GPs are generally the first point of contact for us in the health system – managing acute illnesses while also supporting those with long-term conditions. If there aren’t enough GPs to provide and manage our care, this is felt by the struggle of booking timely appointments, being unable to see our usual GP, and having a less positive experience of care overall. The subject also has extra political importance given the government’s manifesto commitment to boost the GP workforce by 6,000 by 2025.
In this blog – which forms part of our work tracking the NHS workforce – we discuss what has happened to the number of GPs over the first year of this parliament (from December 2019 to December 2020), describe regional variation in the number of GPs and outline other roles in general practice that are seldom reported.
A recent uptick?
To be on course to meet the government target, we would have expected 1,200 more GPs by December 2020. In reality, we had 174 fewer permanent, qualified GPs than in December 2019, as well as 165 fewer locums. However, the number of GP registrars increased by 776 full-time equivalents, meaning there was an overall net gain of 438 GPs (from 34,708 in 2019 to 35,146 in 2020).
The trend of the shift from GP partners (those who own the practice) to salaried GPs (those employed by the practice) has continued over the last year, with the latter accounting for 27% in December 2020 compared to one-fifth (20%) in 2015. While GP numbers are lagging behind against the target, it has been an atypical time with significant challenges for workforce planning and international recruitment in the midst of the Covid-19 pandemic.
However, this increase still leaves the number of permanent, qualified GPs short of the 28,631 there were in 2015 (by 1,876). Substantial variation in the number of GPs between regions in England also still exists, with some areas feeling the effects of GP shortages more severely.
A varied picture regionally
The map below shows the number of patients per full-time equivalent GP – also taking into account the needs of the local population. This ranges from nearly 3,000 patients per one GP in Luton, to around 1,770 patients per GP in the Vale of York (see map).
This regional difference in the number of GPs is not a new finding. In 2016, Health Education England identified areas across the country where “a significant proportion of GP training places were historically unfilled”. Efforts have been made to address this gap through the introduction of the Targeted Enhanced Recruitment Scheme (TERS), which offers a £20,000 salary supplement to attract GP specialty trainees to work in these under-doctored areas. In the last couple of years, all training places through TERS were filled, and the scheme is offering 500 places for 2021/22.
GPs account for only a minority of the general practice workforce
That being said, it is important to remember that for every four people working in general practice, only one of them is a doctor (see chart). The wider workforce matters.
Nearly half of all general practice staff hold administrative or non-clinical roles – such as receptionists and practice managers. These staff ensure the smooth day-to-day running of practices, including patient-facing activities such as booking appointments, preparing administrative letters (such as sick notes), but also many behind-the-scenes responsibilities such as preparing payroll, managing the practice database, ordering medical equipment and keeping up to date with guidance and regulatory requirements.
However, there are many other staff providing direct patient care who are not doctors. The second most numerous clinical group is nurses, but again, there is variation across the country, with 0.2 full-time equivalent practice nurses per GP in Hammersmith & Fulham to one nurse per doctor in the Isle of Wight (see map).
In 2016, the GP Forward View outlined key targets for expanding the general practice staff pool, to better deploy talents of the wider workforce and relieve the workload burden from GPs. Part of this commitment was to support the growth of 1,500 more pharmacists, 1,000 physician associates and an extra 3,000 mental health therapists employed in general practice by 2020. The earlier chart showing a breakdown of staff includes an even greater variety of roles, further highlighting the drive to multidisciplinary working.
As well as this, the NHS Long Term Plan called for the creation of primary care networks (PCNs) – a key reason for which being to improve recruitment and retention of general practice staff. They also intend to allow more flexibility in primary care, through joined-up working across clusters of neighbouring GP practices and community teams. This expansion of neighbourhood teams included more allied health professionals, as well as new roles such as social prescribing link workers, who aim to help patients navigate support networks across community and voluntary services in their area. Based on our estimates, the most commonly employed staff by PCNs are pharmacists (2,206 full-time equivalents), social prescribing link workers (1,720) and physician associates (1,550).
As PCNs are brought more and more into the forefront of local system working, they will play a key role in primary care workforce strategy. Indeed, administering the Covid-19 vaccine through PCN footprints has accelerated this way of working, and further highlights the vital importance of multidisciplinary working and collaborating with local partners in general practice.
About the data
The introduction of PCNs as separate organisational entities to practices makes our attempts at describing the general practice workforce trickier, with PCNs most often listed as the employer for these support roles. NHS Digital has started to collect data on the PCN workforce, but as they have pointed out, the data submitted covers only around 50% of PCNs so far. Until the data is more complete, we have used the current data to estimate the potential size of the combined general practice and PCN workforce.
Rolewicz L (2021) “What does the GP workforce look like now?”, Nuffield Trust comment.