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 11 October 2021
NHS Structure Article Illustration

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 rising demand, practices struggling to recruit staff, and patients having to wait longer for appointments.

Alongside these long-term trends, GP practices have been at the forefront of the NHS’s response to the COVID-19 outbreak whilst maintaining non-COVID care for patients throughout.

 

Changes to data methodology

In June 2021, NHS Digital GP workforce data releases switched from a quarterly to a monthly frequency. The methodology used in the new monthly releases has also changed. 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.

This new methodology suggests that the fully qualified FTE (full-time equivalent) GP workforce has shrunk by 515 since September 2015. In reality, including the previous historical estimates, it has actually shrunk by 1,803 since 2015.

For this reason, the analysis used on this page refers to historical time series data from before the estimates were removed, as we believe this tells the most accurate story.

 

GP workforce data charts

Our analysis

The overall number of FTE (full-time equivalent) GPs has seen little growth since 2015, with the number of GP partners significantly reducing in that time.

In February 2020, to combat the stasis in GP workforce numbers, the Government announced a drive to recruit an additional 6000 GPs by 2024. That’s 1200-1500 extra doctors in general practice per financial year by the end of 2024.

Insufficient growth in GP numbers

There are actually now 1,803 fewer fully qualified FTE GPs today than there were in 2015.

Looking at the last year, between September 2020 and August 2021 the number of GP partners reduced by 918 doctors. The number of salaried and locum GPs increased by 611 over the same period. Factoring in the decrease in partners means that the number of fully qualified GPs by headcount decreased by 307 in this time.

In FTE terms (37.5 hours per week), the number of fully qualified GPs decreased by 380 between September 2020 and August 2021. This is likely because the GPs who left were doing a greater number of extra hours.

GP working patterns

Since 2017, the number of GPs working full-time hours or more in GP practice-based settings has been steadily decreasing. The number of GPs choosing to work some degree of part-time has been climbing.

NHS Digital only very recently started collecting very limited data on GPs working in other settings, for example GP out of hours, NHS 111, urgent care centres.

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

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

  • 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 and from home more

  • over one in 10 (16%) plan to leave the NHS altogether.

GP to patient ratio

There are now just 0.45 fully qualified GPs per 1000 patients in England – down from 0.52 in 2015.

At the same time, the number of practices is also falling. While many practices have entered into mergers, surgeries are also closed for other reasons. This can include inability to recruit staff and GP partners, no longer viable or partner retirements or CQC closures due to under resourcing.

Appointments and prescribing

The number of COVID vaccinations delivered by GP practices has been falling since its peak of 8 million appointments in May, but still amounts to 1.5 million appointments.

The number of ‘standard’ (non-COVID vaccination) appointments in general practice has dropped slightly since last month (by 1.9 million) but remains high at 23.9 million.

These two forms of appointments combined bring the total to 25.5 million. GP practices have been at the forefront of the NHS’s response to the pandemic, but COVID appointments take up practice capacity. Including Covid appointments, the overall appointment count for August 2021 is still two million higher than pre-pandemic levels (August 2019).

There were 315,190,826 repeat prescriptions in general practice in the year between August 2020 and July 2021, with August 2021 seeing 1,833,071 (6%) more repeat prescriptions than August 2020. That's a yearly average of 47,967 or around 922 per week per practice.

The average number of weekly prescriptions in August 2021 was up by 366,615 (6%) compared to August 2020.

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