Primary Care
Over the last decade, the average list size of GP surgeries has grown from just over 7,000 patients to a hall-filling figure. For those wondering, that’s 10,000 patients per practice.1 Per doctor? A single, full-time GP is now responsible for an average 2,295 patients – 357 more than in September 2015.2
It’s no wonder that attracting and retaining primary care staff is proving so difficult. Certainly, recent analysis by the BMA shows the UK has fewer practising doctors per 1,000 people than many OECD EU nations.3 Most concerningly, this already unsustainable situation is projected to go from bad to worse.
In light of a growing ageing population, NHS England predicts a clinical shortfall of between 260,000-360,000 by 2036/37.4 While the Health Foundation notes that without “urgent, significant policy action”, current trends mean close to a quarter of GP posts needed to deliver pre-pandemic standards of care will be vacant by this same time.5
If we were forced to sum it up in one word, that word would be training. Or more specifically, a lack of people being trained.
For years now, the UK has been failing to train enough doctors and nurses, over a period of time when demand for care has been steadily increasing. It doesn’t take a medical degree to understand why this disconnect between supply and demand has become such a major issue.
With so many patients to care for, delivering that care becomes harder. GPs can’t spend as much time with patients, and often can’t provide care to the standard they would like to. This can turn what should be one of the most rewarding careers into a frustrating, sometimes nerve-wracking experience. One that inevitably leads to increasing rates of stress and burnout.
When people are placed under such pressure, it is only natural for them to look at alternatives.
Certainly, a GMC survey reports that GPs are the most likely to experience ‘deep discontent’ practising medicine in the UK.6 A fifth said they were very likely or fairly likely to move abroad in the next 12 months. Furthermore, a survey from Pulse similarly reported almost one in five GPs aged between 30 and 50 were looking to move abroad for better pay and conditions.7
This worrying trend extends to the future generation of clinicians. When the British Medical Journal polled more than 10,000 UK medical students, they found that 32.4% wanted to emigrate to practise medicine.8 Of the primary care clinicians who don’t plan to work overseas, many are taking early retirement or are moving over to roles in private healthcare settings.
It’s clear the supply-demand mismatch is fuelling an endless ‘doom loop’. Not enough doctors and nurses means more work for understaffed GP practices. This in turn leads to lower levels of job satisfaction and higher levels of staff attrition across all roles and departments.
This makes the standard of care that continues to be delivered in spite of the current crisis even more remarkable. General practice provided an incredible 356 million appointments in 2023, up 14% from 2019, and a continuing testament to the resilience and tireless dedication of general practice staff.9
But to answer the question posed at the top of this piece, the current trend cannot continue. We cannot expect GPs and practice teams to perform under current levels of pressure. The problems are clear, and the consequences of doing nothing threaten the sustainability of the health system.
Despite last year’s Long-Term Workforce Plan, some smart thinking is needed to improve things for those working on the frontline to deliver care in the here and now. This is where new solutions, and innovative thinking can help. In our next blog, we take a look at how the system can work towards improving clinical retention, and relieve some of the pressure on hard-working staff.