The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments (3 September 2024)

Summary

This study describes trends in the organisational structure, workforce and recorded appointments by role in English general practice. Over the past decade the number of NHS general practices in England has shrunk by 20%, but patient list sizes have expanded by 40% to just under 10,000, on average, finds an analysis of three national primary care datasets, published in BMJ Open.

Content

While the total NHS general practice workforce grew 20% between 2015 and 2022, as a result of increases in admin staff and other practitioners, the number of GPs per 1000 patients fell by 15% over the same period, when accounting for working hours, the analysis shows.

Major structural and organisational changes have taken place in general practice in England over the past decade,but it’s difficult to get an overall picture because information about different aspects of general practice is dispersed across multiple datasets, explain the researchers.

They therefore combined information from different national data sources to describe changes in the organisational structure, workforce, and appointments provided by different types of staff in English general practice, and to consider the implication of these trends.

They drew on general practice data collected by NHS England, the Office for Health Improvement and Disparities, and the Care Quality Commission, covering periods of between 5 and 10 years from 2013 to 2023.

They found that the numbers of people registered with an NHS general practice in England grew by 11% from 56,042,361 to 62,418, 295 between 2013 and  2023. And the average proportion of patients aged 65 and over rose from just over 16% to 18%.

But the total number of practices fell from 8044 to 6419, equivalent to 178 fewer practices a year and an overall reduction of 20%, while the average practice list size increased by 40% from 6967 to 9724 patients, equivalent to 291 more a year.

The number of large practices with lists exceeding 20,000 patients also rose from 1% (81) of practices in 2013 to 6% (355) in 2023.

Between September 2015 and September 2022, the total number of qualified GPs working in NHS general practice in England rose from 34,474 to 36,492. But after taking working hours into account, the number of those working the equivalent of full time fell from 27,948 to 27,321.

The average number of GPs fell from 0.53 to 0.45 for every 1000 patients, representing a fall of 15%, with the fall significantly steeper among male GPs: 23% vs 4% of female GPs.

College London and the London School of Hygiene & Tropical Medicine (LSHTM). “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.”