College calls for greater efforts to keep existing GPs in the profession delivering patient care

Publication date: 02 December 2018

Greater efforts must go into reducing GP workload in order to keep existing family doctors working in the profession, says the Royal College of GPs as its latest survey shines a light on the intense pressures in everyday general practice, and how this is impacting on GPs' career plans.

The survey of 1,094 GPs in England found:

  • 31 percent of GPs said they are unlikely to be working in general practice in five years with stress and retirement cited as the main reasons for this.
  • 5 percent of GPs* report that their practice is likely to close in the next year. These are not practices that are merging with others.
  • 37 percent of GPs* said that in the practice where they work, there are GP vacancies that have been open for more than three months. 

Efforts to retain the workforce need to replicate the 'excellent' work that has gone into increasing recruitment to general practice, which has seen more GPs in training than ever before, the College is saying.

It has also analysed the latest provisional workforce data from NHS Digital for September 2018, published last month, which showed an increase of 41 from September 2017**. However, looking back to September 2015 – the last set of workforce data before NHS England's GP Forward View was announced, with a pledge of 5,000 more GPs by 2020 – the total number has dropped by 460.

Taking the data at Clinical Commissioning Group-level, it has identified where in the country has seen the biggest increase in GP numbers – with one area seeing an extra 87 GPs since September 2015 – and where has seen the biggest decrease.

Areas with biggest increases in GP numbers between Sept 2015-Sept 2018:

  • NHS Liverpool CCG (87)
  • NHS Northern, Eastern and Western Devon CCG (67)
  • NHS Kernow CCG (54)
  • NHS Lambeth CCG (45)
  • NHS Gloucestershire CCG (41)

Areas with biggest decreases in GP numbers between Sept 2015-Sept 2018:

  • NHS Horsham and Mid Sussex CCG (-52)
  • NHS Walsall CCG (-33)
  • NHS Portsmouth CCG (-29)
  • NHS Hull CCG (-22)
  • NHS Thanet CCG (-19)

The College says that a primary factor in GPs leaving the workforce prematurely is excessive workload, which has risen substantially in recent years both in volume and complexity, yet the share of the NHS England budget general practice receives is less than it was a decade ago, and GP numbers are lower than they were three years ago.

Last month the College renewed its long-standing calls for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS.

The recent announcement that £3.5bn of the promised £20.5bn NHS uplift would be allocated for primary and community care shows a commitment to supporting healthcare services closer to home for patients. However, general practice currently receives 9.5%*** of the NHS England budget, and the College has called for assurances that general practice, specifically, will be a key recipient of this new funding.

It says 11% of the budget for general practice would enable:

  • Larger practice teams, which would enable GPs to spend more time than the standard 10-minute consultation with patients who need it.
  • A wider range of healthcare professionals to provide a wider range of clinical services in GP surgeries.
  • IT systems allowing more surgeries to use video consultations as part of a standard range of consultation options, and to enable joined-up care across the NHS. 
  • Modernised, fit-for-purpose surgeries as the 'hub' of the community
  • A bigger workforce, where more healthcare professionals will choose general practice as a career and are supported by better-funded training placements in the community.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "All GPs are overworked, many are stressed, and some are making themselves seriously ill working hours that are simply unsafe, for both themselves and their patients - it is making them want to leave the profession. It is forcing some GPs to hand back their keys and close their surgeries for good.

"This is having a serious impact on many of our patients, who are waiting longer and longer to secure a GP appointment. But it also means we don't have the time we need with patients – particularly the growing number living with multiple, complex conditions – so the standard 10-minute appointment is simply unfit for purpose. GPs often find ourselves fire-fighting by prioritising the urgent cases, whereas the strength of general practice is to prevent disease and identify conditions in the early stages, to avoid them becoming more serious – and costlier to the health service.

"About a third of the GPs we surveyed said they were unlikely to be working in general practice in five years' time. This is gravely concerning. We are talking about highly-trained, highly-skilled doctors, that the NHS is at risk of losing – some will retire, which is to be expected, but many are planning to leave earlier than they otherwise would have done because of stress and the intense pressures they face on a day to day basis, whilst simply trying to do their best for their patients.

"These GPs are the ones we need to be focussing our energy on – to make their working situation safer and more sustainable.

"NHS England and Health Education England have done excellent work, supported by the RCGP and others, to encourage more doctors to specialise in general practice and we now have more GPs in training than ever before. But GP specialty-training takes three years, and if as many GPs are leaving the profession as entering it, we are fighting an uphill battle, when realistically we need thousands more.

"We need to see this level of effort replicated in initiatives to retain GPs already in the profession, to reduce our escalating and often unnecessary workload, and to support GPs and our teams' own health and wellbeing.

"The RCGP is calling for general practice to receive 11% of the overall NHS budget as part of the forthcoming 10-year plan for the NHS. Investing in general practice is investing in the entire NHS. It is an investment in good patient care."

Further Information

*GPs who do not work only in out of hours services
**All practitioners, including GP registrars, retainers and locums
***Based on an RCGP estimate of GP funding as a percentage share of the NHS England budget. This estimate adjusts the data to account for dispensing fees and reimbursement of drugs and excludes social care spending.
ComRes interviewed 1,094 English GPs online and by telephone between 16 August – 26 September 2018. Data were weighted to be demographically representative of all English GPs. ComRes is a member of the British Polling Council and abides by its rules.

RCGP Press office: 020 3188 7633/7574/7575
Out of hours: 0203 188 7659
press@rcgp.org.uk

Notes to editor

The Royal College of General Practitioners is a network of more than 52,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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