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Understanding pressures in general practice

General practice is in crisis. Workload has increased substantially in recent years and has not been matched by growth in either funding or in workforce. A lack of
nationally available, real-time data means that this crisis has been until recently largely invisible to commissioners and policy-makers. Our report provides the most detailed analysis to date about how and why this crisis occurred.

Our analysis of 30 million patient contacts from 177 practices found that consultations grew by more than 15 per cent between 2010/11 and 2014/15. The number of face-to-face consultations grew by 13 per cent and telephone consultations by 63 per cent. Over the same period, the GP workforce grew by 4.75 per cent and the practice nurse workforce by 2.85 per cent. Funding for primary care as a share of the NHS overall budget fell every year in our five-year study period, from 8.3 per cent to just over 7.9 per cent.

Pressures on general practice are compounded by the fact that the work is becoming more complex and more intense. This is mainly because of the ageing population, increasing numbers of people with complex conditions, initiatives to move care from hospitals to the community, and rising public expectations. Surveys show that GPs in the NHS report finding their job more stressful than their counterparts in other countries.

Practices are finding it increasingly difficult to recruit and retain GPs. GPs reaching the end of their careers are choosing to retire early in response to workload
pressures. They have also been affected by changes to the tax treatment of pensions which create disincentives to work when the lifetime allowance for pensions has been reached.

Fewer GPs are choosing to undertake full-time clinical work with more opting for portfolio careers or working part-time. This is true for both male and female GPs. Trainee GPs are often planning to work on a salaried basis. This continues a longterm trend in which fewer doctors aspire to become partners in their practices.

There are challenges too with recruitment and retention of other members of the primary care team particularly practice nurses and practice managers. This makes it
difficult for some of the work of GPs to be taken on by other staff who are also in short supply.

As the pressures on general practice have grown, the experience for patients has deteriorated, albeit from high levels. The latest national GP patient survey found that 85 per cent of patients were able to get an appointment to see or speak to someone the last time they tried, down from 87 per cent two years previously. It also showed a reduction in the rating patients gave to their interactions with staff in GP practices.

Our findings point to a service that has traditionally been seen as the jewel in the crown of the NHS coming under growing pressure through a combination of factors. The Department of Health and NHS England have failed over a number of years to collect data that would have provided advance warning of the crisis now facing general practice. Action is urgently needed to reverse reductions in funding as a share of the NHS budget and to recruit and retain the workforce needed to meet rising patient demands.