Skip to main content

Shortage of general practitioners in the NHS

In an article published in the British Medical Journal, I discuss the implications of the current shortage of NHS general practitioners. Ensuring that countries have sufficient primary care doctors is a key challenge for health planners globally because of the important role that primary care plays in supporting cost-effective health systems that promote equity in health outcomes. For example, the USA is predicted to need 7,800 to 32,000 additional primary care physicians by 2025.[1] We also know that the National Health Service (NHS) in the United Kingdom is short of general practitioners.[2] What we do not know is the size of the shortage; and how many additional general practitioners the NHS needs to provide comprehensive primary care services.

In its plan for general practice published in 2016, NHS England set a target of 5,000 additional general practitioners by 2020.[3] However, no data was presented to show that this was a sufficient number to meet the needs of primary care in England. Research presented at the Royal College of General Practitioners 2016 Annual Conference concluded that NHS England had substantially under-estimated the current shortage of general practitioners and how many new general practitioners would be needed to address future health needs in primary care. According to this analysis, in 2016 the NHS in England was already around 6,500 general practitioners below the ideal number, rising to 12,100 short by 2020.[4] Given that recruitment to general practice training schemes in England remains below target, shortages of general practitioners will continue in the foreseeable future. What can the NHS do to provide comprehensive primary care services in this era of permanent shortages of general practitioners?

One key issue in workforce planning is the lack of accurate and timely data on workload in primary care; and the lack of accurate information on the number of general practitioners working in the NHS.[5] The NHS does not routinely collect or publish information of the workload of general practices (in stark contrast to hospital activity, where workload statistics are published regularly). Information on the number of general practitioners working in the NHS is also limited and does not fully take into account what proportion of their time general practitioners spend on direct clinical care as opposed to time spent on administrative tasks; or time spent in management roles either inside or outside their general practices. Improving the statistics of the number of general practitioners working in the NHS and their workload would be a useful start. However, it will not by itself address the shortage of general practitioners. That requires more radical solutions than the NHS is currently considering.

The most important step will be to link primary care funding to workload through the implementation of workload-based funding for general practices. Since the NHS was established in 1948, capitation-based payments have been the core method of finding NHS general practice.[6] However, capitation increasingly looks like a 20th century model of funding and one that is not fit for the 20th century. With activity-based funding, general practices would be paid for the work that they do. Any new work would only taken on by general practices if the funding for the work met the full costs of providing the service. Activity-based funding would also allow more rational decisions to be made about the transfer of work from secondary care to general practice; rather than the current situation in which work is often transferred from hospitals to general practices because there is little or no additional cost for the NHS in doing this.

One disadvantage for the NHS of activity-based finding is that this would be considerably more costly than the current method of funding. The government would then have a stark choice: fund NHS general practice entirely from taxation; part-fund it from taxation and allow general practices to charge patients to make up the difference; or scale back the services that general practices offer to fit in with the public funding that was available.[7] All these options are problematic but this an issue on which the government urgently needs to take a decision as the current situation not tenable.

The NHS can also examine the use of non-medical practitioners and to what extent work done by general practitioners can be carried out by groups such as nurses, physician assistants, healthcare assistants, pharmacists and physiotherapists. For example, programmes that allow patients to see physiotherapists directly without requiring a referral from a general practitioner can help reduce demands on general practices and provide an alternative, cost-effective care pathway for patients with musculoskeletal problems.[8] The NHS also needs to make more services fully accessible by patients without requiring a referral from a general practitioner – for example, exercise and weight reduction programmes, antenatal services, podiatry, termination of pregnancy services, and services for drugs and alcohol misuse.[9]

Another action that can be taken to improve the supply of general practitioners is reducing the administrative burden on them.[10] This requires a detailed review of all non-clinical tasks undertaken by general practitioners with the aim of removing as many as possible to free up more time for clinical work. An increasing administrative burden on physicians is a global phenomenon and something that increases stress among doctors. Hence, reducing the administrative burden on general practitioners, as well as releasing time that can be spent on clinical tasks, can also improve their morale and reduce their stress levels.

The NHS also needs to encourage doctors to return to clinical practice after career breaks. This is particularly important for women doctors who may have had career breaks for family reasons. Doctors are expensive to train and for the NHS not to have implemented effective initiatives to encourage their return to clinical work after career breaks is a waste of the public investment in their training. Other sectors – such as universities – have active programmes to encourage women to support women in returning to work and the NHS can learn from them. Key barriers to return to work include the very high indemnity payments that doctors now have to pay (particularly for out-of-hours work) and the poor child care support offered by the NHS to doctors with families. Finally, given that shortages of general practitioners will continue in the foreseeable future, they should be treated by the NHS as a scarce resource and be deployed in a manner that makes full use of their skills and training; with caps on the amount of work they are expected to carry out. In parallel, measures must be taken to remove barriers to recruitment and retention, while we put the systems in place to measure, track, and ultimately fix this threat to the sustainability of the health service.

1. Dall T, Chakrabarti R, Iacobucci W, Hansari A, West T. The Complexities of Physician Supply and Demand: Projections from 2015 to 2030. Association of American Medical Colleges. Washington, DC, USA, 2017.
2. Majeed A. Primary care: a fading jewel in the NHS crown. London Journal of Primary Care; 2015: 7: 89-91.
3. Department of Health. General Practice Forward View.
4. Hayhoe B, Majeed A, Hamlyn M, Sinha M. Primary care workforce crisis: how many more GPs do we need? RCGP Annual Conference, Harrogate, 2016.
5. King’s Fund. Understanding the pressures in general practice. London, 2016.
6. Rhys G, Beerstecher HJ, Morgan CL. Primary care capitation payments in the UK. An observational study. BMC Health Serv Res. 2010;10:156.
7. Iacobucci G. GPs urge BMA to explore copayments for some services. BMJ 2017;357:j2503.
8. Salisbury C, Montgomery AA, Hollinghurst S, Hopper C, Bishop A, Franchini A, Kaur S, Coast J, Hall J, Grove S, Foster NE. Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial. BMJ. 2013 Jan 29;346:f43.
9. Greenfield G, Foley K, Majeed A. Rethinking primary care's gatekeeper role. BMJ: British Medical Journal (Online). 2016 Sep 23;354.
10. Erickson SM, Rockwern B, Koltov M, McLean RM, for the Medical Practice and Quality Committee of the American College of Physicians. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Ann Intern Med. 2017;166:659-661. doi: 10.7326/M16-2697



With majority of newly qualified GPs preferring not to be bound by contracts and management pressures to meet the "targets", with majority of Doctors (not public) aware of the fact that the health secretary has given himself a clean chit from any consequences of imposing the health and social care bill 2012, it should blatantly obvious that this government is not serious about improving the healthcare of the British public. The statement from Prof Stephen Hawkings last week only adds fuel to the fire. With imposition of new contract, junior doctors are completely demoralised. While doctors are leaving NHS or switching to locum by 100s a day, Jeremy hunt is still working on numbers from 2010. He is a disaster for the future of this country. Regardless of what "experts" have to say, I can see the inevitable privatisation of the NHS befor next general election. When people voted for Tories in 2017 elections, that was the death sentence to NHS signed in person. Time to start preparing the funeral cort├Ęge. Soon general public will realise the value of NHS; by then, It is too little too late. Hunt will be counting his notes in America by then.

Popular posts from this blog

Improving discharge planning in NHS hospitals

Factors that need to be considered in discharge planning that have been identified in previous projects include:

Ensuring that discharge arrangements are discussed with patients, family members and carers; and that they are given a copy of the discharge summary.Adequate coordination between the hospital, community health services, general practices, and the providers of social care services.There is a follow-up after discharge of patients at high risk of complications or readmission - either in person or by telephone - to ensure that the discharge arrangements are working well. Medicines reconciliation is carried out. This is the process of verifying patient medication lists at a point-of-care transition, such as hospital discharge, to identify which medications have been added, discontinued, or changed from pre-admission medication lists.Ensuring that any outstanding test results at discharge are obtained and passed on to primary care teams; and ensuring there are clear arrangements …

What will Brexit mean for the NHS?

On the 29 March 2017, the Prime Minister of the UK Theresa May, formally notified the European Union (EU) Council President, Donald Tusk, of the UK’s intention to leave the EU. Theresa May’s letter to Donald Tusk triggers a two-year process during which the UK will have to negotiate both the terms of its exit from EU and the arrangements that will replace those we have had for over 40 years with the other member states of the EU. The consequences of the United Kingdom’s departure from the EU (commonly referred to as ‘Brexit’) will be wide-ranging and will affect all areas of UK’s society, including the National Health Service (NHS).

For the NHS, Brexit comes at a time when it faces many other major challenges. These include severe financial pressures, rising workload, increased waiting times for both primary care and specialist services, and shortages of health professionals in many key areas (such as in general practice and in emergency departments). The NHS also faces challenges fr…

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.60 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…