The number of doctors training to become GPs in England has grown vastly in recent years. In a little under a decade, the number of GP registrars in general practice nearly doubled from around 5,000 in September 2015 to 9,450 full-time equivalent (FTE) by June this year. This latter figure also equates to more than one GP registrar for every three fully qualified FTE GPs (of which there were around 28,300 in June this year). Despite this apparent significant investment in training GPs, there has been longstanding concern about the adequacy and sustainability of the GP training pipeline.
In response to growing anxiety around unemployed newly qualified GPs, in October last year the government took an emergency step by adding GPs who had completed training in the last two years to the Additional Roles Reimbursement Scheme (ARRS), which was initially designed to expand the wider general practice workforce. In this blog we reflect on the problem that this policy sought to fix, drawing on our recently published paper. We also look at claims that over 2,000 GPs had been recruited via this route by June, and reflect too on what the focus of the GP training pipeline should be.
What problem was the policy trying to fix?
Our recent academic paper, published in the Human Resources for Health journal as part of a special collection on the crisis of the primary care medical workforce in Europe, found that of the 14,000 or so doctors who left GP training in England between September 2018 and September 2023, only around a third (34%) were recorded as having taken up a permanent GP role in NHS general practices within six months – rising to over three in five (62%) within two years. And of those who did join the NHS, we estimated that they were employed at an average of two-thirds (67%) of a full-time contract (Figure 1).
Consequently, at that time – and pre-dating policy developments mentioned above – for every 10 doctors completing their final year of GP training in England, NHS general practices gained only around four FTE fully qualified GPs within two years.
In our academic paper, we used statistical modelling to unpick the effects of various factors, including time since leaving training, cohort-specific behavioural patterns, the period in which doctors entered the workforce, gender, and country of primary medical qualification.
Among other findings, our analysis revealed that male GPs and those who attended medical school outside the UK were less likely to join NHS general practice within two years of completing their training. The latter is particularly important given GP training posts have increasingly been filled by those who qualified as a doctor overseas – from just over one in four (27%) in 2012 to over half (55%) in 2024.
Are more newly qualified GPs being recruited?
Numbers of new GPs are trickier to be clear on, given the number of different datasets capturing similar but not entirely overlapping numbers of GPs. For instance, repeating the analysis that we originally set out in our paper would not capture individuals recruited via ARRS.
Since then, separate data from NHS England suggests that 2,068 additional salaried GPs were employed via this route up to June this year. This headcount number is not directly comparable to the data that accounts for levels of part-time working, with the former capturing anyone employed through the ARRS arrangement even if they have subsequently left, whereas the full-time equivalent figures are based on the number currently employed. However, the latest available data suggests there were 957 FTEs employed through ARRS as of May this year.
Data from a separate source – again not directly comparable – suggests that the net increase in fully qualified GPs over the period of the policy was 1,484 (or 762 full-time equivalents) (Figure 2). The number of GP partners and ad hoc locums fell, by 353 and 74 full-time equivalents respectively, between September last year and April this year. However, the number of salaried GPs grew by over 637. Due to known issues around delays in recording GPs through the National Workforce Reporting System, it is not possible to directly compare this number to the figure reporting recruitment through ARRS.
That said, the data does suggest a clear change in the trend in number of salaried GPs, with an average monthly growth of around 31 full-time equivalents between December 2022 and September 2024, compared to around 85 after ARRS was extended to include newly qualified GPs. We also estimate that the 2,068 new doctors equated to half (50%) of the doctors who had left training since September 2022 (broadly capturing those that completed training in the last two years) but were yet to appear in the data for GPs directly employed by general practices.
What next?
These figures indicate that, in a short space of time, ARRS has had a positive effect on recruiting new GPs to the workforce. However, the longer-term effects and unintended consequences of such measures are unclear, and this trend will require careful monitoring, alongside a deeper examination of the diverse career paths taken by doctors leaving GP training.
For this to happen, better information is needed. We have had to draw on three different sources of information to explore the effect of the ARRS policy on GP recruitment, and all three somewhat overlap in their definitions of which GPs are captured. Moreover, the primary analysis tracking newly qualified GPs into NHS practices does not capture those recruited through ARRS or working as ad hoc locums and in out-of-hours services (NHS 111, A&E streaming or NHS-commissioned digital providers). All of these datasets could and should be improved to ensure greater assurance over GP workforce capacity.
In our paper, we discuss several possible supply- and demand-side factors that contributed to a leaky pipeline. These range from the declining appeal of a profession perceived as increasingly demanding, to competition from emerging medical career opportunities and the increasing difficulty GP practices face in offering full contracts to newly qualified GPs.
While extending the ARRS policy has had an immediate impact on employment opportunities for new GPs, other important issues still need to be addressed – including a fairer distribution of GPs across the country, and providing sufficient support for the newly qualified GPs recruited through this route.
There is also a need for an open, wider discussion about the implications for employment models in general practice, given the ever-increasing employment and funding of staff through Primary Care Networks rather than directly by practices.
So, while there has been some progress, with a growing number of GP registrars now qualifying, further efforts are needed urgently to avoid defaulting back to the long-standing pattern of missed targets for increasing GP numbers.
Suggested citation
Rolewicz L, Palmer W and Russo G (2025) “What has the impact of ARRS been on recruiting new GPs?”, Nuffield Trust blog