Seeing a GP could become a thing of the past for most patients as staffing levels reach a ‘tipping point’, analysis has shown.
In the ‘near future’ patients will be more likely to have an appointment with other practice members– such as a nurse or controversial physician associates – a study found.
Doctors’ surgeries have fallen by a fifth over the last decade while patient numbers have leapt by 40 per cent.
But while overall practice staff levels has increased with demand, the number of GPs per 1,000 patients fell by 15 per cent.
Experts warned the trend will effectively end continuity of care, with often elderly patients instead forced to see less qualified staff, such as controversial physician associates or nurses.
Doctors’ surgeries have fallen by a fifth over the last decade while patient numbers have leapt by 40 per cent. Stock image
Researchers from University College London (UCL) and the London School of Hygiene and Tropical Medicine (LSHTM) analysed NHS data together with figures from other sources, including the regulator, the Care Quality Commission.
People registered with an NHS GP practice in England grew 11 per cent, rising from 56,042,361 to 62,418,295 between 2013 and 2023.
Meanwhile, the total number of GP practices fell from 8,044 to 6,419 over the same period – a 20 per cent drop.
The general practice workforce increased by 20 per cent but doctor numbers have not risen in line with population growth, with many now opting to go part time.
Overall, full-time GP numbers fell from 27,948 to 27,321, according to the findings published in the BMJ.
This means there are now 0.45 GPs per 1,000 patients, down from 0.53 a decade ago.
Researchers found GPs continue to provide half of all appointments while nurses accounted for about 20 per cent.
Other patient care workers such as pharmacists, physician associates and social prescribers carried out another 20 per cent while it was unclear who delivered the remaining 10 per cent.
The authors wrote: ‘Falling GP numbers delivering the same number of appointments (per 1,000 patients) seems unsustainable; therefore, there is likely to be a tipping point in the near future where the majority of appointments in English general practice are no longer delivered by GPs.
‘Maintaining relational continuity of care will be harder to achieve if there is a shortage of GP appointments and if patients need to see different clinicians for different problems, this will likely have implications for quality of care.’
Roles, such as pharmacists, social prescribers and physician associates, rose by 67 per cent between 2015 and 2022 as part of a drive to plug gaps in provision.
Admin jobs are up 14 per cent over this period, making up over half of the NHS general practice workforce by September 2022.
Large practices, with lists exceeding 20,000 patients, have also risen from 81 to 355, or from one to six per cent.
The study did not include all GP surgery work, such as managing correspondence, prescriptions and reviewing test results, while workforce data is unlikely to cover overtime, which is common in general practice.
GP leaders said in the past year, they have delivered an average of 30 million appointments per month – over 4 million more each month than in 2019.
This is despite the number of fully-qualified, full-time equivalent GPs having fallen by 601.
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said the findings make it ‘very clear’ more GPs are needed.
She said: ‘We need to recruit more, but crucially we need to retain more in the profession for longer, delivering patient care.
‘Whilst GP workload is escalating, both in volume and complexity, this is falling to a smaller number of GPs than we had five years ago.’
The British Medical Association has raised concerns over the role of physician associates, drawing up their own guidelines saying they should not be diagnosing patients.
A Department of Health and Social Care spokesman promised to ‘fix’ what it called ‘broken’ primary care, by shifting the focus of healthcare out of the hospital and into the community.
He said: ‘We have also committed to hiring an extra 1,000 GPs into the NHS by the end of this year, have announced a pay rise for GPs and practice staff and will ensure practices have the resources they need to offer patients the highest quality care and meet increased patient demand.’
