Exclusive Around 6% of GP practices in England have been forced to make staff redundant, with a further 20% being unable to replace departing team members, a joint Pulse and Management in Practice survey has revealed.
Respondents to the survey, carried out in September and answered by 744 practices in England, said they are having to reduce staff – including GPs – as a result of the financial squeeze, and warned that patient care could be adversely affected as a result.
Pulse has reported on a number of practices that have had to make GPs and other staff redundant over the past couple of years, including 130 staff members in a large GP federation, and 80 potential redundancies in a large Plymouth practice.
These findings form part of the Cogora General Practice Workforce White Paper, launched in Parliament last week, which looks into how England is undergoing a crisis in GP unemployment at the same time as practices report a shortfall in GPs and other staff.
As we reported last week:
- 7% of the 399 salaried or locum GPs who responded to Pulse’s September survey said they were currently looking for work;
- The average time GP jobseekers have been searching is seven months, and they have reported finding an average of 2.47 appropriate roles in three months of looking;
- GP partners and practice managers, representing 640 practices in England, reported a 16% shortfall in the ideal number of GPs they would employ if recruitment wasn’t a problem – working out at around 5,300 across England;
- Almost half of 387 practice managers (45%) said the reason they haven’t been able to hire is due to funding, with 37% citing premises space;
- Practices in areas of higher deprivation and with larger non-white populations have fewer GPs per 1,000 patients than those in more affluent practices with a higher proportion of white patients.
The survey asked GPs and practice managers from 744 distinct practices in England: ‘Have you had to make any redundancies in the past 12 months?’ Around 6% answered ‘yes’, and 20% answered ‘No, but we deliberately didn’t replace departing staff’.
A GP partner in the West Midlands said: ‘We made the nurse associate role redundant and we have not been able to pick up the slack with any other roles.
‘We have had two salaried GPs leave and we now have two partners remaining – we used to be four partners in 2016. We have to offer one of the highest wages in our county to attract staff, which has meant personal losses for two consecutive years for us partners.’
They said that their ratio of staff expenses to contract income is 90%, which is ‘very high’, and with rising costs, they were unable to offer pay rises.
The GP partner added: ‘The employers’ National Insurance rises will mean some more of our staff may end up being made redundant or let go, which is a difficult decision if we want to carry on working as a GP surgery. It seems that instead of helping us attract partners, the Government’s decisions are punishing us for helping our patients.
‘We would ideally want to have two more full-time GPs, ideally partners, and one to two more nurses and a pharmacist. However, we are actually squeezed and worse than we were in 2016 in terms of numbers, equivalents and what we can offer.’
Another GP partner in Leicestershire said the practice is ‘always short of appointments’ and ‘patient demand is tremendous’. They added: However, purely for financial reasons and the fact that the practice is struggling to function at a profit, when our three-session salaried GP resigned we made the decision not to replace them. Instead, we decided to try to manage as best as we could without these sessions. This was in spite of the fact that when we advertised to recruit a replacement for another departing GP in the last year, we had more than 20 applicants, so would have had no difficulty finding a good-quality candidate to fill the sessions had we chosen to.
‘In addition to this, we have also chosen not to replace two reception staff members who left – again, in the hope to save money. I reiterate, not for profit, but hoping to break even.’
This is affecting patient care. One GP partner in Buckinghamshire said their practice had to ‘restructure [to] keep our doors open and allow us to continue to provide a service including not replacing all the clinical sessions a retiring GP used to offer. More GP sessions are being replaced by cheaper clinicians’.
In September last year, Pulse reported a large GP federation covering 540,000 patients has gone bust, resulting in 130 redundancies and ‘significant’ disruption to patient care.
Earlier in the year, we reported up to 80 members of staff at a Plymouth GP provider could lose their jobs following a redundancy process aimed at mitigating the financial effects of falling patient numbers.
In January last year, a practice in Surrey announced it was making three GPs redundant – pointing to ‘new ways of working’, including virtual appointments and the use of ARRS staff – but it recently announced it was re-hiring for a salaried GP. Documents obtained by Pulse had revealed that the GP partners had not taken drawings in the last year and that the practice was ‘running at a loss’.
You can find all the data and the methodology in the full report. Click here to download the full report
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If that “quarter of GP practices” that have “had to shrink team size” are also ones where the partners earn well above average, ie £150k – £250k, then this is highly material and crucial. Otherwise, it may be the case that some GP partners while publicly moaning to the press about not being able to get staff and about their “terrible workloads”, privately they are actually contented by their increased profits and by saving into pensions before it all goes broke…
I know at least 3 local practices whose team staffing has reduced since Covid but whose partner earnings have shot up (all 3 in inner-city and BAME patient areas)..
Being recently retired but still in touch with my younger friends who are locums and salaried, I make these points in support of them, some of whom have large mortgages, many who are p/t while juggling families, children etc..
The “I’m alright Jack” and “it’s all swings and roundabouts” attitude of some GP partners is cold comfort to them…
Additionally, some GP partners complaining of recruitment shortages decline to do sessions in their own GMS practices but then operate separate APMS contracts purely as a business for profit, immune from some of the pressures faced by private businesses.
In these businesses, the GP partners run their APMS contracts at vast profits, preferentially and intentionally avoiding recruiting GPs in my view to maximise the profit gains of the partners and use PCN ARR funds (much easier if some are also PCN CDs) .
All GPs, whether locum , partner , salaried and for that matter patients should be closely analysing the actions and motives of this group of GP partners with additional APMS contracts in my view and this APMS subgroup along with the PCN CD supported replacement (the degree of replacement has always been a choice) of GPs requires closer scrutiny.
Major cost of any business is paying staff.
If staff costs are rising and profits are falling then the simple fix is to cut back on staff. Look at Sainsburys and Morrisons.
Probably not a good long term answer to the problem but it may keep the business afloat a bit longer.
The solution might be to fund General Practice adequately.
@anthony.roberts, I agree with you that in practices, perhaps like yours, where hardworking GP partners earnings are falling well below average, say £120k, then sadly perhaps difficult decisions need to be made re staffing costs.
But what about practices where “enterprising” GP principals (eg those that Centregroundx2 indicates) are earning, say £180k, but decreasing their staff numbers (especially in recruiting salaried GPs or offering locum sessions) in order to increase their own profits? This happens. We only discover the truth of the situation if GP principals declare their interest in this debate by disclosing their ballpark profits.
I agree that after at least 14 years of the failed economics of austerity, we need huge increases in primary care funding, easily achievable through reasonable capital taxes (that even some rich people are demanding).
Calls for unity among GPs in the ongoing BMA negotiations are humbug. It seems all GPs are equal, but some are more equal than others.
Re Sainsbury’s, you know they’re a private company not part of the public sector. They can screw over who and what they like, for the profit they seek – that, in economic theory, is their law.
Support locums and salaried GPs.
The sad reality is that GP profits are down. The need for capital retention or servicing credit is up. Unless the GP contract is improved to recognise this simple fact then all GPs Partner, salaried, locum or reg loses out in addition to the hardworking non GP team members. A whole scale NHS provider salaried gp service will not make anyone’s lives better including our patients 😢