A recent study published in The BMJ has unveiled an alarming trend within England’s NHS general practice workforce, revealing that despite increased patient demand and governmental pledges to fortify primary care, approximately one in three General Practitioners (GPs) licensed to practice in England are currently not working within the NHS general practice framework. This research, drawing from multiple national data sources and conducted using robust observational methods, highlights a growing disparity in the distribution and retention of GPs, underscoring profound implications for primary care capacity and the broader NHS system.
The dynamics of the NHS workforce have shifted dramatically over the past decade. From 2015 to 2024, data indicates an incremental rise in the number of GPs licensed by the General Medical Council (GMC); however, this growth has been counterbalanced by a significant attrition of full-time equivalent (FTE) GPs actively working within NHS general practice. For every five additional licensed GPs, roughly one full-time equivalent GP leaves the workforce each year. This pattern signals not only a stagnation but a net loss in primary care capacity, posing a critical threat to the sustainability of NHS general practice services.
Concurrently, the patient load per GP has experienced a stark increase. Since 2015, the average number of patients assigned to each full-time equivalent general practice GP has risen by 15%, reflecting intensifying pressures on already stretched primary healthcare professionals. By the end of 2024, this metric revealed a striking imbalance: the patient-to-GP ratio nearly doubled compared to the patient-to-consultant ratio in secondary care, underscoring a disproportionate demand being placed on primary care relative to specialist services.
This workforce disequilibrium is further exacerbated by demographic and geographic disparities. The study elucidates that attrition rates vary considerably among different GP subgroups. Younger, female GPs and those qualified within the UK are disproportionately represented among those leaving NHS general practice, both in headcount and by full-time equivalency. In relative terms, foreign-qualified GPs exhibit different patterns of workforce engagement, and regional variations are pronounced, with London and the South East experiencing the most acute shortages.
In stark contrast to these troubling trends within primary care, the NHS’s specialist workforce paints a more optimistic picture. Within the same evaluation period, for every five additional GMC-licensed specialist doctors, the NHS has been able to retain approximately 4.3 full-time equivalent consultants. This comparative stability highlights a widening chasm in workforce sustainability between primary and secondary care sectors, raising concerns about the NHS’s ability to realize its ambitions of shifting care delivery towards prevention and community-based management.
Additionally, the study takes into account population growth, reinforcing the gravity of workforce strain. While patient numbers per GP rose by 15%, the number of patients per full-time equivalent NHS consultant actually declined by 18%. These contrasting trends underscore the systemic pressures concentrated on general practice and reflect a healthcare system increasingly reliant on an overburdened primary care workforce.
The implications of these findings extend beyond mere statistics. Persistent challenges in recruitment and retention of GPs have previously been attributed to multiple factors, including unsustainable workloads, rising patient expectations, and insufficient consultation time, all contributing to job dissatisfaction and attrition. This study corroborates these issues through comprehensive data analysis, reflecting entrenched systemic barriers that must be addressed to stabilize and strengthen primary care services.
While the findings are observational in nature—precluding definitive causal inferences—the authors acknowledge potential underestimations of actual GP working hours due to data discrepancies and recording limitations. Nonetheless, the evidence presented offers a strong signal that deeper structural and cultural reforms are vitally needed to reverse the attrition trend and meet the government’s objectives to enhance community-oriented healthcare delivery.
An associated editorial within The BMJ contextualizes these data trends within policy frameworks, noting that after a prolonged period of decline, the number of full-time equivalent fully qualified GPs has shown an uptick since January 2025. This positive development suggests potential inflection points in the workforce crisis. However, the commentary stresses that recruitment alone is insufficient. Sustained retention, quality of work-life balance, provision of meaningful roles for newly trained GPs, and systemic support mechanisms are equally critical components of a comprehensive workforce strategy.
The complexities underlying the exit of a significant proportion of licensed GPs from NHS general practice are multifactorial and intertwined with broader health system challenges. The editorial asserts that a piecemeal approach will fail, advocating for a holistic resolution that simultaneously addresses workload pressures, professional morale, training pathways, and regional inequalities within the NHS.
With the UK government committing to a long-term workforce plan due to be unveiled in the autumn, this study illustrates the urgency and scope of the challenge ahead. Policymakers will need to grapple with entrenched workforce imbalances, expand capacity at the community level, and recalibrate incentives to retain talent within NHS general practice. Failure to do so risks undermining the foundational principles of accessible, continuous, and comprehensive primary care for the population.
Ultimately, this research serves as a clarion call to healthcare leaders and stakeholders. The sustainability of NHS general practice — and by extension, community health services — depends not just on increasing headcounts but on crafting resilient, engaging, and well-supported roles for GPs. Achieving this will be pivotal in transitioning the NHS towards a model of care that prioritizes prevention and holistic patient management, as envisioned in contemporary health policy.
Subject of Research: People
Article Title: Trends in the shortfall of English NHS general practice doctors: repeat cross sectional study
News Publication Date: 17-Sep-2025
Web References: 10.1136/bmj-2024-083978
Keywords: Health care
