NHS faces ‘tipping point’ in England where most appointments will not be with GPs

The NHS in England is heading towards a “tipping point” after which GPs will no longer provide the majority of appointments because their numbers are falling so fast.

That is the conclusion of an extensive piece of new research that also shows one in five surgeries has shut and the number of patients each family doctor looks after has soared over the last decade.

It is unrealistic to expect the diminishing number of GPs working full-time to continue providing about half of all consultations, as they do now, according to the study, which has been published in the journal BMJ Open.

“Falling GP numbers delivering the same number of appointments per 1,000 patients seems unsustainable,” warn the researchers from University 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.”

Patients seeing a GP less often would damage the quality and continuity – defined as regular contact with the same doctor – of the care they receive, they added.

“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,” say the team, led by Dr Luisa Pettigrew, a GP and research fellow at LSHTM.

The findings paint a picture of general practice becoming increasingly busy as a result of more GPs going part-time, amid the pressures caused by a relentless rise in demand for appointments and much heavier workloads owing to Britain’s ageing and growing population.

They help explain why so many patients have struggled in recent years to get an appointment with a family doctor from their practice.

Practice nurses and other staff such as pharmacists, physiotherapists and mental heath counsellors are playing an increasing role in seeing patients, to help ease GPs’ workloads and improve access.

The four authors analysed data collected by NHS England, the Office for Health Improvement and Disparities and Care Quality Commission about the organisation, workforce and appointments provided by GP practices in England between 2013 and last year. They found that:

• 1,625 GP surgeries closed between 2013 and 2023 – a fall of 20% or 178 a year – reducing the total number from 8,044 to 6,419.

• The average number of patients on each surgery’s books rose by 40% – or 291 a year – over the same period, from 6,967 to 9,724.

• Total patient numbers have grown from 56 million to 62.4 million.

• Although the overall number of GPs working in the NHS rose, after taking changes in working hours into account those working the equivalent of full-time fell from 27,948 to 27,321.

The analysis also found that the average number of GPs for every 1,000 people in England has fallen from 0.53 to 0.45 – a drop of 15%. That decline is particularly stark among male GPs.

Prof Kamila Hawthorne, the chair of the Royal College of GPs, said the findings shows that the NHS needs to recruit more GPs and also do more to retain ones already working. “While GP workload is escalating, both in volume and complexity, this is falling to a smaller number of GPs than we had five years ago,” she said.

“In the past year, GPs and their teams have delivered an average of 30m appointments a month – [more than] 4m more each month than in 2019 – while the number of fully qualified, full-time equivalent GPs has fallen by 601.”

A Department of Health and Social Care spokesperson said: “The NHS is broken and these findings show how much general practice has been neglected. But this government will fix it by shifting the focus of healthcare out of hospital and into the community.”

Labour has promised to tackle the dual crises of patents’ access to GP and family doctors’ going part-time to help them manage the pressures of the job by hiring an extra 1,000 GPs by the end of the year. It has also given family doctors and practice staff a pay rise to help persuade them to keep working.