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Revealed: Why GP numbers will barely increase under national workforce plan

Published on: 23 Sep 2024

More than 1,000 medics funded to take GP training every year will not go on to work as fully qualified GPs in England, according to details of the NHS long-term workforce plan obtained by HSJ.

Key assumptions in the modelling underpinning the long-term workforce plan were not revealed at the time of its publication in June last year. However, the modelling has now been released after a Freedom of Information request by HSJ. The assumptions in the model include that: 

  • Only 70-75 per cent of GP training places – which are funded by government and the NHS – will result in fully-qualified working NHS GPs. This equates to more than 1,100 trainees every year not going on to become GPs; 
  • Of those who do, the plan expects they will work just 0.65 of a full-time equivalent – ie just over three working days;
  • That, even after planned attempts to improve retention of existing GPs, at least 6-7 per cent will leave each year. Retention can only be improved by “<1 percentage point” over the 10-year period, assumes the model.

The NHS England modelling details state: “Completion and conversion rates for GP training [mean the NHS will see only] 450-500 fully qualified GP FTEs per 1,000 GP training places.”

The weak conversion from training places to fully-qualified GPs, and ongoing problems stopping people from leaving are the key reasons why – despite substantial increases in funded GP trainee places – the LTWP envisages working GP numbers will barely increase, even in 12 years time, while medical consultants grow by 49 per cent.

It comes as some have called for government to mandate medical trainees to go on to work in the service, and others suggested writing off their loans as an incentive.

NHSE’s information says there are several reasons for training places not converting to working GPs, including people failing to start the course; dropping out during it; and those qualifying but not starting work as GP in England. 

Several senior GP sources said they believed one growing factor was international medical graduates, which make up a large majority in some areas, increasingly deciding against starting work as GP in England.

They said it appeared to be for a range of reasons, including more choosing other medical jobs after training; problems getting visas; GP workload and pay; Brexit; and the UK economy.

Nonsensical

The Royal College of General Practitioners chair Professor Kamila Hawthorne said: “International medical graduates currently make up 56 per cent of GP trainees (SoMEP 2024), and we must ensure they are supported, valued and encouraged to stay working in the NHS post-qualification, while also supporting efforts to train and retain more GPs in this country.

“Currently IMGs who have undergone specialty GP training in the UK have to jump through hoops in order to stay working in the NHS as they need to secure work in a surgery able to sponsor them.” This was ”nonsensical given the investment the UK has put into their training”, she said.

However, others refuted that IMGs not taking up posts was a factor. British Medical Association GP committee chair Katie Bramall-Stainer said “many [IMGs] stay on to work in areas that are difficult to recruit for and provide much needed care to patients in deprived areas”, adding: “These invaluable GPs are certainly not to blame for the country’s GP unemployment crisis.”

Others refuted the idea that fewer IMG trainees were becoming GPs was a factor.BMA GP committee chair Katie Bramall-Stainer said “many [IMGs] stay on to work in areas that are difficult to recruit for and provide much needed care to patients in deprived areas”, adding:“These invaluable GPs are certainly not to blame for the country’s GP unemployment crisis.”

Official calculations of average GP working hours have also been questioned by some, arguing GP sessions worked are longer than assumed, which may mean 0.65 WTE is an underestimate.

An NHSE spokesperson said: “NHS England is committed to building on the 4,000 GP training places that we currently offer as laid out in the NHS Long-Term Workforce Plan, which takes into account the need to replace those who are leaving the profession. We are also working to improve working conditions for GPs to help to lower the rate of leavers.”