NHS faces ‘tipping point’ in England where most appointments will not be with GPs

The NHS in England is heading towards a ‘tipping point’ where GPs will no longer provide the majority of appointments because their numbers are falling so rapidly.

That is the conclusion of an extensive new study which also shows that one in five practices has closed and that the number of patients each GP treats has increased enormously over the past ten years.

It is unrealistic to expect the declining number of full-time GPs to continue to carry out around half of all consultations as they do now, according to research published in the journal BMJ Open.

“The decline in the number of GPs making the same number of appointments per 1,000 patients appears unsustainable,” warn the researchers from University College London and the London School of Hygiene & Tropical Medicine (LSHTM). “Therefore, a tipping point is likely to occur in the near future, where the majority of appointments in English general practice are no longer made by GPs.”

If patients visited their GP less often, it would harm the quality and continuity of the care they receive, they added.

“Maintaining relational continuity of care will be harder to achieve if there is a shortage of GP appointments, and if patients have to see different clinicians for different problems, this is likely to impact on the quality of care,” said the team, led by Dr Luisa Pettigrew, a GP and researcher at LSHTM.

The findings paint a picture of GP practices becoming increasingly busy as more GPs move to part-time work, driven by increased demand for appointments and a much heavier workload as a result of Britain’s ageing and growing population.

They help explain why so many patients have had difficulty getting an appointment with their GP in recent years.

Practice nurses and other staff, such as pharmacists, physiotherapists and chaplains, play an increasingly important role in seeing patients, to reduce the workload of GPs and improve access.

The four authors analysed data collected by NHS England, the Office for Health Improvement and Disparities and the Care Quality Commission on the organisation, staffing levels and arrangements made by GP practices in England between 2013 and last year. They found that:

• Between 2013 and 2023, 1,625 GP practices closed, a decrease of 20% or 178 per year. This brought the total number down from 8,044 to 6,419.

• The average number of patients in each practice’s administration increased by 40% over the same period, or 291 per year, from 6,967 to 9,724.

• The total number of patients has grown from 56 million to 62.4 million.

• While the total number of GPs working in the NHS has increased, the number of GPs working full-time has fallen from 27,948 to 27,321, taking into account changes in working hours.

The analysis also found that the average number of GPs per 1,000 people in England has fallen from 0.53 to 0.45 – a fall of 15%. The fall is particularly striking among male GPs.

Prof Kamila Hawthorne, chair of the Royal College of GPs, said the findings showed the NHS needed to recruit more GPs and also do more to retain those already in the workforce. “Although GP workloads are increasing, both in volume and complexity, this has fallen to fewer GPs than five years ago,” she said.

“Over the past year, GPs and their teams made an average of 30 million appointments per month – (more than) 4 million more per month than in 2019 – while the number of fully qualified, full-time equivalent GPs fell by 601.”

A Department of Health and Social Care spokesman said: “The NHS is broken and these findings show how much general practice has been neglected. But this Government will fix it by shifting the focus of health care from the hospital to the community.”

Labour has pledged to tackle the twin crises of GP access patents and part-time GP working to help them cope with the pressures of work by hiring 1,000 extra GPs by the end of the year. It has also given GPs and practice staff a pay rise to persuade them to stay in the workforce.