Pressures in general practice: British Medical Association


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.

They have been at the forefront of the NHS's response to the COVID-19 outbreak, delivering vaccines whilst maintaining non-COVID care for patients throughout.

England has a shortage of GPs

GP growth has stagnated for many years

As of August 2022, there were 36,752 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 27,515 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.

The Government has failed to deliver on promised recruitment

In February 2020, in a bid to reverse the stasis in GP workforce numbers,
Yet despite these promises, as of August 2022 (latest data) we actually now have the equivalent of 1,850 fewer fully qualified full-time GPs compared to the baseline of September 2015 (which is when the current collection method began).the Government announced a drive to recruit an additional 6,000 GPs by 2024.

Yet despite these promises, as of August 2022 (latest data) we actually now have the equivalent of 1,850 fewer fully qualified full-time GPs compared to the baseline of September 2015 (which is when the current collection method began).

Over the last year, the NHS has lost 328 individual (headcount) GP partners and 242 salaried, locum and retainer GPs. This has created a net loss of 570 individual GPs since August 2021.

In FTE terms of 37.5 hours per week, this amounts to an equivalent loss of 314 full-time fully qualified GPs in the last year alone.

With over one in 10 (16%) of respondents to a BMA survey telling us they plan to leave the NHS altogether after the pandemic, this figure is expected to rise further.

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. 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
Despite there being 1,850 fewer fully qualified FTE GPs today than there were in September 2015, each practice has on average 2,222 more patients than in 2015.

There are now just 0.44 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 310 – or 16% – since 2015, and now stands at 2,248.

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.

Appointment levels are high

General practice appointment bookings reached record highs over the winter of 2021 with GPs seeing more patients than ever.

The number of standard (non-Covid vaccination) appointments booked this month remains high. The August 2022 total of 26.5 million booked appointments has slightly increased from the 26 million booked in the previous month. One explanation for this could be the fact that August has one extra working day than July.

In terms of access, over 44% of appointments in August 2022 were booked to take place on the same day, and over 84% of appointments were booked to take place within 2 weeks.

The ratio of F2F (face-to-face) versus remote appointments has shifted with the waves of the pandemic, but the majority of appointments have always been delivered in person. Currently, around two thirds of appointments are F2F.

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