Most Future NHS Appointments Won’t Be With GPs, Study Says

A doctor checking a patient's blood pressure at the Temple Fortune Health Centre GP Practice near Golders Green, London, England, on July 29, 2024. Anthony Devlin/PA Wire

England faces a “tipping point in the near future” when the majority of appointments in doctors’ surgeries are no longer delivered by GPs, according to a new study.

It found the number of GP practices in England has dropped by a fifth over the last decade at the same time as population growth is resulting in more people registering with surgeries.

Academics from University College London and the London School of Hygiene and Tropical Medicine analysed NHS data together with figures from other sources, including the Care Quality Commission, which regulates practices.

Writing in the BMJ Open journal, the team found that although the number of people working in practices has risen over the past 10 years, these staff are in administrative and other roles—such as physician associate—while the number of GPs per 1,000 patients has fallen.

Expanding Role of Physician Associates

Concerns have been raised, including by the British Medical Association, over the expanding role of physician associates, with the union saying they should not be diagnosing patients.

The number of people registered with an NHS GP practice in England grew by 11 percent from 56,042,361 to 62,418,295 between 2013 and 2023. At the same time, the total number of doctors’ surgeries fell by a fifth, from 8,044 to 6,419.

The data showed GP lists are rising, with the average practice list size increasing by 40 percent, from 6,967 to 9,724 patients, researchers said.

The number of large practices with lists exceeding 20,000 patients also rose from 1 percent (81) of practices in 2013 to 6 percent (355) in 2023. The research did not pinpoint how many practices either merged into larger ones or closed for good.

Overall, the number of GPs working the equivalent of full-time fell from 27,948 to 27,321, with the number of GPs per 1,000 patients falling by 15 percent when accounting for hours worked and population growth.

Steep Decline in Male GPs

Although overall there are now more GPs than there were 10 years ago, the average number of GPs fell from 0.53 to 0.45 for every 1,000 patients, representing a 15 percent drop. The fall was significantly steeper among male GPs (23 percent compared to 4 percent of female GPs.)

The data showed that while the average number of nurses in surgeries remained reasonably stable between 2015 and 2022, the average number of other roles, including pharmacists, social prescribers, and physician associates, rose by 67 percent.

Meanwhile, administrative roles rose by 14 percent, making up over half of the state-run general practice workforce by September 2022.

GPs continued to provide half of all appointments, while about one fifth were with a nurse and another fifth with other patient care workers such as pharmacists, physician associates, and social prescribers, while it was unclear in about 10 percent of cases who the appointment was with.

The study found: “Falling GP numbers delivering the same number of appointments (per 1,000 patients) seems unsustainable; therefore, there is likely to be a tipping point in the near future where the majority of appointments in English general practice are no longer delivered by GPs.

“Maintaining relational continuity of care will be harder to achieve if there is a shortage of GP appointments and if patients need to see different clinicians for different problems, this will likely have implications for quality of care.”

‘A State of Transition’

Dr. Luisa Pettigrew, lead author of the study and a GP and research fellow at the London School of Hygiene and Tropical Medicine, said the government must prioritise retaining GPs.

“While the headcount of GPs in NHS general practice has marginally increased, when you factor in reported working hours and the growing population, the total number of full-time equivalent GPs per 1,000 patients working in NHS general practice has fallen,” she said.

“General practice in England appears to be in a period of transition, from the smaller partnership-based model of general practice to that of larger organisations with more administrative and multidisciplinary staff but fewer GPs.

“However, patients are struggling to get appointments; concerns have been raised regarding the safety of introducing new roles without adequate supervision; and we are now facing the lowest ever levels of public satisfaction with general practice recorded.”

The government has pledged to “fix” general practice by shifting the focus of health care out of the hospital and into the community.

A Department of Health and Social Care statement said, “We have committed to hiring an extra 1,000 GPs into the NHS by the end of this year, have announced a pay rise for GPs and practice staff and will ensure practices have the resources they need to offer patients the highest quality care and meet increased patient demand.”

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said, “The findings of this study make it very clear that we need many more GPs—we need to recruit more, but crucially we need to retain more in the profession for longer, delivering patient care.”

She added: “We work in multi-disciplinary teams, and whilst our excellent nursing staff and other members of the wider team, such as pharmacists and physiotherapists, are highly valued, these roles aren’t substitutes for GPs and mustn’t be used to plug gaps in the workforce.”

PA Media contributed to this report.