Warning over GP appointments as number of doctors falls by more than one in seven in last decade

The number of General Practitioners per 1,000 patients has fallen by 15 per cent since 2013 as experts warn that doctors will soon no longer be providing the majority of appointments.

England faces a “tipping point in the near future”, where the majority of appointments in doctor surgeries are no longer delivered by GPs as the number of doctors diminishes, according to a new study, with other medics such as nurses taking on the work.

Experts found the number of GP practices in England has dropped by a fifth over the last decade at the same time as more patients join surgery lists.

And while the number of staff working in GP surgeries has risen during this period – such as administrators and non-doctor roles – the number of GPs per 1,000 patients has fallen.

The news comes after GPs voted to take collective strike action last month, meaning some could cap the number of appointments they do.

Writing in the BMJ Open journal, the research team from University College London and the London School of Hygiene and Tropical Medicine analysed NHS data together with figures from the Care Quality Commission.

They found the number of people registered with an NHS GP practice in England grew by 11 per cent from 56,042,361 to 62,418,295 between 2013 and 2023.

Meanwhile, the total number of GP practices in England fell from 8,044 to 6,419 over the same period – a 20 per cent drop.

The data showed GP lists are rising, with the average practice list size increasing by 40 per cent from 6,967 to 9,724 patients, equivalent to 291 more per year, researchers said.

The number of large practices with lists exceeding 20,000 patients also rose from 1 per cent (81) of practices in 2013 to 6 per cent (355) in 2023.

However, the research was unable to pinpoint how many practices closed for good or merged to become the “branch” of another practice.

The study found that while the total NHS general practice workforce grew 20 per cent from 2015 to 2022, the number of GPs per 1,000 patients fell by 15 per cent when accounting for the hours they worked and population growth.

Overall, the number of GPs working the equivalent of full-time fell from 27,948 to 27,321.

The data showed the average number of nurses in GP surgeries remained pretty stable between 2015 and 2022 but the average number of other roles, such as pharmacists, social prescribers and physician associates, rose by 67 per cent.

Admin roles also rose by 14 per cent over this period, making up over half of the NHS general practice workforce by September 2022.

Nevertheless, GPs continued to provide half of all appointments, while about 20 per cent were provided by nurses and a further 20 per cent by other patient care workers such as pharmacists, physician associates and social prescribers. For about 10 per cent of appointments, it was unclear who delivered these.

The researchers wrote: “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.”

Dr Luisa Pettigrew, lead author of the study, said the Government must prioritise retaining GPs.

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.”

A Department of Health and Social Care spokesman said it has committed to hiring an extra 1,000 GPs into the NHS by the end of this year and has announced a pay rise for GPs and practice staff.

It added it, “will ensure practices have the resources they need to offer patients the highest quality care and meet increased patient demand.”

The researchers said their study did not include all GP surgery work, such as managing correspondence, prescriptions and reviewing test results, while workforce data is unlikely to cover overtime, which is common in general practice.

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.

“Whilst GP workload is escalating, both in volume and complexity, this is falling to a smaller number of GPs than we had five years ago.”