General practice in England is at a tipping point. A recent study published in BMJ Open Journal highlights a startling reality: the number of GPs per 1,000 patients has fallen by 15% since 2013. As the number of GPs dwindles, other healthcare professionals are stepping in to fill the gap, but the consequences of this shift could be severe.
A System Under Pressure
For patients, this reduction in GP availability is not just a statistic—it’s a tangible problem felt in everyday life. GPs can no longer see as many patients, waiting times for appointments are growing, and the quality of care may be compromised when complex cases are handled by less experienced staff.
While it’s encouraging to see an increase in non-GP roles, such as pharmacists and physician associates, GPs provide a unique and essential service. No matter how competent, others cannot easily replicate their ability to manage complex conditions and provide continuity of care holistically.
The Tipping Point is Approaching
The study warns of an impending tipping point when GPs will no longer deliver the majority of appointments. This is a fundamental shift in the way primary care is provided in England. At first glance, the solution of increasing reliance on other healthcare professionals might seem logical. However, it’s not a sustainable replacement for GP-led care.
We need to ask ourselves: what will be lost if GPs no longer provide the majority of patient appointments? The answer lies in the depth of expertise that GPs bring. From managing long-term conditions to spotting the early signs of serious illness, GPs undergo extensive training to understand the complexities of healthcare in a way that other professionals do not. The thought of losing that crucial GP-patient relationship should concern us all.
Falling GP Numbers: A Symptom of a Bigger Crisis
The decline in GP numbers is symptomatic of a deeper crisis. The workload in general practice has ballooned, with GPs facing increased patient demands and the system itself. The average GP list size has grown by 40% over the last decade, yet the number of GPs has not kept pace. More patients are joining practice lists, but fewer doctors care for them.
This imbalance is unsustainable. GPs are burning out, leaving the profession earlier than ever, and the pressure to deliver high-quality care is mounting. The government’s promise to hire 1,000 extra GPs by the end of this year is a step in the right direction, but it doesn’t go far enough. Recruitment alone will not solve the problem—we must focus on retaining experienced GPs who are the backbone of primary care.
The Importance of Retention
Retaining GPs must be a top priority. Professor Kamila Hawthorne, chairwoman of the RCGP, rightly points out that while recruitment is necessary, retention is crucial. Losing experienced GPs is a devastating blow to general practice. These doctors mentor younger colleagues, manage complex cases, and provide stability to practices. Without them, the quality of care will inevitably suffer.
The reason GPs are leaving the profession is multifactorial: escalating workloads, increasing patient complexity, and inadequate support. The solution is not just about pay rises or promises of additional staff; it’s about creating an environment where GPs feel valued, supported, and able to provide the kind of care they are trained for.
Patient Safety and Public Trust
Introducing new roles, such as physician associates and social prescribers, is a welcome development, but it can lead to patient safety risks without adequate supervision. There has been a 67% increase in non-GP roles between 2015 and 2022. These professionals must work alongside GPs, not in place of them.
Public satisfaction with general practice is already at an all-time low. Patients are frustrated by long waits for appointments, and many feel they are not receiving the level of care they once did. If we allow GP numbers to continue falling, we risk eroding the trust that the public places in general practice—a trust that has been hard-earned over decades.
Conclusion: A Call to Action
The findings of this study are a stark reminder that general practice in England is in crisis. We must prioritise the retention of experienced GPs, reduce their pressures, and ensure that they can provide the comprehensive care that patients deserve. It’s time for the government to move beyond promises and deliver real solutions that will support GPs and protect the future of our primary care system.
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