GPs at 'breaking point' in England's most deprived areas

GP practices are under growing strain, with Sky News analysis revealing a "vicious cycle" of workload pressures and recruitment shortfalls in England's most deprived neighbourhoods.

One in every five GP practices in England and Wales has closed since 2013, according to Sky News analysis of NHS data. Doctors are now warning that staff shortages are putting primary care provision at serious risk.

Those practices that remain open are increasingly stretched thin amid rising numbers of patients and falling numbers of GPs.

Nearly one in five GP practices have closed since 2013

“GPs are at breaking point,” says Dr Anita Raja, a GP in the West Midlands.

“We’re immensely understaffed. Partners are leaving their partnerships, practices are closing down. If it goes on the way it is, we will have no primary care anymore.”

Image: Dr Anita Raja, a general practitioner in the West Midlands, says GPs are at 'breaking point'

The number of patients per fully qualified GP has grown in two thirds of practices (66%) since 2015. Almost one in four (24%) have seen their patient-to-GP ratio increase by more than 50%.

As a result, GPs face a growing workload, with the number of attended appointments per GP rising by 21% between March 2019 and March 2023.

The British Medical Association recommends that GPs should see no more than 25 patients per day, and describes 35 appointments as the upper limit of “safe” care.

Over the whole of March, the local GP practices for more than three in five people living in England’s most deprived neighbourhoods (62%) saw over 25 patients per day on average, while the nearest practice of over a quarter (28%) saw more than 35 – almost twice the rate across England as a whole (16%).

The average GP is now responsible for 2,337 patients – up from 2,014 in 2015.

“When I was a young GP, it was considered normal to have a list size of about 1,700 to 1,800 patients,” says Professor Kamila Hawthorne, chair of the Royal College of GPs.

“We’re not seeing it slowing down and we’re not seeing it stopping and that is extremely worrying.”

Sky News analysis has found that the average local GP serving people living in the most deprived 10% of neighbourhoods is even more stretched, with 3,453 patients on their list.

“Those patients that they’re looking after in deprived areas also tend to be sicker,” says Prof Hawthorne.

“And this means that in an already overburdened picture, you’re getting a kind of double whammy in deprived areas.”

Using NHS data to adjust for these higher health needs, Sky News has found that the local GP for someone living in one of England’s most deprived areas has, on average, a 61% higher patient workload than the average local GP for residents of the country’s wealthiest areas.

Deprived areas have the busiest GPs

This gap has increased slightly since 2015, when it stood at 59%. That’s despite the government’s efforts to incentivise trainees to take up posts in under-served areas.

Launched in 2016, the Targeted Enhanced Recruitment Scheme offers trainees a one-off payment of £20,000 if they agree to spend three years working in an area struggling with recruitment shortfalls.

The fifth of practices with the highest patient-to-GP ratios in 2015 have seen significant improvements, with their ratios falling by 21% on average.

However, increases in other practices have meant that the overall impact has been small. The gap in average patients per GP between the busiest and least-busy GP practices has fallen from 4,523 to 4,345, a decline of just 4%.

Ethnic disparities, meanwhile, have grown. The local GP for an average person of South Asian background has 22% greater patient workload than that of the average white person, up from a 17% difference in 2015.

That’s true even if we account for other key factors, like rurality and deprivation. Among people living in the most deprived parts of Britain’s major cities, for instance, those of South Asian background on average have a GP with a 25% higher patient workload than those of a white background.

GPs serving people from minority backgrounds are particularly stretched

Practices with more patients per doctor tend to perform worse in the NHS’s annual quality survey. Those that came in the bottom 10% of the survey last year have an average of 3,245 patients per GP, compared to just 2,278 in the best-performing practices.

A record 3,497 English GPs quit general practice in the year to March, with overall GP numbers falling by 379.

Nearly 3,500 GPs quit last year, the highest on record

England’s missing GPs

During the 2019 general election campaign, the Conservative party promised they would recruit an extra 6,000 GPs by the end of 2024.

Since the election, the number of fully qualified GPs in England has risen by 486. Yet increasing rates of part-time work mean the number of full-time equivalent GPs has actually fallen by 514.

That has left GP practices increasingly reliant on trainees. As of April, trainees now account for 25% of all doctors in GP practices, up from 15% in 2017.

Health Secretary Steve Barclay has pointed to the rise in trainee numbers as evidence that the government is making progress on GP shortages. Speaking to MPs in May, Mr Barclay noted there were now “2,000 more doctors in general practice” than in 2010, a figure which includes trainees.

The problem for the health service is that few of those trainees are staying on to become fully qualified GPs.

“The recruitment is great, but retention is a huge issue,” says Dr Raja.

“The government hasn’t realised that what people are going to do now is get into GP recruitment schemes, get the Royal College exams from the UK and leave – because they are paying them much more abroad and they’re going to welcome them with better working hours and less patients per doctor.”

Between 2018 and 2019, the number of GP trainees working in English practices increased by 700.

While most of those beginning their training in 2019 would have finished last year, there has been no equivalent surge in the number of newly qualified GPs. In fact, the number joining the register aged under 35 fell slightly last year, from 798 to 758.

More trainees hasn't meant more GPs

“There’s a belief that you just need to train more, and you’ll get more at the end,” says Billy Palmer of the Nuffield Trust, a health think tank.

“Well, that’s not what’s happened in general practice. All the push at the moment is just to train more, but we don’t see any more joining.

“Are they going to the private sector? Are they going abroad? It might just be competition for GPs at the end of the pipeline, and the NHS losing out.”

Part of the problem may be rules around immigration, says the Nuffield Trust’s Lucina Rolewicz.

“GP training typically takes three years, and after that it’s typically too early to apply for leave to remain. And it’s quite hard for them to then find a practice that would act as a sponsor for their visa for those two years.”

In March, a members’ survey by the Royal College of GPs found that 30% of foreign trainees were considering not staying on as an NHS GP because of the difficulties surrounding the visa process.

‘It’s a vicious cycle’

“There’s also a question of once you’ve got that cohort joining, how do you get them to stay?” adds Mr Palmer.

In the year to March, 500 GPs aged under 35 quit general practice – more than one in every eight (12.9%), the highest rate on record.

More than one in eight newly-qualified GPs have quit in the past year

A survey by the Royal College of GPs last year found that 43% of GPs leaving the profession cited burnout or work-related stress as a factor in their decision.

“It’s a vicious cycle,” says Mr Palmer.

“If you’re in a workplace where they’re struggling to recruit fully qualified GPs, of course that puts pressure on other members of staff and makes it less desirable as a place to work.”

In the same survey, one in four active GPs (23%) reported being unable to cope with the stress of the job most days, while two in five (39%) said they were “likely” or “very likely” to quit within the next five years.

“You sometimes question why you’re doing this. I mean, do you want to do this for the rest of your life?” says Dr Raja.

“I’m in my late 30s now. I’ve spent my whole youth studying medicine. You almost feel obliged to keep going. Of course, you’ve got the option to emigrate. And that’s probably what most of us are looking at.

“It’s just so difficult, because I was trained here and I want to give this system my 100%. But the way things are, we do think about these things. It’s a broken system.”

News Related


Mythbusting the world of EVs: are today's lithium-ion batteries obsolescent?

Mythbusters Top Gear June 2023 I had a conversation recently with a senior Nissan engineer about solid state batteries, one of those buzzword new technologies that make you imagine the ... Read more »

Intervention needed to stop kidney disease overwhelming NHS, charity says

Man receiving dialysis The Government must do more to prevent kidney disease becoming a public health emergency amid mounting pressure on the NHS, a charity has said. Kidney Research UK ... Read more »

Senegal government suspends mobile internet access amid days of deadly clashes

Senegal’s government temporarily suspended mobile phone data on Sunday as the country reels from days of deadly clashes between police and supporters of opposition leader Ousmane Sonko. The ministry of ... Read more »

No point in food price measures without targeting small stores, Which? warns

Photograph: Amer Ghazzal/Shutterstock UK ministers’ efforts to reduce soaring food shopping bills “won’t touch the sides” without measures to make small grocery stores more affordable for low-income households, the chancellor ... Read more »

US banks could face 20% boost to capital requirements - WSJ

FILE PHOTO: A picture illustration shows U.S. 100 dollar bank notes (Reuters) – U.S. regulators are preparing to force large banks to shore up their financial footing, the Wall Street ... Read more »

Andy Murray turns to new coach in doubles specialist Jonny O’Mara

andy murray Andy Murray has added a new coach to his entourage ahead of the grasscourt swing with doubles specialist Jonny O’Mara. The 28-year-old was in Murray’s box at the ... Read more »

Two-year-old killed and 22 people injured in Putin's missile raid on Ukraine

A toddler was killed and 22 people injured during an air strike on a residential area of Dnipro in central Ukraine. The two-year-old is the latest of an estimated 500 ... Read more »

Jeans shopping is still a total nightmare

‘Jeans shopping is not fun. It’s a mission’ (iStock) Taking off yet another pair of jeans that simply wouldn’t fit, I was on the verge of tears. Under the harsh ... Read more »

Love Island can’t hide from its ugly past – what place does the series have in 2023?

Dani Dyer crying on ‘Love Island’ (ITV) Has Love Island finally given us the ick? As ITV2’s annual celebration of sun, skin and snogging returns, it’s a question many of ... Read more »

Prince Harry news – latest: Duke of Sussex finally gets his day in court for phone-hacking case

✕ Close Phone hacking: Duke of Sussex to be at centre of trial against tabloid newspaper publisher The Duke of Sussex is due to appear at the High Court as ... Read more »

Rishi Sunak to outline his vision to take world lead in policing AI threats when he meets Joe Biden

Rishi Sunak wants to launch a global AI watchdog and host international summit He will discuss the proposals with Joe Biden during talks at the White House  Rishi Sunak will ... Read more »

India train crash – latest: Services resume as most likely cause of deadly accident identified

LIVE – Updated at 05:41 Train services have along the tracks in Odisha which suffered India’s deadliest crash in more than two decades on Friday, as family members continued a ... Read more »

War brings urgency to fight for LGBT rights in Ukraine

Photograph: Valentyn Ogirenko/Reuters The Ukrainian MP Andrii Kozhemiakin is a wiry, conservative ex-spy who likes to emphasise his Christian faith and large family. He is also an unlikely new recruit ... Read more »

If I’d invested £1,000 in Lloyds shares in June 2018, here’s what I’d have now

Middle-aged white man pulling an aggrieved face while looking at a screen Lloyds Banking (LSE:LLOY) shares are arguably one of the most popular investments in the UK. The bank stock ... Read more »

Libraries should be ‘ringfenced and protected’, Malorie Blackman says

Photograph: Antonio Olmos/The Observer Libraries should be “ringfenced and protected” to ensure that all children have access to books, the author Malorie Blackman has said. “I lived in my local ... Read more »

Sex and The City's Kim Cattrall had 'NO CONTACT' with cast and filmed spinoff cameo in 'garage' after ugly public feud with Sarah Jessica Parker, reveals co-star Evan Handler

Kim Cattrall reportedly had ‘no contact with anybody’ in the cast while shooting her upcoming cameo in And Just Like That…, the Sex and The City spinoff. Her co-star Evan Handler, 62, ... Read more »

NHS plan to fix workforce crisis ‘will double number of medical school places for doctors’

Some 24,000 nurses and midwives would be trained by 2030, and there would be 2,000 more trainee GPs and thousands more dentists, under workforce plans being considered by the Government ... Read more »

Diablo 4's Race to World First may get its first winners later today

null Despite some players crashing out of early runs because of glitches and bugs, it looks like hardcore Diablo 4 players will be crossing the line to be one of ... Read more »

Thailand air force says U.S. has denied request to buy F-35 jets

FILE PHOTO: A F-35A fighter aircraft rolls on a tarmac at the Swiss Air Force base in Emmen BANGKOK (Reuters) – The United States has declined to sell its F-35 ... Read more »

Kate and William may be forced to ditch new approach to royal visits due to 'high demand'

The Prince and Princess of Wales may have to rethink their new modern approach to royal life as they “may not be able to stick” to it, a royal expert ... Read more »

DVLA to give update on health condition rules ‘within weeks’

The Government will do ‘whatever it takes’ including possible privatisation to improve the Driver and Vehicle Licensing Agency (DVLA) amid delays in processing driving licence applications, Transport Secretary Grant Shapps ... Read more »

Chillaxing at Chequers: how Boris Johnson used the PM’s country house

When Chequers was gifted to the nation a century ago, the intent was to allow prime ministers two days a week of relaxation in the Chiltern hills, because “the better ... Read more »

Mercedes W14 Formula 1 UPGRADES ‘leaked’ online ahead of Monaco Grand Prix

Formula 1 journalist Albert Fabrega has taken to social media to share a photo of the reported new sidepods on the Mercedes W14 ahead of the Monaco Grand Prix. The ... Read more »

Six managers left on Daniel Levy Tottenham manager short list after Arne Slot decision

Tottenham could turn to Julen Lopetegui or Roberto De Zerbi to be their next manager Tottenham chairman Daniel Levy can cross another name of his new manager short list after ... Read more »

Keen to up your fitness levels? These are the best workouts for beginners you can do

null If you’re looking for workouts for beginners, you might have scoured the web for home workouts or fitness classes to sign up too. Not sure where to begin? Take ... Read more »

Sergio Perez fears Monaco Grand Prix will be 'TRICKY'

Sergio Perez says this weekend’s Monaco Grand Prix may be slightly awkward due to potentially inclement weather conditions. Following an enforced three-week break due to the cancellation of last weekend’s ... Read more »

Labour would seek 'practical changes' to Brexit deal in first year in government, says Rachel Reeves

Rachel Reeves, the shadow chancellor, says Sir Keir Starmer would seize on a baked-in ‘review’ of the pact, scheduled for 2025 – Stefan Rousseau/PA Labour would open talks with Brussels ... Read more »

Ukrainians trying to convert to Judaism in Israel face Kafkaesque trials

THE AGPOV family with ITIM head Rabbi Seth Farber (L) after receiving Israeli citizenship at the Netanya Interior Ministry offices. The Zoom interview begins, and the smiling face of Yael ... Read more »

Suez traffic returns to normal after ship briefly stranded

Suez Canal authority has successfully refloated ship CAIRO (Reuters) – Tugboats refloated a large ship that had been stranded for several hours in the Suez Canal on Thursday, and sources ... Read more »

Chris Packham wins libel battle over 'tiger fraud' allegations

It comes after the TV star told the High Court in London he had been a "victim of a campaign of vile and relentless intimidation". Read more »
Kênh kiến thức kỹ năng, phát triển bản thân, hướng nghiệp, blog nhân sự