Struggling to get a GP appointment is a frustrating and sometimes worrying occurrence for patients across the UK. But what is happening behind the scenes that can make GP appointments difficult to come by?
Long story short, there is a GP shortage in the UK.
The GP to patient ratio across the UK has fallen to levels not seen since the 1960s. According to the World Health Organisation (WHO) statistics in 2019, the UK has 2.8 doctors per 1,000 population. This puts us well below the average EU country.
There are several reasons for the fall in GP numbers, from an aging and burnt out workforce to struggles with recruitment, and of course, the small issue of Brexit mixed with a global pandemic.
We’re going to break down the issues to better understand what is really going on.
Where are all the new doctors?
Being a doctor is a respected and rewarding career, so surely more new doctors are being trained each year?
Unfortunately, it’s not quite that simple.
There are increases in medical student spaces available across the country, with new medical schools in places like Lincoln and Kent. However, the number of students taking up those places has fallen.
The stats for GP training specifically resulting from those medical students are even less promising, with 1 in 3 specialty GP trained doctors not going on to work as an NHS GP.
The British Medical Association (BMA) reported concerns that it could take a decade for the new student places to result in qualified doctors on the ground. All in all, we could see a shortfall of 7,000 GPs by 2023.
If we don’t have enough new GP’s coming through, what’s happening with our current qualified NHS GP’s?
Increases in retirement and part-time working for GP’s
The number of GP’s is going down, but not training enough new doctors isn’t the only factor affecting the future and current availability of GP’s.
A lack of new GP’s coming into the profession means any increase in GP’s taking retirement will have a bigger impact on the shortage of doctors in practices. In the last decade, the number of GP’s taking early retirement has increased from 198 in 2007 to 721 in 2017.
Currently, 30% of GP’s and specialist registered doctors are over 55 meaning an inevitable drop in numbers due to retirement is coming down the line.
Overall, the number of fully qualified, permanent GP’s has dropped in the last 4 years. In England particularly, there has been a shift in working patterns with more GP’s choosing to work part-time.
The reasons behind these shifts in working patterns are a huge factor in the GP shortfall.
GP pressures and burnout during COVID-19
There’s no doubting that GP’s are working extremely hard. Caring for patients as best they can either via video or phone consultation, or in-person during the middle of a pandemic. Many are working late hours to keep up with demand for the stretched service.
They are also human beings with personal lives and emotional, mental and physical health of their own to take care of. Many GP’s are working part-time to try and balance their workload to avoid burnout and stress. However, this is not always possible.
A survey by the BMA done in April 2021 showed:
- Almost 50% of doctors are suffering from depression, anxiety, stress, or burnout.
- Around 60% are experiencing ‘higher than normal’ levels of fatigue.
- Nearly 30% have undertaken additional unpaid hours.
With statistics like these, it’s not hard to see why GP’s would consider reducing their hours or retiring early.
Brexit and foreign GP’s
There was a lot of fear and uncertainty around what Brexit would mean for EU doctors in the UK, who make up 9.7% of the medical workforce. Even now Britian has left the EU, there is much uncertainty about the effects of the visa changes for doctors coming to work in the UK.
One of the biggest problems could be the new criteria to meet a minimum pay cap of £30,000 per year. To put this into perspective, the starting salary for a foundation year 1 doctor was £27,146 in 2019/20.
This does not directly impact qualified GP’s but in the long-term, the loss of junior doctors who may then go on to specialise in general practice is not a good prospect.
What about doctors from outside the EU?
With 37% of UK doctors being trained abroad, over half of them in Asia, there is potential for more foreign GP’s to be recruited into the NHS. Thankfully the EEA visa cap, which saw over 1,500 doctor visa applications being rejected in 2017/18, has been lifted.
This means caps on immigration from outside the EU do not apply to doctors and nurses wanting to work in the UK.
As EU negotiations continue, it’s still unclear what the effects of Brexit will be on GP numbers. What is clear is the future of general practice must include the ongoing and enthusiastic recruitment of foreign GP’s.
Recruitment and retention
What can be done to help the UK’s GP shortage?
As you’ve seen, it’s a complex issue and we don’t have all the answers, but a focus on recruitment and retention of GP’s is certainly needed.
General practice care is resilient, but making sure GP’s (and all primary care staff) are valued and supported is key. The recruitment of more locum GP’s is also essential to help fill gaps and keep patients being seen.
Are you a GP, locum GP, or other primary care staff? Tell us what you think about the GP shortage in the comments.