How can we halt the decline in GP numbers?

Panorama highlighted an analysis by the Nuffield Trust think tank for the BBC last night, which showed the number of GPs per 100 000 people has fallen from nearly 65 in 2014 to 60 last year.

The last time numbers fell like this was in the late 1960s, and it comes at a time when the population is ageing and demands on GPs are rising. Patient groups said the fall in GP numbers was causing real difficulties in making appointments.There have been reports of waits of up to seven weeks for a routine appointment, while those needing urgent appointments have been forced to queue outside practices in the early morning to guarantee to be seen.

The Nuffield Trust analysis looked at the number of GPs working in the NHS – both full and part-time – per 100 000 people across the UK. It shows that during the late 1960s the numbers were falling, before four decades of almost continuous growth. A peak of 66.5 was reached in 2009, before the increases tailed off, and there have now been four consecutive years of falls, with the biggest drops being seen in England.

The NHS has been struggling to attract junior doctors to become GPs for a number of years. At one point, as many as one in 10 training places were going unfilled. This has now been rectified – and the number of training places has increased. Last year, nearly 3500 GP trainee posts were taken up in England, up by 800 since 2014. This boost in numbers has yet to be fully felt as it takes at least three years to train a junior doctor to become a GP. What is more, one in three junior doctors who accept places on GP training courses drop out of the system, according to the Nuffield Trust.

Meanwhile, the numbers retiring early have been increasing (two-thirds of retirements by GPs come early – double the rate seen just five years ago) and this is partly due to burn-out, but also the pension issue. Dr Richard Vautrey, of the BMA, said workloads were now ‘unmanageable’ for many, with doctors being asked to work longer and harder, without recognition or an increase in pay.

With hospitals referring more patients back to primary care, the system is under now extreme strain. Of course, more support staff would help, but at the end of the day the patients like to see their own GP. However, it feels as though too little is being done too late. Do you agree? What are you thoughts on the fall in GP numbers? 

Comments (10) Add yours ↓
  1. Richard Cons Anaesthetist

    I’m not sure we can prevent the decline in GP numbers. I think we have to face the fact that practising medicine is no longer as satisfying and fulfilling as it once used to be. Despite the Government continuing to increase medical student places the sad fact is that increasing percentages of new doctors are not practising clinically within 5 years of qualification.
    Perhaps the solution lies not in increasing GP numbers but restructuring roles and responsibilities. This is complex, will involve writing multiple care pathways and could even entail legislation. The task to persuade the public that they don’t have a right to see a GP for “chats” and minor ailments is probably even more difficult especially politically.
    Radical thoughts perhaps but I believe the answer lies elsewhere.

    May 9, 2019 Reply
  2. Mike GP

    Hi
    I speak as a GP still going after 36 years.
    So many changes needed
    In short and in no particular order:

    Ditch appraisal and start again – monitor referral patterns and quality instead.
    Value GPs more
    Stop public naming and shaming
    Stop so many changes made each year
    Understand the multitude of day to day problems that we face
    Bring back direct payments for staff – they are usually underpaid and too few in number
    Support and value GP education. Don’t leave it to drug companies and private hospitals.
    Support and value GP research
    Stop assuming we have time to read, digest and respond to so many daily emails from all and sundry
    Recognise the issues around so many drugs being temporarily available
    Bring back seniority – why on earth did go? It sends the wrong message to take this carrot away and undervalues GPs that stay the course.

    That’s a start – fat chance I feel of any of the above actually happening

    May 11, 2019 Reply
  3. Jonny Coxon Dr

    We can only hope that the pendulum will start to swing back, which it so often seems to do when pressures become immense.
    At least recent contract negotiations and subsequent changes have been largely warmly received by Local Medical Committees and GPs on the ground. As ever, the proof there will be in the pudding.
    Much of the solution seems as though it will have to fall at the feet of allied professions coming in to support a population of GPs who do seem to be at breaking point.
    These next few years seem absolutely crucial…

    May 12, 2019 Reply
  4. Ahmad GP

    try abolishing the impossible task of delivering safe good care in 10 minutes consultation time in GP land ….that would improve retention.

    GP

    May 12, 2019 Reply
  5. Alan GP

    The problem of recruitment and retention has many aspects. Professional and government bodies are all aware of the problems which require a joined up approach. Part time working and portfolio careers may be a factor but the pension situation requires urgent action.
    Graduate entry and targeted incentivised recruitment schemes may help a little.
    A RCGP initiative in the last three years has aimed to support later career as well as retired GPs. Government support for later career GPs in practices to help retention needs to be more ambitious beyond facilitating changing work patterns, allowing job sharing and reducing practice on call.
    The UK and devolved governments should consider creating recruitment and retention czars to co-ordinate and champion all current intiatives to make general practice attractive again.

    May 13, 2019 Reply
  6. Julia Doc (GP)

    The increase in the use of ECPs, nurse practitioners, paramedics, VOWAS practitioners in the front line of Primary care has generated rather than reduced workload in general practice..GPs’ appointments are fully booked and between them we are doing telephone consultations, Tasks by the dozen, call-backs, and making numerous alterations and tweaking of things set in place by practitioners who have seen the acute cases…just as an example there seems to be a pandemic of ‘otitis externa’ and the makers of otomize must be laughing all the way to the bank!
    GPs’ appointments are taken up with patients with long term conditions, polypharmacy being just one!
    We are being de-skilled….minor surgery, contraceptive services, minor injuries, all out of our hands now.
    Admitting patients to hospital is another issue, the countryside is full of blue light ambulances dashing all over to pick up children with sneezing then heading to A+E and queueing outside for hours as there are no hospital beds, leaving any patient who needs admission form primary care to wait for literally up to 8 hours for an ambulance, by which time they are either deteriorating with a condition that could have had treatment started, or ended up with a lift from the 90 year old neighbour…meanwhile you might have been to see them again twice and eventually ‘upgrade’ the ambulance …
    Then of course there’s the Meetings you have to go to…Time in, Time out, CCG, etc. ..at least you can snooze during some of these…
    All in all General Practice as a job is losing its charm with many frustrations and unprecedented pressure.
    Hopefully the new recruits won’t mind all this turmoil and (like 3 yr olds with iPads) will be a different breed of GP already grown up with this evolving muddle.

    May 13, 2019 Reply
  7. Jon Rees GP

    Concur with all of the above – but, on a positive note… the new GP contract offers the opportunity to bring in new staff to help us with the currently impossible task of delivering primary care to our patients. We are just recruiting a ‘social prescriber’ – and last year employed our first clinical pharmacist, who has been superb. I am excited that we can grow our multi-disciplinary team ion primary care, and escape the old model that the beast majority of clinical work needs to be done by the GP’s. There are many things that our new colleagues will be far better at than us, and we can try to concentrate more on those areas of medicine where we are most needed.
    In the meantime, we have to keep going – I still firmly believe that UK primary care is absolutely vital to the future of the NHS and has a future! Let’s hope I’m right…

    May 14, 2019 Reply
  8. Roger Kirby Professor of Urology

    More than half a million UK patients had to change their GP practice last year as a result of their surgery going under or merging with another practice to cope with rising workloads, an investigation has found.
    At least 138 surgeries across the UK shut their doors in 2018, meaning 519,000 patients may have been displaced. This compares to 134 in 2017, and just 18 which were found to have closed in an equivalent investigation in 2013.
    GP leaders said that closures were typically a last resort, where the loss of other partners had left one doctor unable to recruit full-time staff and no way to maintain safe care. All rather worrying.

    May 31, 2019 Reply
  9. Roger Kirby Professor Roger Kirby

    The NHS is at risk of losing ‘large swathes of expertise from the NHS’s most experienced doctors at a time when the overstretched service needs it most’, a letter from BMA chair Dr Chaand Nagpaul to the prime minister warns.

    GPonline reported last month that one in three GPs had been forced to cut back on work or refuse shifts to avoid taxes that can mean they lose money for working more. The BMA has warned that even GPs in their 30s have been advised by accountants to reduce their working hours to avoid incurring annual allowance tax charges.

    June 11, 2019 Reply
  10. Roger Kirby Professor of Urology

    More than 50% of GPs are planning to stop practising before they hit retirement age, according to a new survey.

    A majority (53%) of the 940 GPs surveyed by Pulse said they will retire early due to reasons including issues with their pension, increasing workload and burnout.

    GPs also told Pulse that they would ‘like to’ retire before hitting their retirement age but feared they might not be able to afford to do so.

    July 10, 2019 Reply

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