Pressures in general practice

We monitor data on GP workforce, working patterns and appointment numbers to help build a picture of the level of strain GP practices in England are under.

Location: England
Audience: GPs Practice managers
Updated: Monday 17 January 2022
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The NHS is currently experiencing some of the most severe pressures in its 70-year history.

GP surgeries across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.

In addition, GP practices have been at the forefront of the NHS’ response to the COVID-19 outbreak, delivering vaccine appointments whilst maintaining non-COVID care for patients throughout.

 

Changes to data methodology

In June 2021, NHS Digital changed the methodology and frequency of how they release their GP workforce data. It no longer includes data estimates for the small number of practices that uploaded no or partial workforce data.

It also removed the historical way of showing data.

We believe this does not tell the most accurate story. Analysis on this page uses data from before the estimates were removed from the official data.

Changes to methodology and misleading data

NHSD releases since June 2021 no longer includes data estimates for the small proportion of practices that have historically uploaded no or partial workforce data.

The historical time series containing estimates were removed from publication at the same time, leaving only the new methodology for current and previous months’ data.

We believe this is misleading: the new methodology suggests that the fully qualified FTE (full-time equivalent) GP workforce has shrunk by just 456 since September 2015. In reality, when the previous historical estimates are included, it has actually shrunk by 1,704 since 2015.

These data are no longer available on NHSD’s website, so our figures may differ to reports from outlets or organisations reporting figures using the newer methodology.

GP workforce data charts

Our analysis

The overall number of GPs has seen little growth since 2015, with the number of GP partners significantly declining over that time.

In February 2020, in a bid to reverse the stasis in GP workforce numbers, the Government announced a drive to recruit an additional 6,000 GPs by 2024. That’s a commitment of 1,200 - 1,500 extra doctors in general practice per financial year by the end of 2024.

The Government has failed to deliver on GP recruitment

Yet despite these promises, as of November 2021 (latest data) we actually now have the equivalent of 1,756 fewer fully qualified full time GPs compared to 2015.

Over the last year alone, between December 2020 and November 2021, the NHS lost 934 GP partners but gained 227 salaried and locum GPs. This means that the number of fully qualified GPs by headcount decreased by 707 over the last year.

In FTE (full time equivalent) terms of 37.5 hours per week – as defined in NHS Digital’s official statistics - this equates to a loss of the equivalent of 333 full time fully qualified GPs in the year between December 2020 and November 2021.

GPs are changing their working patterns

Since 2017, the number of GPs working full-time hours or more in GP practice-based settings has been steadily decreasing.

At the same time, the number of GPs choosing to work some degree of part-time has been climbing. Although, 'part-time' as a GP very often means working a considerable number of additional unpaid hours just to get through the large numbers of appointments, delivering the workload of more than one member of staff and patient follow-up (administrative) work.

The trend appears to show that doctors are, understandably, moving towards working patterns that allow them to better control their hours and workload. This is most likely to reduce stress, ill-health and burnout and to improve work-life balance.

This educated assumption is supported by recent survey responses from BMA members (July 2021; just over 2050 overall respondents):

  • just over half (51)% of respondents said they are currently suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition
  • of these, one in five (23%) are suffering 'worse than before the start of the pandemic'
  • just under half (47%) plan to work fewer hours after the pandemic
  • slightly more than two in five (44%) plan to work more flexibly / from home more
  • over one in 10 (16%) plan to leave the NHS altogether.

Fewer doctors are looking after greater numbers of patients

Insufficient investment in the GP workforce does not prevent patient numbers from rising. In fact, despite there being 1,756 fewer fully qualified FTE GPs today than there were in 2015, each practice has on average 2,222 more patients than in 2015.

There are now just 0.45 fully qualified GPs per 1,000 patients in England – down from 0.52 in 2015. For the GPs that remain, this means increasing numbers of patients to take care of. The average number of patients each GP is responsible for has increased by around 300 – or 16% - since 2015.

At the same time, the number of practices is also falling. While many practices have entered into mergers, surgeries can also be closed for other reasons, for example:

  • inability to recruit staff and GP partners
  • no longer viable
  • partner retirements
  • CQC closures due to under resourcing.

Appointments and prescribing remain high

NHS Digital’s Appointments in General Practice dataset is classified as ‘experimental statistics’ due to variations in quality and practice coverage. This means data may be incomplete or missing. The following should, therefore, be interpreted with caution and seen as a guide, not a complete or exhaustive indicator of activity.

Appointments

General practice booked a record 34.6 million total appointments in November 2021, consisting of 30.5 million standard appointments and 4.1 million vaccination appointments.

November saw 90,000 more standard appointments and 546,000 more vaccination appointments than the previous month.

The total of 34.6 million appointments is 7.1 million (26%) more than the comparable pre-COVID levels of November 2019.

Face-to-face appointments

The number of F2F (face-to-face) appointments slightly decreased from 19.4 million in October to 19.0 million in November (a 2.3% decrease). F2F appointments now make up close to two thirds (63%) of all appointments.

Prescriptions

Prescriptions are also rising. The average number of weekly prescriptions in October 2021 was up by 272,109 (4.5%) compared to October 2020.

There were 319.3 million repeat prescriptions in General practice in the year between November 2020 and October 2021, with October 2021 seeing 1.09 million more repeat prescriptions than October 2020.

That's a yearly average of 48,599, or around 935 per week, per practice.

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