There has been a recent, sustained fall in the number of GPs relative to the size of the population across the UK nations that appears to be the first such drop since the 1960s, according to a new Nuffield Trust analysis* for the BBC. The authors calculated that for the overall number of GPs to have kept pace with the number of people in the UK since 2014, we would have needed some 3,400 more GPs than we have.
The BBC reported this morning that the number of GPs per 100,000 people has fallen from nearly 65 in 2014 to 60 last year; and, it pointed out, the decline “comes at a time when the population is ageing and demands on GPs are rising”. It added that patient groups have said there are “real difficulties in making appointments”.
Senior fellow in health policy at the Nuffield Trust Billy Palmer noted that the fall in number of GPs has been particularly marked in certain regions of England, such as north-west London and the east of England, and that these regions also have the lowest total number of GPs per 100,000 people. Scotland has the highest. He said the fall in GPs per person reflects insufficient numbers previously being trained and going on to join the NHS; failure to recruit enough from abroad; and more practitioners leaving for early retirement. However, he also acknowledged that the trends should be interpreted with caution because tracking the number of GPs is made difficult by changes in the way that data are collected.
Mr Palmer also pointed out that these data reflect GPs headcount, rather than their full-time equivalent. He commented: “Based on data specifically from England, there has been an increase in part-time working. GPs were employed to work on average 82.1% of a full-time contract in September 2015, compared to 79.8% in December 2018. This would be equivalent to around a 1,000 fall in headcount across 42,000 GPs.”
He went on: “In one way we might have underestimated the fall in GPs per person. Demographic changes over time – such as an ageing population – may mean that the ratio of GPs to patients would need to actually rise to keep up with need. … Our recent joint report with the Health Foundation and The King’s Fund suggested the shortfall in GPs could grow by around 4,500 full-time equivalents in five years unless urgent action is taken.”
The British Medical Association said today’s figures “reflect a perfect storm” as GP numbers are “in freefall” with the failure of repeated government pledges to boost numbers. BMA GP committee chair Dr Richard Vautrey said: “Family doctors are under intense pressure to meet rising demand from a growing population, many of whom are elderly and living with increasingly complex conditions, and in many cases, workload has become unmanageable, leading doctors to reduce their hours or retire.
“As more doctors leave the profession, the workload gets heavier still for those left behind, and the situation gets far more serious for both patients and staff. Add to this punitive and confusing pension regulation that punish doctors who take on more work, we have seen a perfect storm brewing for the GP workforce.”
The Royal College of GPs said the figures are disheartening, but unsurprising to GPs and their patients dealing with the impact of “relentless workforce pressures”. It pointed out that there are more GPs in training than ever before thanks to excellent work to boost recruitment into general practice, but warned that while these new GPs are still in training existing GPs are left struggling to manage escalating workloads.
College chair Dr Helen Stokes-Lampard said this morning: “Demand for GP services is escalating both in terms of volume and complexity – and when this is compounded by falling GP numbers, it creates a perfect storm that is leading to GPs becoming stressed and burning out, and in many cases leaving NHS general practice far earlier than they might otherwise have done.
“More must be done to keep our hard-working, experienced GPs in the profession for longer – not only are they vital to delivering vital care to over a million patients a day, but they have a huge amount of wisdom to impart to new colleagues.”
* Palmer B. Is the number of GPs falling across the UK? 2019, Nuffield Trust blog.