GP practices need more GPs but can’t afford them, College warns

The Royal College of GPs is warning that decades of chronic underfunding have left GP practices struggling to increase their GPs numbers, even as patient numbers grow and need for GP care and services soars.

Over 8,200 GPs and GP Registrars have written to the Secretary of State for Health and Social Care, Wes Streeting, urging him to ensure that the forthcoming 10-year Workforce Plan commits to train, recruit and retain the GPs needed to deliver safe and timely care.

The letter calls for a commitment to additional ring-fenced funding for practices to hire the GPs they need, as well as a Primary Care Investment Standard that would ensure funding increases for the service year on year.

It comes as a survey of GP Practice Managers conducted by RCGP found 61% agree that their practice needs to expand their GP workforce over the next 12 months to meet patient health needs, but more than 90% of those cited that a lack of core funding in general practice prevented them from doing so.

One Practice Manager responding to the survey said: “We cannot afford to recruit any GPs. We desperately need more GPs and it’s difficult to work within safe working limits. Without additional funding there is nothing we can do to resolve the situation. In our area the issue used to [be a] lack of people, now we have people available and no money to recruit with.”

The survey also found that 83% of Practice Managers cited the increase in NI contributions in last year’s Budget as a driving factor in being unable to employ much-needed GPs. As such, the College has also warned the Chancellor, ahead of next week’s Budget, not to target GP partnerships for further tax rises.

RCGP Chair Professor Kamila Hawthorne said: “Whilst some of the financial burden of the NI rise was offset by an increase to core funding in the GP contract, this is money practices should have been able to spend on enhancing the care and services they provide for patients. GP partners should be exempted from tax hikes, not targeted for them. We hope the chancellor takes heed in the upcoming budget.”

A fully qualified, full-time GP in England is now responsible for approximately 2,241 patients on average, an increase of 304 patients, or 15.7%, per GP in ten years.

In the 12 months up until September this year, a record 386 million consultations were delivered in general practice - the equivalent of more than a million a day and over 80 million more than the number delivered in 2019.

Record numbers of GPs are set to complete their specialty training and enter the profession this year, with the College estimating that almost 50% more GPs will qualify in 2025 than in 2019.

However, GP Registrars – those currently undertaking GP specialty training – report concerns that they will not be able to find an appropriate role within the NHS upon qualification. In a recent College survey, that 66% of final year GP registrars who have looked for work found it difficult to find one. Of those who have been unable to find work, 70% said that there are not enough suitable jobs anywhere in the country, and, concerningly, 65% are considering leaving the UK to find work.

Over one in four of all GPs said that they have been looking for work in the past year but struggled to find a suitable vacancy.

Professor Hawthorne continued: "We have more GPs coming through than ever before - that should be brilliant news, but if they can't find work or the work they can find isn’t right for them, for example it would mean having to relocate their lives and families halfway across the country, then we still have a critical issue that is going to affect patients. We need more GPs, thousands more, but practices also need to be funded properly to hire them.

"We need to remove any barriers that are preventing GP practices from employing the GPs their community needs. We are hearing real concern from GPs across the profession that they can’t find appropriate roles or sufficient hours.  That’s why we’re calling for ring fenced funding for practices to hire newly qualified and underemployed GPs, to ensure that our new recruits are able to start seeing patients.”

The College’s letter urges the Government to lay out a clear route to the ‘many thousands more GPs’ that it has promised. It calls for the forthcoming 10-year Workforce Plan to:  

• Set out how many full-time equivalent additional GPs are needed to meet patient demand in the 10 Year Workforce Plan and publish annual progress updates.  
• Guarantee additional ring-fenced funding for practices to hire newly qualified and currently under/unemployed GPs at all career stages as practice-based GP.  
• Accelerate the planned expansion of GP training places set out in the 2023 LTWP, reaching 6,000 places earlier than the current 2031/32 target, and expand training capacity by increasing the number of GP trainers as well as providing the space in practice buildings needed to meet future demand.   
• Develop a National Retention Strategy for general practice with increased and ringfenced funding for GP retention efforts.  
• Commit to a Primary Care Investment Standard, with the Secretary of State and ICBs reporting annually on general practice funding, to ensure funding increases year on year.

Professor Hawthorne continues: “GP workload pressures are so pronounced that many of our members are telling us they are worried they can’t guarantee safe care when there aren’t enough GPs to keep up. The number of patients per GP is rising higher and higher, while our clinical work has become more complex with our ageing population - we don’t have the workforce to manage this safely or give the continuity of care that we know benefits patients. We urgently need more GPs on the frontline – and more than 8,200 GPs have written to the health secretary today urging him to use the forthcoming 10-year workforce plan to set out how he’s going to achieve this.

“At present, what we’re hearing is that GP practice finances are so tight that they can’t afford the GPs they need to keep up with demand. I heard from one GP whose practice couldn’t afford to replace a salaried GP, so she was stepping in and taking on more and more work, working completely unsafe hours to the point of burnout – this isn’t safe for the GP or her patients. We need time and headspace with patients to be able to listen, and to deliver safe care.

"GPs will always push themselves to do what’s best for our patients, but we can’t go on like this. We need the Government to provide real detail – including numbers - in the 10-year workforce plan on how we are to get the promised thousands more GPs on the frontline, delivering patient care. A plan without numbers isn’t a plan at all, and while the Government has made a number of promising commitments, we need a clear roadmap out of this crisis.”

View and sign the joint letter

Further information

The GP workforce gap: Survey evidence on GP employment (PDF file, 283 KB)

RCGP press office: 0203 188 7659
press@rcgp.org.uk

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 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.