Pressures in general practice

The NHS is currently experiencing some of the most severe pressures in its 70-year history.

GP surgeries across the country are experiencing significant and growing strain with rising demand, practices struggling to recruit staff, and patients having to wait longer for appointments.

An ageing population coupled with rising multimorbidity (people who have more than one chronic illness) means that GPs face an increasingly complex and intense workload. 

Alongside these long term trends, in recent months GP practices have been at the forefront of the NHS’s response to the COVID-19 outbreak.

Caring for more patients, with fewer GPs

• Over the past year and a half, the number of general practice appointments per month in England has increased overall.
• In January 2020, the monthly appointment count (27.8 million) increased by 15% compared to December 2019 (24.1 million) – an increase of 11% compared to December 2018 and January 2019 increase. There tends to be an increase in appointments between December and January due to the holiday season.
• 30,000 more appointments occurred in January 2020 than January 2019.
• The overall increase in appointments underestimates the increase in workload for GPs, who must also deal with a variety of other patient commitments.
• The number of FTE (full-time) GPs has not kept pace with this growing demand – despite the number of doctors entering GP training being higher than ever (with 3,538 training places accepted in 2019), the overall number of FTE qualified GPs has been decreasing since September 2015 (1,084 decrease).
• As of December 2019, there are 28,319 FTE GPs, a 1% (277) decrease from December 2018 and a 3% (871) decrease from December 2017. This is approximately the same amount as the 28,350 FTE GPs that were practising in September 2019.
• Whilst GP partner numbers are dropping, the number of salaried/sessional GPs (including locums and GP retainers) had increased over the period – this highlights the GP workforce shift toward more flexible working options to control workload and improve work-life balance.
• NHS England’s international GP recruitment programme set a target to recruit 2,000 overseas doctors by 2020; as of September 2019 only 140 doctors have been brought in through this programme.
• The Government has pledged to deliver an additional 50 million appointments annually – this means that between 2019 and 2020 there will need to be a 16% increase in the total number of appointments, instead of the 1.22% increase seen between 2018 and 2019.
• These commitments will be hard to meet without large increases in primary care workforce, otherwise they will just result in an even higher burden of work for primary care workers. The Government has also promised to deliver 6,000 more GPs by 2024-2025.

Other members of the practice team

• 45.4% of GP appointments occurred with a non-GP healthcare professional in England in January 2020 - this is a similar proportion to December 2019 (45.3%) and January 2019 (44.4%).
• The total number of direct patient care staff increased from 12,858 to 14,050 between December 2018 and December 2019 – this represents an 9.3% annual increase in staff. 

Longer wait for appointments

• In January 2020, 17.1% of patients waited longer than two weeks for an appointment – this is a 0.2% point decrease on December 2019.
• 54.1 million patients waited over 2 weeks between February 2019 and January 2020, compared to 47.6 million in the 2018/19 period.
• It is impossible to know from current data what proportion of patients are choosing to book later because the appointment is a pre-planned follow-up, scheduled review clinic, or a preference to see a particular clinician.
• However, the 2019 GP patient survey found that only 3.8% of respondents wanted an appointment with a week or more wait, and 57.2% of all patients saw or spoke to someone at a time they wanted or sooner (58.2% in 2018). 64.7% of patients were satisfied with the general practice appointment times that were available to them (65.9% in 2018).

Impact on GPs

• A recent BMA survey found that 79% of GPs are often or very often working beyond their regular hours – the highest of any branch of practice.

• Despite these pressures, the 2019 GP patient survey found that 95.5% of patients had trust in the last healthcare professional they saw at their GP practice, and more than 8 in 10 describe their GP practice as ‘very’ or ‘fairly’ good, a credit to GPs’ hard work and dedication.

Number of GP practices falling

• In February 2020, there were 6,813 GP practices open in England, a decrease of 180 compared to February 2019 – meaning more than three practices closed every week over that period (on average).
• Some of this reduction is due to smaller practices merging. However, many of these closures are also likely to be due to practices becoming unviable due to lack of staff, particularly a shortage of GP partners.

Spending on general practice has not kept pace

Budget share

The share of NHS budget invested in general practice (8.1% in 2018/19) remains significantly lower than in 2005/06, when 9.6% of the budget was allocated to general practice. The BMA’s GP committee has called for 11% of the NHS budget to be spent on general practice to reverse this trend and expand primary care.

Long Term Plan

The January 2019 NHS Long Term Plan committed to increase spending on primary and community health services, including general practice, by £4.5bn by 2023/24 and promised that spending on these services will increase faster than the overall NHS budget (predicted average annual real-terms increase of 3.1% between 2019/20 and 2023/24).

GP contract

The 2019 GP contract, used to implement the NHS long-term plan, specified that core contract funding would increase by £978 million by 2023/23, with some practices receiving funding worth £1.8bn by 2023/24 for additional staff. These changes correspond to a 22.6% real-terms increase in overall general practice funding between 2018/2019 and 2023/24.

Conservative manifesto

In their 2019 manifesto, the Conservatives pledged to increase the number of GPs by 6,000, the number of primary care professionals by 26,000, and the number of nurse associates by 7,500, as well as delivering 50 million extra GP appointments per year.