The GP workforce paradox: more trained GPs, fewer in NHS general practice

Successive governments have pledged to expand the number of GPs in England. On paper, they have succeeded: the number of doctors licensed to practise as a GP has steadily increased over the past decade. However, new research published in the BMJ reveals a troubling disconnect – more GPs are being trained, but proportionally fewer are working in NHS general practice. 

This growing gap raises urgent questions about the sustainability of the primary care workforce and the government’s ability to shift care from hospitals into the community, as proposed in the 10-year plan.

What the data show

The study compared national datasets, including the General Medical Council (GMC) Register, the GP Performers’ List and NHS workforce data. It found that between 2015 and 2024, the proportion of licensed GPs not working in NHS general practice rose from 27% to 34% by headcount; and from 41% to 52% by full-time-equivalent hours (FTE). Over this period, on average, for every five additional licensed GPs, NHS general practice only gained one GP by headcount and, in fact, lost one GP by reported FTE hours. As a result, despite a shortage of GPs in NHS general practice, by the end of 2024 nearly 20,000 licensed GPs were not working in NHS general practice. This rose to over 30,000 when adjusted for reported FTE hours, although the study highlights FTE figures are likely to underestimate true working hours in NHS general practice.

With the total cost to train a GP estimated at £430,540 in 2022, the authors indicate this represents a loss of £8.6bn by headcount and up to £13.1bn by FTE, although the figures will be less for the UK after adjusting for international medical graduates. However, these figures do not include GPs who have left the workforce entirely and relinquished their licence before retirement, meaning the true scale of attrition is likely to be even greater.

The gaps between GMC-registered GPs and those working in NHS general practice were not evenly distributed. They were largest among women; younger GPs; and UK-trained GPs in absolute numbers, but in relative terms among international medical graduates. Regionally, the discrepancies were most pronounced in London, which also had the worst patient-to-GP ratio in NHS general practice at 2,496 patients per FTE GP.

What are GPs doing instead?

Maintaining a GMC licence requires annual fees, regular clinical work and revalidation every 5 years, so these GPs must be engaged in some form of clinical practice. However, despite the scale of the issue, there are no publicly available data on what these licensed GPs are doing instead.

Around 4% of GMC-licensed GPs are not on the Performers’ List, suggesting they may be working privately or – if trained both as a GP and specialist – may be working as a hospital specialist. Most, however, are on the GP Performers’ List, meaning they are eligible to work as a GP in the NHS – in general practice or elsewhere in the NHS. Some may work in settings not captured in NHS general practice workforce data, like prisons or walk-in centres, or be pursuing ‘portfolio careers’, combining clinical work with teaching, research, policy or leadership. Others may be on parental leave, sick leave or working part time.

What is driving the paradox?

The study does not explore reasons for leaving NHS general practice, but previous research points to workload pressures and GPs feeling unable to provide care to the standard they would like. UK GPs report some of the highest levels of stress and intention to leave among doctors internationally.  

The findings are particularly concerning for younger GPs, who appear less likely to enter or remain full-time in NHS general practice. Recently there have been reports of GP unemployment, attributed to misaligned financial incentives and limited job opportunities. The 2025 GMC Workplace experiences report found GP trainees were the most likely of all doctors to cite a lack of jobs as a barrier to career progression.

While the gap is larger for women, the rate of change is faster for men – suggesting widespread dissatisfaction. However, women more frequently face challenges balancing work with caring responsibilities, contributing to part-time working patterns and the gender pay gap. Tackling these challenges is vital to retain a workforce that is increasingly made up of women.

International medical graduates now make up over half of GP trainees, however, the study found they are less likely than UK graduates to work in NHS general practice. They also often face visa restrictions, find it harder to pass GP exams and end up working in the most challenging of settings. This raises important questions about the ethics of international recruitment and the inequities international graduates face. Regional variations in GPs per head highlights potential geographical disparities in patient access, shown to be most marked in the most deprived areas.

What are the implications?

The NHS is not losing GPs because they are not being trained, it is losing them because they are not staying or are reducing their hours. Addressing this shift is essential to building resilient, equitable and effective primary care. Expanding the skill mix, with roles such as pharmacists and social prescribers, and using technology such as AI, may ease pressures. But it will not replace the need for GPs – particularly given the growing expectations of what primary care should deliver. 

Understanding the drivers of the GP workforce paradox and implementing policies to aid GP retention must be central to the NHS Workforce Plan. Increasing GP trainees alone will not solve the problem, and risks wasting investment if they do not want to work in NHS general practice once qualified.