Influx of trainee GPs fails to halt general practice decline

As reported by Practice Index, despite an increase in trainee numbers, the availability of doctors in general practice continues to decline, raising concerns among primary care leaders about the impact on service and patients, prompting calls for immediate action

The NHS England data, released yesterday, confirmed fears raised by the Nuffield Trust that expanding trainee numbers is not proving a solution to the problems of general practice. Last month many trainees took up posts as fully qualified GPs while more than 10,000 doctors took up training posts – an increase of 1,500. The end result was a reduction in the hours available from doctors in general practice in August, the data shows. The total full-time equivalent GP workforce, including trainees, was 35,307, 26 fewer than in August 2022. There was a total reduction of 206 in the number of doctors working in general practice.

However, the influx of trainees led to a small increase in doctor numbers in general practice compared with July, of 73. It happened as practices undertook nearly two million more appointments in August compared with August 2022, according to NHS England data. In spite of the holiday season, practices also undertook 430,000 more appointments than in July – at 28.2 million.

Ruth Rankine, director of primary care at the NHS Confederation, said: “With increasing workloads and the number of GPs and general practices reducing, primary care leaders will be concerned about the toll these issues are having on the service as well as the patients they look after. While practice and workforce numbers continue to decline, and with a bleak winter ahead it is vital that the needs of primary care are considered as part of wider system planning and funding for winter.”

Dr Katie Bramall-Stainer, chair of the British Medical Association’s GP committee for England, said: “It is positive news to see a modest rise in GP numbers within the past month, likely reflecting the newly qualified colleagues who joined the profession on completion of their training each August. What must not be diminished, however, is how long they are retained, and our profound concerns regarding the longer-term trend in the number of fully qualified GPs massively declining in recent years. The truth is that we have thousands fewer fully qualified, full-time equivalent GPs today than we did 8 years ago, and unsurprisingly, our current workforce is subsequently stretched beyond capacity.”

Dr Victoria Tzortziou Brown, vice-chair of the Royal College of GPs, said: “These latest figures show, yet again, the worrying state of general practice. We are dealing with over 20% more appointments per month than in August 2019 – all with 883 fewer fully qualified, full-time GPs than in December 2019. The average number of patients per GP in England is now an overwhelming 2,279 – an increase equivalent to an extra 136 patients per GP since the end of 2019.

“Not only have GPs seen a substantial increase in their workloads – processing nearly five million more appointments than in August 2019 – we have also seen the nature of appointments become more complex. A growing number of patients now need care for multiple or chronic conditions, and many are presenting to GPs with concerns and conditions linked to the cost-of-living crisis. There is still hope that this situation can be turned around. We need to see immediate action that addresses the workforce and workload pressures within general practice.”