Reasons for GP unemployment highlighted at workforce report launch

PCN and GP leaders discussed the issues surrounding GP employment at the launch of a workforce white paper by Pulse PCN’s publisher, Cogora, in the House of Commons.

The white paper investigated the reasons behind a simultaneous recruitment and employment crisis in general practice.  

It states that a quarter of salaried GPs and locums are looking for a permanent role at the same time as practices are facing a shortfall in GP numbers .

It highlights a Bristol locum who reported having to take shifts in the Shetland Islands explaining that ‘For 20 years, I had been earning most of my income as a locum GP in Bristol. In March 2024, I noticed fewer vacancies being advertised in Bristol. I saw an agency advertising for vacancies in NHS Highlands. I’d previously worked for a week in Shetland – because I wanted to at that point, not because I needed to. But when I saw the role come up this time around, I felt like I had no other option.’ And sister title Pulse has reported on locums travelling several hours to shifts, including from Cumbria to Cornwall.

The General Practice Workforce White Paper called upon the government to remove restrictions from the additional roles reimbursement scheme (ARRS), as they ‘no longer make sense’.

‘When the ARRS was first introduced, there was some justification for limiting the roles PCNs could employ, to protect other areas of the NHS from having staff taken away,’ said the report.

‘The time has come to give general practice owners free rein on who they now employ. Everyone agrees a strong general practice is essential for the NHS to function. If this requires a shift in staff then so be it,’ it states.

It also highlighted the tensions the scheme has created in primary care such as pressures on estates, wage disparities between practice and ARRS staff, the effectiveness of ARRS staff in easing workload and the clinical appropriateness and safety associated with ARRS staff – a debate which has focused on physician associates.

The Cogora event, on Thursday 23 January,  was co-hosted by the Rebuild General Practice campaign and Labour MP and working GP Dr Simon Opher.

It was attended by the chairs of RCGP and the BMA’s GP Committee, Doctors Association UK (DAUK), the Institute of General Practice Management (IGPM) and several LMC leaders from around the country, many of whom significantly contributed to the white paper.

Clinical Director for Manchester City Centre and Ancoats PCN and deputy chair of the BMA’s GP Committee England (GPCE), Dr Samira Anana, said: ‘We welcome this report which is yet another stark example of the unemployment crisis facing General Practice.

‘These shocking results reinforce what many GPs are telling us – they cannot get any, or enough work and struggle to find employment when they qualify. This leaves us in the unforgivable situation where many patients are being denied the chance to see a GP, even though we have GPs wanting to work and care for them, and we have practices crying out to employ them but can’t, due to lack of funding.

‘A crucial challenge for this Government will be to find a way to keep the GPs we already have in the NHS, helping patients to see their family doctor in their practice.

‘We hope this is something that will be addressed and resolved during our negotiations with the Government on the latest GP contract.’

Editor-in-chief of sister title Pulse and report author, Jaimie Kaffash, said: ‘GPs and practices are stuck in a vicious cycle. Rising GP unemployment alongside underfunded practices means that practices are unable to recruit the vital workforce to meet growing patient demand. Fewer GPs and more unemployed GPs is leading to unmanageable workloads for GPs and a severe increase in the risk to patient safety.

‘At the same time, GPs struggling to find work are stuck in a bottleneck – where demand for long term secure GP contracts is high while availability of these jobs is low. At the heart of the issue is core funding. The profession needs to see real-terms increase in funding for general practice, to expanding practices and encouraging training in the profession.’

Dr Opher said: ‘As a GP, I understand the workforce resourcing desperately needed within the profession. As the Government, we must place a priority focus on general practice as the backbone of our NHS. General practice is the first point of patient care and therefore we must ensure that this foundation is well equipped, resourced and funded to meet our patients’ needs. I am committed to continue working with our Government to ensure we can address the gaps within general practice to ensure the profession is fit for the future.’

Rebuild General Practice representative Dr Rachel Warrington, a former GP partner from Bristol who now works as a locum in North Wales, told event attendees that she was the perfect example of a GP lost to general practice in England.

On the white paper, she said: ‘These findings reflect our day-in and day-out experiences as GPs. We desperately need more GPs within the system to meet this increasing patient demand, but we simply do not have the funding or the space in our local practices for recruiting GPs. This means our workloads have reached unsustainable and unsafe thresholds.

‘As GPs, our unwavering commitment remains focused on patient safety, which is why we are sounding the alarm for immediate change. We are urging the government to allocate fair, real-time funding to general practice and prioritise the retention of GPs.’

RCGP chair Professor Kamila Hawthorne said: ‘The troubling findings of this report sadly come as little surprise, and tally with what the College has heard from members.

‘Despite the frustration of both GPs and patients over long waiting times, practices are finding themselves unable to recruit the GPs they need, and GPs are reporting not being able to find appropriate work. This makes no sense. While there may be a range of reasons for this at practice-level, at the heart of this crisis is the chronic underfunding and poor workforce planning that have plagued general practice for decades. The efforts made to address this by freeing-up ARRS funding to employ GPs has been positive, but it is just a first step in resolving an endemic issue – and we agree with the recommendation in this report, that core funding that would allow practices to spend money in ways that best serve their local populations, should be increased.

‘As is often the case, this report also makes clear that patients living in deprived communities, and the practices working hard to care for them, are the hardest hit. On average, GPs in deprived areas are already responsible for 2,450 patients – over 300 more patients than GPs in more affluent areas – and this disparity will only intensify if employment difficulties persist and if our funding streams are not reviewed and more funding channelled to areas of greatest need.

‘We need to see the Government tackle the employment crisis in general practice head on. This not only means introducing measures to allow practices to recruit the GPs they need but placing a greater focus on retention, improving the situation for frontline GPs and supporting those who are working in areas of greater deprivation. It is simply unacceptable that practices are unable to recruit the GPs they need when so many patients are crying out for our services.’

Download our General Practice Workforce White Paper here.