GP practices 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.
This page provides analysis on the pressures in general practice and is updated monthly with new data.
Last updated: 30 November 2023
NHS Digital publishes workforce data as both headcount and FTE (full time equivalent).
Headcount refers to the number of individual doctors, while FTE is the proportion of full-time contracted hours that the post holder is contracted to work. 1 FTE would indicate they work a full set of hours, 0.5 that they worked half time.
As FTE reflects the true number of clinical hours the NHS has at its disposal, we usually find FTE to be more meaningful than headcount. However, we also use headcount where appropriate. This page uses both headcount and FTE and will be clearly stated throughout.
Full-time here is taken to be 37.5 hours in accordance with the standard definition of 1 FTE used by NHS Digital. This calculation is for illustrative purposes only, as we recognise that in practice some employed doctor contracts can be 40 hours.
England has a shortage of GPs
GP growth has stagnated for many years
As of October 2023, there were 36,826 individual (headcount) fully qualified GPs working in the NHS in England. In Full Time Equivalent (FTE) terms of 37.5 hours a week, this equates to 27,368 full-time fully qualified GPs.
The overall number of GPs has seen little growth since 2015, with the number of GP partners declining significantly over that time.
England has around 7.8 (headcount) GPs per 10,000 people, compared to the OECD average of 10.8. England would need an additional 16,700 GPs to be on equal footing with the OECD average.
The Government has failed to deliver on promised recruitment
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.
Yet despite these promises, as of October 2023 (latest data) we now have the equivalent of 1,996 fewer fully qualified full-time GPs compared to the September 2015 baseline (when the current collection method began).
The longer-term trend shows that the NHS is losing GPs at an alarming rate. Over the past year (between October 2022 and October 2023) in FTE terms of 37.5 hours per week, it lost the equivalent of 254 fully qualified full-time GPs.
Over the last year alone, the NHS lost the equivalent of 387 fully qualified full-time GP partners. On a headcount basis, this is equivalent to a loss of 446 GP partners.
With mounting pressures in general practice, these losses are set to continue further if the Government does not take appropriate action.
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 less than full-time has been climbing. This is likely because doctors are, understandably, moving towards working patterns that allow them to better control their hours and workload in order to reduce stress, ill-health and burnout and to improve work-life balance.
Although these GPs may be working less than one FTE on paper, in reality 'part time' as a GP very often means working a number of additional unpaid hours just to get through the large numbers of appointments and essential patient follow-up (administrative) work.
Survey responses from BMA members suggest this trend is likely to continue (September 2021; just over 2,050 overall respondents) with half of respondents saying they plan to work fewer hours after the pandemic.
We are also seeing more than two in five (42%) planning to work more flexibly and from home more.
Fewer doctors are looking after greater numbers of patients
At the same time, the number of practices is also falling. While many practices have entered into mergers, practices can also be closed for other reasons. For example, inability to recruit staff or GP partners, no longer viable, partner retirements or CQC closures due to under resourcing.
Whilst the GP workforce is declining, the number of patients is increasing. In October 2023, another record-high of almost 62.93 million patients were registered with GP practices in England.
As a result, the average number of patients each full-time equivalent GP is responsible for continues to rise, and now stands at 2,299.
This is an increase of 361 patients per GP, or 19%, since 2015, demonstrating the ever-mounting workload in general practice.
Appointment levels are high
General practice appointment bookings (including Covid vaccinations) reached a record high of 37.2 million in October 2023.
The overall number of standard (non-Covid vaccination) appointments booked has also remained high. In October 2023, around 34.3 million standard (non-Covid) appointments were booked, with an average of 1.56 million appointments being delivered per working day. This is higher than the previous month (1.48 million in September 2023) and above the average of 1.39 million for the past year (November 2022 – October 2023).
Despite this incredibly high demand, GPs are working hard to see patients: almost half (42%) of appointments were delivered by a GP.
In terms of access, 39% of appointments in October 2023 were booked to take place on the same day – roughly the same as the previous month. Approximately 78% of appointments were booked to take place within 2 weeks – very similar to September 2023.
The majority of appointments (72%) were delivered face-to-face, consistent with previous months.
What the BMA is calling for
The BMA is calling for long term investment in increasing the NHS workforce. This must be accompanied by a workforce strategy to ensure that the appropriate number of future staff are being recruited and trained. There must be immediate implementation of measures to retain existing staff. See our NHS workforce data analysis for more detail.
The BMA is calling on the Government to urgently and properly invest in general practice staff, services and premises and to remove unnecessary targets and bureaucracy.
General practice has faced media scapegoating for simply implementing Government and NHS policies designed to keep patients safe.
The BMA is calling for the Government to provide consistent public statements of support for GPs and deliver on its commitment to work with the BMA and other healthcare organisations on a national campaign to stop abuse of NHS staff.
We also call on the Government to deliver on its promise of increased sentencing for those who assault emergency workers to two years, and introduce heavier punishments for verbal abuse against NHS staff.
See our support your surgery campaign for more detail.
