Experts were warning before the pandemic that chronic recruitment and retention issues had left primary care at breaking point.
The focus has largely been on the number of people going into hospital with COVID and those missing out on treatment as a result of backlogs – but GPs are also in crisis.
Sky News analysis has found that the number of fully qualified GPs has fallen in four out of five areas in England since March 2016, with the North experiencing some of the biggest drops. The figures are adjusted for GPs working part-time and job sharing.
There were 45 GPs per 100,000 patients in Blackburn with Darwen in March 2016. Five years later, that rate is now 27% lower, with 33 GPs per 100,000 patients.
We’ve had a rising rate of complaints from patients that they’re struggling to get access to the GP, and rising distress amongst the GPs that they are not able to fulfil all the demands on them.
This affects our economy as well as the health and well being of our population.
Dominic Harrison, Director of Public Health and Wellbeing at Blackburn with Darwen council.
In March 2021, North Cumbria had 24% fewer GPs than five years ago, going from 63 per 100,000 patients to 48.
These are the areas with the biggest drop in the rate of GPs between March 2016 and March 2021. The ratio of fully qualified GPs has fallen in four out of every five CCG areas in England.
The decrease has been greater than 10% in more than a third of places, with several of the worst-affected areas in the north of England.
And analysis of the current number of practitioners shows that the north is also home to several areas with the lowest number of GPs per 100,000 patients as of August.
Blackburn with Darwen is again among the worst-affected areas, with the second lowest rate in England…
…after NHS Hull CCG.
The East of England also has some of the lowest numbers, with Thurrock in Essex having the third lowest rate in the country.
“The shortage of GPs has both a huge impact on the remaining colleagues, whose workload increases, but crucially it has an effect on the care practices are able to offer,” Dr Krishna Kasaraneni, executive member of the British Medical Association’s (BMA) GP committee says.
The Patient: Sometimes I just feel like crying out for help, and there's just nobody there to help
Our analysis also reveals that more deprived areas generally have fewer GPs than wealthier ones and that gap has widened over time.
“Wherever you are in the country, it’s feeling very, very difficult for GPs at the moment,” Dr Kasaraneni says. But “there are significant challenges with areas of deprivation.”
“We tend to struggle to recruit GPs more because the workload there is significantly higher and more challenging.”
A study by the Health Foundation also concluded that general practice is under the most pressure in England’s poorest areas – where it is least equipped to make improvements.
“Initiatives to recruit and retain more GPs are necessary but not sufficient to level up general practice. Specific programmes are needed to ensure that additional GP capacity is directed to the areas of highest need,” the report says.
More appointments but fewer face to face
While the number of doctors is going down, Sky News has found the number of appointments is going up.
Between July and August there were 4% more GP sessions than in the same period in 2019.
“Workload in surgeries across the country is soaring, with an increase in demand from people living with a number of complex conditions, as well as mounting bureaucracy and a record backlog of patients” because of the pandemic, Dr Kasaraneni says.
Despite that, people are still hesitant to seek medical help, with the most recent GP People Survey showing 42% of those polled had avoided making an appointment in the past 12 months.
Although digital triage systems can help manage resources better by directing people to pharmacists, physiotherapists and nurses instead, they can still increase workloads for doctors.
“For some people digitalisation works really well,” Beccy Baird, senior fellow in health policy at the King’s Fund told Sky News.
“But there’s a lot of complex risk to be managed over the phone and it’s very intense for GPs. When the pandemic hit and digitalisation was mandated for everyone, there wasn’t enough support for GPs to do it well.”
GP recruitment and retention crisis
Before the pandemic, in February 2020 the government committed to recruiting 6,000 new GPs and a further 26,000 health professionals across NHS England by 2024.
But so far, numbers have been going down. There are two different ways of measuring the number of doctors. Both show a reduction.
A target “isn’t going to be enough”, Dr Kasaraneni says.
“We need better investment and infrastructure and we need some of the bureaucracy to be removed so we can spend more time looking after patients and clinical capacity.”
Less than 1% of the GPs in England is under the age of 30, compared to 23% who are over-55, Sky News has found.
“More younger doctors are choosing general practice,” Dr Kasaraneni says. “But this is not keeping up with the numbers of invaluably experienced GPs leaving at the other end.”
“It’s pretty clear we don’t have the number of GPs other countries do,” Ms Baird says. “We’re training more GPs than ever before, but what’s happening is we’re not keeping them.”
“Retention is the most significant problem across the whole country – particularly in more deprived areas,” Professor Marshall of the RCGP says.
“We’re seeing an increasing number of GPS that is only managing to cope by working part-time. And we’re seeing a growing number of GPS in their 50s and early 60s, who are retiring early as a consequence.”
“We need to keep on training, but we also need to make general practice attractive later in careers so that people feel able to work and not feel forced into retirement because the job is basically undoable.”
The GP: I cannot do any more than what I'm doing at the moment. It’s frustrating
Access is only part of the problem
“Both access and continuity of care are important,” Professor Marshall says.
If people have regular contact with their GP serious conditions are less likely to go undiagnosed and require hospital care.
But when patients struggle to see a family doctor they can seek emergency care in hospital, experts warn.
“Investing in Primary Care will actually decrease the burden for the whole of the NHS”, Dr Kasaraneni says.
The problems Primary Care is facing have “implications for the quality of patient care. They have implications for the mental health of GPs. And of course, they have implications for the wider NHS as well,” Professor Marshall says.
“When general practice struggles, the whole of the NHS struggles.”
Additional reporting: Inzamam Rashid and Mark Thompson
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