New analysis published today by the Health Foundation’s REAL Centre warns that without urgent, significant policy action, the NHS in England is facing a crippling shortage of GPs and general practice nurses over the coming decade.
The REAL Centre’s projections show that the shortage of qualified, permanent GPs is set to get substantially worse over this decade. There is currently a shortage of around 4,200 full-time equivalent (FTE) GPs, which is projected to rise to around 8,900 FTE GPs in 2030/31, relative to the number needed to meet the rising need for care. This means that without a change to current workforce trends and policies, close to 1 in 4 of the 37,800 general practitioner posts needed to deliver pre-pandemic standards of care would be vacant. However, if an increasing number of GPs leave the profession due to burnout and if newer roles are not successfully integrated in multidisciplinary general practice teams, the projected shortfall could increase to 18,900 FTE GPs, or around half of posts being vacant, in 2030/31. See notes to editors for a breakdown of the figures.
Under any of the REAL Centre’s scenarios there would be a shortfall of GPs and general practice nurses in the decade ahead. However, the shortfall could be limited to around 1,200 GPs (around 3% of projected demand) by 2030/31 if government puts in place policies to improve recruitment and retention of family doctors and if more allied health professionals (such as pharmacists and physiotherapists) can be effectively integrated into primary care to reduce pressure on GPs and nurses. While the NHS plans to recruit 26,000 allied health professionals by 2023/24, the authors highlight that in the short term, the demands on GPs are likely to increase rather than decrease due to the increased supervision and management of these staff.
The researchers warn workforce shortfalls of this magnitude pose a significant risk to the quality of health care. GPs are the front door of the NHS – issuing over 1 billion prescriptions a year in England. The researchers also note that under current policy, an estimated shortfall of around 1,700 FTE in general practice nurse numbers in 2021/22 is projected to grow to around 6,400 FTE – close to 1 in 4 posts – by 2030/31, exacerbating the impact of GP shortages. In a more pessimistic scenario involving increasing nurse leaver rates and unsuccessful integration of newer roles, the projected shortfall rises to around 10,100 FTE nurses in general practice by 2030/31, close to 1 in 2 posts, again worsening the impact of GP shortages.
The REAL Centre’s projections highlight that the government is unlikely to reach its target of hiring 6,000 additional GPs by 2023/24 relative to 2018/19. Under current policy, the REAL Centre estimates that the overall number of GPs might be around 3,000 higher in 2023/24 than in 2018/19, but the number of qualified permanent GPs is projected to have fallen by around 500, so any overall increase will be attributable to higher numbers of GP trainees and locums.
Anita Charlesworth, Director of Research and the Health Foundation’s REAL Centre, said:
‘England’s GP services are under huge pressure. It’s sobering that over the next decade things are set to get worse, not better, with a growing shortage of GPs and practice nurses. While these issues are not unique to England, it is critical that government takes action to protect general practice and avoid it getting locked in a vicious cycle of rising workload driving staff to leave, in turn creating more pressure on remaining staff and fuelling even more departures. It must also be clear with the public that the way they access general practice will need to change.
‘There are steps the government can take to limit the size of the shortfall, but there are no quick fixes. General practice is vital for a high quality and efficient health system, but the pressures it faces are longstanding, significant, and growing. Action is urgently needed to retain existing GPs and practice nurses, and to ensure that sufficient numbers are trained for the future. Beyond this, there needs to be a comprehensive plan for the successful integration of allied health professionals in general practice teams and sufficient capital investment to ensure primary care has the buildings and equipment it needs for the future.’
Notes to editors
- The number of qualified permanent FTE GPs declined from around 27,900 to around 27,000 between December 2017 and December 2021. The REAL Centre’s projections suggest that in the ‘current policy’ scenario, this number will barely increase by 2030/31, leaving a shortfall of around 8,800 FTE GPs by 2030/31 (relative to projected demand of around 37,800 FTE GPs, see Table 1 below). In the optimistic scenario, the number of qualified permanent FTE GPs is projected to increase to around 33,200, leaving a shortfall of around 1,200 relative to projected demand (34,400). In the pessimistic scenario, the number of qualified permanent FTE GPs is projected to decline to around 20,800, leaving a shortfall of around 18,900 relative to projected demand (39,700).
- The REAL Centre also analysed projected numbers of nurses in primary care up to 2030/31. In the ‘current policy’ scenario, the number of FTE nurses in general practice is projected to decline by around 0.6% a year (from 16,600 in 2021/22) over the 9 years to 2030/31. Even in the optimistic scenario, we project only a slow increase in nurse supply in general practice from around 16,600 in 2021/22 to just over 17,000 by 2030/31. In the pessimistic scenario, our model projects that nurse supply in general practice will decline by just over a quarter (28%) to around 12,000 by 2030/31. This is driven primarily by current trends and our assumptions regarding increases in nurse leaver rates in this scenario.
- Shortages in general practice staff numbers are not unique to England. In 2021, the OECD noted that many member countries had taken steps to increase the number of training places in ‘general medicine’ to address concerns around GP shortages. (OECD 2021: Health at a Glance 2021: OECD Indicators. https://www.oecd-ilibrary.org/sites/aa9168f1-en/index.html?itemId=/content/component/aa9168f1-en)
07941 156 827
Note: The first version of this press release published on 20 July 2022 contained an error affecting the GP projections. This has now been corrected, and an updated version was published on 25 July 2022.
Table 1: FTE demand and supply estimates and projections for qualified permanent GPs in England, 2021/22–2030/31
|Current policy scenario||Optimistic scenario||Pessimistic scenario|
|GP demand||GP supply||GP demand||GP supply||GP demand||GP supply|
Note: The numbers in the table are rounded and refer to FTE qualified permanent GPs (ie all GPs excluding GPs in training and locum GPs); 2021/22 GP supply data are for March 2022 (source: NHS Digital). The shortfall is calculated as the difference between GP supply and demand. Due to rounding, the shortfall estimates presented in the table do not all align precisely with the differences between GP supply and demand in the corresponding cells.