‘We are stuck in a system where GPs pay to work’

Dr Deepthi Lavu reflects on the hidden costs of GP unemployment, arguing the profession is becoming sustainable only for those who can afford the wait

The value of a GP in the UK is beyond contention, yet our profession consistently struggles with practice closures, workforce shortages, recruitment crises and retention problems. With colleagues exiting for the greener pastures of Canada and Australia, one can’t help but look internally to unpick less explored areas of the job environment. Such as, the cost of a suitable GP job in the UK. Not the salary on offer, but the accumulation of costs that sit quietly beneath the surface. There is the obvious societal cost, such as the price paid by practices, the NHS and the cost borne by public in the form of taxes but there is another hidden cost, that isn’t spoken about nearly enough. And that is the cost to the individual; newly-qualified GPs are being unfairly priced out of the system.

Exam fees. GMC registration and revalidation. Visa fees. Relocation expenses. The costs of moving families, losing support networks, starting again. More recently, in many cases, the cost of repeated applications, of uncertainty, of being perpetually ‘available’ but not secure. Add to this the health and wellbeing costs; stress, burnout, anxiety, the emotional toll of constantly proving employability.

For some, the sums no longer make sense. There are GPs who spend more on staying registered than they earn from the work available to them from their core GP roles. Others leave the profession entirely, not because they cannot work, but because continuing to position themselves for work has become financially and psychologically unsustainable.

We now find ourselves in a system where the cost of acquiring a job is often higher than the returns from the job itself. As this happens, we are no longer selecting the best people for the role. We are merely selecting the people who can afford to stay in the game the longest – or even worse; those that have no way out. This system which demands hundreds of trained GPs to compete for limited employment opportunities is not just, efficient, or meritocratic, no matter how often we pretend it is.

In our search for solutions to the employment and recruitment crises, we keep circling around alternative ways of working. ARRS funded roles in PCN models, portfolio careers and potential roles in future neighbourhood centres appear to address concerns. But without sustainable and predictable funding attached, these ideas remain fragile. Flexibility without security simply redistributes risk; it does not remove it.

If we want to change this, yes, increased core funding to practices is a must as we know that practices need more GPs but can’t afford them. Not losing hope on that front, but shifting focus to practical alternatives, some of the costs linked to attempting to secure employment can be addressed by making recruitment processes a part of the conversation.

Job adverts should be on standardised platforms that don’t require applicants or practices to pay. Adverts that are vague, non-committal, or overly aspirational shift risk onto applicants. More focused adverts that are clear about expectations, pay, workload, and support including for visas would already reduce unnecessary churn. Staged application processes might prevent people expending huge effort for posts that were never right for them. We need to save where we can and reduce these initial costs to get the conversation moving.

Talking about cost inevitably leads us to value. We know that general practice is the most cost-effective component of the NHS, with employing GPs in roles generating enormous downstream savings. The cost to hire them may feel high, but the value returned is disproportionate. And just as importantly, it reduces costs to job seekers and retains would-be GPs in the system.

Considering these individuals is within the very fabric of general practice itself. Because being a GP is not just a job. It is relational work, contextual work, human work. If we reduce it to metrics alone, we risk losing the very things we are trying to protect: the people we care for, the people we work alongside, the people we go home to and finally ourselves, the people who make up this amazing profession.

Until we acknowledge the true cost of GP jobs – and the true value of GPs – we will continue to run a system that consumes its workforce while claiming it cannot afford to keep them. However, general practice has always operated in complexity and uncertainty. We have always innovated and adapted where systems fall short. If this system is to be re‑imagined sustainably, there is no workforce better placed to do so than GPs themselves.

Dr Deepthi Lavu is a GP in Devon and former co-chair of the RCGP GP registrar committee