencing the highest stress levels and lowest job satisfaction when compared to their counterparts in nine other high income countries.
Between March 2016 and March 2024 the number of patients registered with a GP in England increased by 10%, from 57 to 63 million. GP numbers have not increased to meet this higher demand – indeed over the same period, the number of fully-qualified GPs has reduced by 15%. Unsurprisingly, therefore, the number of people waiting more than two weeks for a GP practice appointment has increased by 18% from 4.2 million in February 2020 to 5 million in March 2024.
Yet – staggeringly – at the same time there has been an unemployment crisis amongst newly-qualified GPs in the UK. A BMA survey on GP under- and unemployment in 2025 found that one in five GPs surveyed were planning to change career because they can’t find any or enough work as a doctor. So while GPs in permanent roles are groaning under unsustainable workloads; another raft of the profession cannot find work at all. Ironically, both those in permanent positions, and those who cannot find employment are looking to relocate overseas, with many making the move.
This year, Wes Streeting himself said: ‘We inherited a ludicrous situation where patients couldn’t get a GP appointment, while GPs couldn’t get a job.’ It goes without saying, that NHS England needs to keep a razor sharp focus on the underemployment of GPs. The UK cannot afford to continue to lose qualified GPs with years of experience, when the workforce is already in a highly fragile state.
But back to NHS England’s utter incompetence… Labour are supposedly attempting to shorten waiting times for hospital outpatients and procedures. Arguably, the best measure they could take to reduce pressure on secondary care – in the present context of a shortage of GP appointments – would be to increase GP capacity (ideally while maintaining continuity of care). A significant proportion of those patients waiting to see a specialist could be effectively managed in primary care – if there were appointments available for thorough assessment, treatment, and follow up.
If the health service cannot provide timely and consistent access to a GP, there is a greater risk that patients will be referred unnecessarily, have missed diagnoses, or inappropriate treatment. Likewise, acute hospital admissions can be reduced by better access to a GP. Day in and day out, general practice provides the vast majority of healthcare interactions in the NHS; and we hold risk safely, when we are able to provide continuity and have adequate appointment availability.
So: there are GPs available to work, there are patients waiting to be seen, there are stressed and overworked GPs threatening to quit, and there are hospitals buckling at the seams because the dam upstream has broken. Theoretically, NHS England could solve many of these problems tomorrow by providing a significant emergency funding package earmarked for surgeries to offer their doctors extra paid sessions, recruit locum GPs, and bolster appointment numbers. But can anyone at NHS England or in government join these dots?
Dr Katie Musgrave is a GP in Devon
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READERS' COMMENTS [9]
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But that would be sensible and pragmatic— surely not
The NHS is our biggest employer and in many respects it’s our worst.
Now it’s in danger of becoming a case-study in false economy.
I’m afraid to say this is incompetence at the heart of government
A perfect example being the proposed hatchet job on NHS England and ICBs NHS England Chief Executive Jim Mackey didn’t know NHS England was going to be abolished when he took on the role-.Apparently, Wes Streeting didn’t know either until he was informed by Keir Starmer
I have it on good authority that negotiations with the Treasury have basically hit a brick wall. They realised fully that if you’ve got half the workforce to do the same job, it will just end up with consultancies and reappointment of staff, and they’re not prepared to go along with it.
Add into the mix plans to rehash failed policies in the early noughties from Alan Milburn and Lord Darzi and you have a perfect mix of complete chaos-League tables and zero tolerance for urgent and emergency care star ratings, Streeting’s belief that foundation trusts were one of the most successful NHS reforms in the last 25 years, with earned autonomy and greater responsibility, when the evidence suggests exactly the opposite, recreating a massive reorganisation almost as daft as the one in 2012 under Lansley, promising hospitals when the Treasurer had squashed any thought of a revival of PFI for major NHS projects—it’s all the politics of madness.
As far as secondary care goes, they’re expecting trusts to make savings when, for many, simply balancing the books has been impossible.
They still haven’t come clean on the future of the GMs contract and are forever touting digital AI and skill mix. They’ve basically got one over on us around access the 40 billion raising the last budget has disappeared in a sort of settlement with junior doctors pay arises and increasing costs to borrow it they currently seem to have stopped listening
There is a danger that they think digital innovation, AI, and skill mix with a broader range of health professionals delivering general practice and primary care, could be preferable to increasing the GP workforce.
Wes seems to embody the worst of student politics by his antagonism, bullying, egotism and arrogance.
Wrecker rather than fixer
Didn’t get the big job as PM but always expected to and Can now see that slipping away from him due to the underperformance of labour in government
At the top of government there appears to be a toxic environment that’s cliquey and closed and Taking instructions from Morgan McSweeney and other unelected advisers
The GPC will have its work cut out
Full disclosure: I’m a paid-up member of the Labour Party. I’m rather speechless at the first 12 months, expecting far more and far better.
Last post on this feed
” Roy Lilley calls him, a silly man without any plausible plan but with a massive contempt for the organisation that he wishes to control?”
Unless that is, Streeting is considerably more incompetent than even I have imagined, which I think is possible. In fact, that is my best hope, because every other alternative is worse.
It requires a very high degree of lunacy to maintain a situation in which demand for a service exceeds supply because the extra supply, while available, is prevented from being accessed.
I am a GP returning from abroad after a career break. In the last two months, I have applied for almost 10-15 GP jobs from NHS jobs and RCGP jobs , few interviews, yet still no luck. Will continue with a belief that I will find the right GP post but these circumstances were never ever before. This is unbelievable. ‘ No GP appointment and no jobs for the qualified GPs’ !
The answer is always more Government spending
Have you noticed the Country is broke?
Taxes are at record levels?
The Economy looking more than a little poorly?
Perhaps time to charge the punters a contribution?
Or perhaps look at spending less on paying the “disabled” to watch daytime time TV, and spend the money on GP?
Or look at all the time wasting nonsense taking up GP time, and the financial incentives that reward fobbing-,off rather than seeing patients?
Good article Katie, and Douglas Callow’s comments. This is the sort of Govt that, if it saw a pile of dogsh*t, it would spend weeks discussing and workshopping a 10 point Plan on how to manage it. Then hand it over to some private contractors!!
Anyway, below, some comments I’ve posted to another piece and relevant to this.
1. We’re not broke. Basic economic facts – as a currency sovereign, we can never go broke – that’s a myth peddled by crazy neoliberal economists. Deficits are good (in fact over the last >200 years we’ve mainly had deficits). Debt is not a burden but an investment in our country, and never needs to be repaid (eg by our children, as the neoliberals’ lie goes). 50 years evidence of neoliberal economics has clearly shown that it serves the rich and powerful, has created huge inequality, and is corrupting democracy.
2. Taxes aren’t at record levels – post ww2 when we built the NHS and large parts of our common public goods, not only had we just spent loads on the war but we spent even more, and taxes went up to >90%. We thrived well for decades.
3. The economy would do better if the Govt spent and allocated idle resources (labour, capital etc) to drive the economy instead of using the “fear of debt and spending and how will we pay for it” to disguise the fact that they’re catering to private interests, just like the Tories did. Eg why are some GPs being left unemployed and unused? Proving the Govt’s an idiot.
4. None of the above is the fault of ordinary people so they shouldn’t have to pay, but is the fault of our political class.
5. To properly fund the NHS is a decision of political will, the constraints are whether we have the available resources to put into use (labour, capital, infrastructure etc) and to monitor inflation (which can be managed by monetary and fiscal policies)
6. We need stories of hope from our leaders, not demonise and divide politics.