The ‘supply’ of GPs in England has shrunk by almost 3% since 2015, partly driven by male GPs reducing the number of hours they work, a study has found.
Research by the University of Manchester, funded by the Health Foundation, looked at GP practice data from 2015 to 2022 to explore ‘associations between GP supply and practice-level demand’.
They found that overall GP supply decreased by 2.7% as a result of GPs reducing the time they are contracted to work, leading to a ‘massive rise’ in patients per full-time equivalent GP.
Over that period, the average number of FTEs per fully-qualified GP fell from 0.8 to 0.69, which was ‘mainly’ due to a reduction of contracted time among male GPs rather than female GPs.
Alongside this drop in GP supply, the researchers found a 9% increase in registered patients per FTE GP, and the increase was ‘steeper’ – at 32% – when assessing the numbers of chronic conditions with QOF disease register data.
They predicted that in 2022 there were 2,478 patients per FTE GP, compared with 2,271 in 2015.
The study, published today in the British Journal of General Practice, also adjusted for deprivation and concluded that ‘persistent deprivation gradients in GP supply highlight the need to recruit and retain GPs more equitably’.
Practices in the most deprived decile had 17% more patients and 19% more chronic conditions per GP FTE when compared with the least deprived decile.
The study also used the number of patients aged 65 and over as a metric for patient demand, with the number increasing by 12% across England during the study window.
However, the researchers found that there were more older patients per FTE GP in the least deprived areas, while practices in the most deprived decile saw a 25% drop.
When adjusted for region, the study showed that all regions have more chronic conditions per GP FTE than London, which it claimed is an ‘outlier with the lowest level of demand’.
The researchers concluded: ‘The findings of this study showed that GP supply has decreased over time during the study period 2015–2022 as a result of both a reduction in the average time that GPs are contracted to work and an increase in the number of practice population or patients with the number of chronic conditions.’
They suggested that policies are needed to ‘incentivise GPs to work more hours’ – particularly among male GPs – since the reduction in average FTE over time was the ‘largest contributor to the overall decrease in supply’.
‘However, this is arguably a systemic problem, with GPs very likely unwilling or unable to face the intense, day-to-day pressures in UK primary care,’ the study warned.
As well as policies which encourage GPs to work more hours, the study also argued that the Government needs to reduce GP workload and incentivise GPs to work and remain in deprived areas.
Overall, the data covered the FTE of over 300,000 GPs between 2015 and 2022, and almost 6,800 English GP practices per year.
Distribution of contracted FTE for each fully qualified GP
| All GPs – median | Male GPs – median | Female GPs – median | |
| 2015 | 0.80 | 0.99 | 0.67 |
| 2022 | 0.69 | 0.85 | 0.66 |
Lead author Dr Rosa Parisi said that the ‘year-on-year reduction’ in total working hours by GPs is ‘down to early retirement, high levels of GP turnover and low retention, insufficient number of newly trained GPs joining the workforce, and lack of overseas recruitment’.
Of their finding that the reduction contractual hours was most pronounced among male GPs, she said: ‘We’re not entirely sure why male GPs are reducing their hours, but policies are desperately needed to incentivise them to work longer.’
Senior author Professor Evan Kontopantelis, professor of data science at the University of Manchester, said: ‘In 2015 and 2019, the Government promised 5,000 more GPs by 2020 and an additional 6,000 GPs by 2024, respectively.
‘Though there was a rise in GP headcount of 5.9%, specifically 2,154 GPs between 2015 and 2022, the promised increase has not happened. That is why the change in working patterns of GPs makes the challenges facing primary care even more acute.’
A study published earlier this year argued that the BMA definition for GP full-time working is ‘inappropriate’ when compared to the NHS standard of 37.5 hours per week.
The researchers argued that full-time working should be defined as six sessions per week in order to reflect the ‘current duration of sessions’.
All the government needs to do is redefine the term “full time equivalent”. If the number of hours that qualify as FTE is reduced the GP head count could be positively transformed over night. The temptation must be almost irresistible – think of the headlines. Think of the Daily Mail. Wow.
As AB says, Wow.
It is strange maths though, since a Partner contracted at 26 hours (the maximum possible), might cease being an FTE partner, doing 70 hours per week, and become a 9-session salaried doctor on FTE at 37.5 hours per week, and now only work 33.25 hours. There are very few other Practice Staff types who can understand the above sums, so I doubt the Government can , as we all know all Practice staff are much brighter than any Government !
So it’s NOT the large influx of part-time female GPs that’s to blame, it’s those pesky lazy remaining full-time male GPs going part-time, the selfish swines.
Glad we sorted that one out then.
Seriously though, if we dragged the portfolio-career GPs kicking and screaming away from the boardroom and back to the coal face, that would be a start.
And if governments are not prepared to make the job more palatable/survivable/rewarding, they will just have to train/import more part-time doctors.
My experience is that the new male GPs joining are often stipulating a maximum of 3 days, 6 sessions a week (they say too high pressure in the work to do 8-9 sessions) & then the older male partners are winding down to 3 days a week as they move towards retirement so I don’t think this is any surprise. Female hours have remained stable. This seems to suggest that current pressures mean that working 3 days a week is the chosen commitment for work life balance (alias survival) for both sexes.
If the government want male GPs to work longer hours again then they need to look at the work pressures that have driven this decision and seek to reverse them.
It seems fairly obvious that the workload, complexity and demand has pushed this as well as “portfolio careers”. Instead of maintaining GP as a desirable job in its core, many have spent the last 10-20 years pushing portfolio careers as a way to maintain worklife-balance. If only the same energy and zest was put in to ensuring GP work was well resourced and appropriately timetabled
If full or part time GPs want to work more hours who do I approach for funds to pay them?
I can’t believe there are still published peer reviewed ( presumably) studies that still think it appropriate to use age as a measurement of demand ! There is a massive difference in life expectancy across the country – in the most deprived areas demand for services increases 20 years before the most affluent and no doubt some of the ‘demand ‘ in the affluent areas will be dealt with by the private sector.
You get what you pay for. Put your money where your mouth is. They will come. The perverse incentive in the GMS contract where the more you seen and deal with , the less you get paid per patient contact is honestly ridiculous.
I still can’t understand how the number of hospital senior doctors has gone up 3 fold while GP numbers decreased over the last 20 years.
Don’t see the point or the purpose of this study open to critique of its aim, methodology, data collection tool, sampling etc. Anecdotal or empirical experience tells you the same. Time to start funding general practice and continuity of care for its common good. Abandon tired economic growth theory and switch to economic justice and redistributive theory…and abandon the crap materialistic GDP metric for newer proxies of welfare..
Bravo Dr Banner, just carry on, divide et impera! The government will be happy to see that even GPs hate each other, kicking and screaming all directions, so it will be easier to nail them. Clearly poor portfolio GPs stuck it in for you when they tried to do something and escape from the one-way-street of ‘more patients in less time for less money’ direction that partners and service managers set for them. Job satisfaction? To hell with the portfolio GP – the patient has to be satisfied (meaning patient does not write a complaint), who cares about the portfolio GP being satisfied? It is also curious that many of these portfolio GPs tend to be female. How come they cannot pick and choose whom they see while male doctors can (being worried about complaints re sexual harassment)? All female patients (well, 99%) insist to see a female GP with any innocent gynae (or other) problem. Why? Male GPs are not qualified to do the same job? Isn’t it a tax-payer funded system? So then why the discrimination and giving more work to women? Many portfolio GPs would go for the 37.5 hour week (paid fully as a full time job and with 24 patients per day max as in some more cultured oversees countries) and hopefully that would cut the poison from male partners too.