GP numbers falling at fastest rate for 50 years

GP numbers falling at the fastest rate for 50 years

A recent investigation by the Nuffield Trust carried out on behalf of the BBC, found that in the UK, numbers of GPs are continuously falling, in the first sustained drop since the late 1960s.

Currently, there are 3,400 fewer GPs in the NHS than expected, with a real risk of the figure increasing to 7,000 within 5 years. In 2018 there were 60 GPs per 100,000 people, compared with 65 in 2014.[1] The Nuffield Trust’s director of strategy said of the results, ‘We think there are a number of reasons. There was a decrease in training places […] and not all those who go into training stay in the NHS once they’ve qualified.’[2] But that is not the whole picture. So, what is happening exactly?

Full time vs part-time

Today, there are around 1,600 fewer GPs working full time, compared to 2015.[3] With mounting pressures, more GPs are cutting their working hours: last year more than one third reduced their hours and two-thirds are considering this step this year. Male GPs aged between 30 and 40 years old are the most likely to consider reducing their working hours. A recent survey of over 1,000 GPs found that they explicitly blamed long hours and increasing workloads as a reason for stress, and a staggering two-thirds felt emotionally exhausted by their work. Overall one in three GPs felt that patient care had suffered due to these factors.[4]

More patients per doctor

It is not that these family doctors are not working hard. The average number of registered patients per GP is now 2,087.[5] 65% of all GPs work beyond their allocated hours every day, compared to 47% in 2018, with 17% feeling unable to cope with their daily workload, up from 11% last year. Now GPs are working an average 11-hour day and are seeing up to 60 patients in this time, double the number considered safe.[6] So, many of these doctors are working longer hours and more intensely, without an increase in their pay.

Surgeries closing

Then there are the GP surgery closures: 138 closed in 2018 compared to 18 closures in 2013, running at an all-time high and affecting around half a million patients.[7] Under resourcing and problems in recruiting, doctors were the main reasons for closure. Smaller surgeries serving less than 5,000 patients were the worst affected, representing 86% of all closures.

Early retirement

Finally, there are the retirements. The number of GPs retiring early is increasing: now two-thirds are retiring early, which is double the rate five years ago. This high figure is attributed to burn-out as well as the well-recognised problem with pensions.[8]

Pressure mounting: patients suffering

The pressure on the system caused by these statistics is clear. The country’s general population is ageing and demands on GP services is rising. It is difficult to make appointments, with waits of up to 7 weeks. The latest figures show that 5.8 million patients wait for at least 2 weeks, with 34.3% waiting at least 8 days. This year there has been an 18% overall increase in numbers waiting a full month.[9]

Chief executive of the Patient’s Association, Rachel Power said, ‘Patients will clearly suffer if the availability of GPs reduces further’.[10] Indeed, the waiting lists are only going to become longer and the stress on the remaining GPs will continue unless there is some slack built into the system. Professor Marshal, Chairman of the Royal College of GPs said, ‘It’s not surprising to see more GPs reducing […] the number of clinical hours they work. […] this flexibility […] makes the job sustainable, so that GPs and our teams can continue to deliver safe care to a million patients a day across the country’.[11]

Government taking appropriate action?

The Government has pledged to recruit 5,000 more GPs by 2020. However, over the last several years, the NHS has found it difficult to recruit young doctors to train as GPs, with as many as 1 in 10 training places lying empty.[12] To compound matters, it takes at the very least 3 years to train a junior doctor as a GP, so while in 2018 nearly 3500 GP training posts were taken up, the beneficial effects are not due to be felt for at least another 2-3 years.

A spokesman for the Department of Health and Social Care said, ‘GPs are the bedrock of the NHS. […] We’re backing primary and community care with an extra £4.5 billion by 2024 and are committed to […] giving GPs the support they need’.[13] So, there is reason to be cautiously optimistic about the future of general practice. Investment in technology and increased funding should help. However, the falling number of GPs needs to be addressed urgently: with a loss of skilled family doctors, patient care and training of new doctors suffer. Whereas, bolstering GP numbers will ultimately benefit not just primary care but the NHS as a whole.

Blog post written by Stephanie Prior, Head of Medical Negligence team

[1] https://trendsinmenshealth.com/how-can-we-halt-the-decline-in-gp-numbers/

[2] https://inews.co.uk/news/health/gp-numbers-training-doctors-nuffield-trust-540087

[3] https://www.independent.co.uk/voices/nhs-tory-conservative-government-boris-johnson-brexit-a9249076.html

[4] https://www.telegraph.co.uk/news/2019/12/18/one-third-gps-have-cut-hours-last-year-two-thirds-plan/

[5] http://www.pulsetoday.co.uk/news/all-news/number-of-registered-patients-per-gp-rises-to-almost-2100/20039037.article

[6] https://www.theguardian.com/society/2019/may/31/gp-surgery-closures-in-uk-hit-all-time-high-in-2018

[7] https://www.theguardian.com/society/2019/may/31/gp-surgery-closures-in-uk-hit-all-time-high-in-2018

[8] https://trendsinmenshealth.com/how-can-we-halt-the-decline-in-gp-numbers/

[9] https://www.telegraph.co.uk/news/2019/12/18/one-third-gps-have-cut-hours-last-year-two-thirds-plan/

[10] https://www.telegraph.co.uk/news/2019/12/18/one-third-gps-have-cut-hours-last-year-two-thirds-plan/

[11] https://www.telegraph.co.uk/news/2019/12/18/one-third-gps-have-cut-hours-last-year-two-thirds-plan/