The number of GPs in England has fallen every year since the government first pledged to increase the family doctor workforce by 5,000, a minister has admitted.
Denis Campbell www.theguardian.com
There were 29,364 full-time-equivalent GPs in post in September 2015, when the then health secretary, Jeremy Hunt, first promised to increase the total by 5,000 by 2020.
However, by September 2020 the number of family doctors had dropped to 27,939, a fall of 1,425, the health minister Maria Caulfield disclosed in a parliamentary answer. And it has fallen even further since then, to 27,920, she confirmed, citing NHS workforce data.
In the 2019 general election campaign, Boris Johnson replaced Hunt’s pledge with a new commitment to increase the number of GPs in England by 6,000 by 2024. However, Sajid Javid, the health secretary, admitted last November that this pledge was unlikely to be met because so many family doctors were retiring early.
Organisations representing GPs say their heavy workloads, rising expectations among patients, excess bureaucracy, a lack of other health professionals working alongside them in surgeries, and concern that overwork may lead to them making mistakes are prompting experienced family doctors to quit in order to improve their mental health and work-life balance.
The British Medical Association (BMA) said the figures Caulfield cited showed that the lack of doctors in general practice was “going from bad to worse for both GPs and patients”, and it warned that patients were paying the price in the form of long waits for an appointment.
“Despite repeated pledges from government to boost the workforce by thousands, it’s going completely the wrong way,” said Dr Kieran Sharrock, the deputy chair of the BMA’s GP committee. “As numbers fall, remaining GPs are forced to stretch themselves even more thinly, and this of course impacts access for patients and the safety of care provided.”
Dr Dan Poulter, the Conservative MP who tabled the question, said: “These figures are hugely worrying because they show that GP numbers in England have been falling, despite ministerial pledges to increase them.
“GPs’ relentless workloads are clearly a major factor here. Patients and the entire NHS desperately need more family doctors, in order to reduce waiting times and ensure people who are ill get care, and referral on to hospital if needed, as soon as possible.”
Although record numbers of young doctors are choosing to train as GPs, the persistently high rate of early retirement means moves to increase the workforce are faltering. Hunt has cited that as the key reason his pledge of 5,000 more family doctors was not fulfilled.
Poulter, a former health minister who works part-time as a psychiatrist in the NHS, urged the government to push through changes to help ease the pressure on GPs.
“As an immediate step, the pension penalties that see many GPs, hospital doctors and other healthcare professionals penalised simply for working should be scrapped to avoid many deciding that early retirement is the best option.
“In addition, as has been done successfully in Australia, incentives and relocation support packages need to be put in place to attract GPs to work in parts of the country where there are acute shortages.”
Prof Martin Marshall, the chair of the Royal College of GPs, said the Covid pandemic had exacerbated the existing “intense workloads and workforce pressures” that GPs face.
“GPs and our teams make the vast majority of NHS patient contacts, in turn alleviating pressures across the health service. But with the service buckling under staffing and resource pressures, workload is unsustainable, and this is leading to GPs burning out and leaving the profession earlier than planned,” he said.
“Good progress is being made recruiting more doctors into general practice but, if more GPs are leaving the profession than entering it, we’re fighting a losing battle.”
Marshall urged Javid to deliver as soon as possible on a separate government pledge to increase the number of pharmacists, physiotherapists, mental health therapists and other health professionals working in GP practices by 26,000 by 2024.
Sharrock said the growing population and workforce shortages meant that each GP in England was responsible for 300 (15%) more patients than they were in 2015.
The Department of Health and Social Care said Caulfield’s figures only related to fully qualified GPs, and that once trainees were included there were 1,672 more full-time-equivalent family doctors in December 2021 than December 2019.
A spokesperson said: “We are committed to growing the general practice workforce to ensure everyone receives the care they need and there has been an increase of more than 1,600 doctors in general practice over the past two years.
“To boost recruitment, we have increased the number of GP training places and in 2021/22 we saw the highest ever number of doctors accepting a place on GP training – a record-breaking 4,000 trainees, up from 2,671 in 2014.”