General practice
What are the trends in staff numbers working in general practice?
Most of the contact that people have with the NHS is with general practice: there are an estimated 300 million appointments each year. These services provide the first step in diagnosing and treating most patients’ health conditions.
Due to changes in the data, trends in general practice staff are limited to 2015 at the earliest. The data do not include staff working in prisons, army bases, educational establishments, specialist care centres including drug rehabilitation centres and walk-in centres. From July 2019, primary care networks (PCNs) will offer services to patients and employ new specialist staff such as clinical pharmacists, social prescribing link workers, physiotherapists, physician associates and paramedics. NHS Digital has started to publish information on the PCN workforce, but the data does not presently cover all PCNs. Based on the PCN data that is available, we have estimated the number of certain primary care staff groups employed by PCNs across England in some of the charts below.
Since 2016, the number of fully qualified GPs has fallen by 360. We would have expected levels to increase to be on course to deliver 6,000 more GPs by 2025.
About the target: The GP Forward View (2016) stated that GP staffing would be expanded to create an extra 5,000 doctors working in general practice by 2020. The Interim NHS People Plan (2019) then superseded this and called for 5,000 more GPs “as soon as possible”. The Conservative Party Manifesto has more recently committed to 6,000 more doctors in general practice by 2024/25. It is not clear whether GP registrars or locums are supposed to be counted, and whether the pledge relates to headcount or FTE.
GPs themselves make up only a minority of the total practice workforce. The total number of health professionals (excluding GPs) has increased by over 1,100 in the last year. When including non-clinical staff, numbers have increased by over 18,000 since 2016, reaching a total of 100,000 staff in December 2020. This exceeds the target set in the GP Forward View of 5,000 more staff working in general practice by 2020.
About the target: The GP Forward View (2016) called for 5,000 more staff working in general practice by 2020 and for 20,000 more health professionals (excluding GPs) by 2023/24. On top of this, the update to the 2020/21 GP contract stated that the recruitment scheme for general practice staff was expanding by 6,000, therefore aiming for 26,000 additional staff by the end of 2023/24. It was not clear whether the targets related to headcount or FTE.
Variation between regions in the number of GPs is long-standing. Though there have been efforts to fill these gaps through targeted recruitment schemes, differences still remain. When taking account of the relative needs of a CCG’s patient population, the number of patients per one GP as at June 2021 varied from 2,804 patients in Hull CCG to 1,318 patients in Wirral CCG.
Growing the number of physician associates and clinical pharmacists in general practice have been national priorities in recent years. As at December 2020, the number of clinical pharmacists has grown by a little over 1,300 since 2016 – below the level that was needed to meet the target. Over the same period, the number of physician associates has increased by only 360, which is well below the ambition of 1,000 more by the end of 2020.
Despite this, we recognise that both of these professions are likely to be registered to primary care networks as their place of work, rather than general practice. Using our estimates based on PCN workforce data, it appears as though the number of pharmacists has well exceeded its target. Conversely, we estimated that there were around 500 more physician associates employed in primary care in December 2020 than there were in 2016, which was still not enough to meet the 1,000 target.
About the target: Targets for 1,500 more pharmacists and 1,000 physician associates in primary care by 2020 were detailed in the GP Forward View (2016). It was not clear whether the targets related to headcount or FTE.
Social prescribing link workers were introduced to support individuals who feel socially isolated, with a particular focus on patients managing multiple long-term conditions. As at June 2021, there were an estimated 453 link workers in primary care in England.
About the target: The Mental Health Implementation Plan committed to 4,500 social prescribing link workers by 2023/24. It was not clear whether this target was intended to be measured using headcount or full-time equivalent staff.