The Doctors’ Association UK’s (DAUK) GP Committee says the shortages of GPs is because practices are not being funded to retain, employ, or increase their capacity.

The committee was responding to BBC analysis which found that the average GP in England has to care for 17 per cent more patients than nine years ago.

According to the BBC online report, for every permanent GP there are more than 2,300 patients, a rise of nearly 350 since 2015, with some areas exceeding 3,000 patients. The widely recognised safe limit is one GP to 1,800 patients.

Dr Steve Taylor, DAUK’s GP spokesperson, said the figures do not tell the whole story.

Shortage of GPs

He said: “Although there are fewer GPs working, and it’s often worse in areas of deprivation, the cold reality is that there is a shortage of funding not general practitioners.

“Many GPs are now finding it increasingly difficult to get work and some are even taking on roles outside of medicine to pay the bills.

“NHS England has cut funding to GP practices by 20 per cent per patient in the past eight years alone.

“GPs themselves are earning 20 per cent less in real terms and practices don’t have the funds to retain, recruit, or expand their GP roles.

“Instead NHS England has moved funding into other roles via the Additional Roles Reimbursement Scheme (ARRS) at the expense of GPs.”

Dr Ellen Welch, DAUK’s vice chair and a GP in Cumbria, said: “We currently have GPs who are unemployed and on benefits who cannot get the work they have been trained to do.

“I lost work as a locum at the start of the year as the practice was given Government funding to employ a pharmacist instead of a locum GP.”

Unemployed

Dr Lizzie Toberty, DAUK’s GP lead said a ‘fundamental shift in thinking towards retention’ was needed.

“We have full training schemes, we have unemployed GPs, and we need meaningful jobs for them to go into,” said Dr Toberty.

“The addition of GPs to the ARRS up to March is too little, too late and is only for newly-qualified GPs.

“There are GPs with 20 to 30 years’ experience who can’t get jobs or are being made redundant by some companies who are taking over practices and trying to run them with nurses, paramedics, and physician associates with just a GP to oversee them.

“We need achievable, worthwhile and meaningful careers for GPs to aid retention, and ultimately continuity of care which has the potential to save the NHS a fortune.”

Become a member of DAUK and support our work.

In a letter to the Times, Dr Lizzie Toberty, DAUK’s GP lead, and Dr Ellen Welch, DAUK’s vice-chair, said investment was needed in preventing the problem with better information and support for families and schools.

Their letter was in response to an article on weight-loss drugs.

Dr Toberty and Dr Welch said: “… instead of investing in drugs to reduce obesity we could invest our efforts into preventing the problem in the first place.

“How about creating sweet-free schools, removing grab bags and snacks at tills, and educating on the harms of fizzy pop and sugary drinks?

“Investment in public health is not glamorous, and will not make money for Big Pharma, but it will make us and our children healthier, happier and cost less to the NHS in the long run.”

Read their letter in full.

Dr Toberty added to the letter with a post in X, formerly known as Twitter.

She posted: “It’s great we’ve got drugs to help people lose weight, but we’re not getting the basics right.

“Why aren’t we nudging everyone, including kids towards a healthier life?”

Support the work of the Doctors’ Association UK by becoming a member.

Dr Toberty told national radio listeners that the government needed to invest in public health to improve the health of the nation and prevent people getting unwell.

Speaking on Nick Ferrari’s breakfast time programme on LBC, Dr Toberty said: “We need to look at public health and the reasons why we are unwell and getting unwell.

“The public health budget has been slashed by about a third in real terms since 2010.

“We need to urgently look at and try to improve the health of our nation proactively and not just wait until people are getting unwell.”

Dr Toberty was commenting on the latest NHS referral to treatment figures for June 2024 show that the waiting list stood at 7.6 million cases, with an estimated 6.4 million patients.

Among the 7.6 million, in 302,693 cases the patient was waiting more than 52 weeks, the NHS said.

In 58,024 cases they were waiting more than 65 weeks, in 2,621 cases they were waiting more than 78 weeks, and in 120 cases they were waiting more than 104 weeks.

In 58.9 per cent of cases the patient had been waiting up to 18 weeks, missing the target of 92 per cent.

Dr Toberty told national radio listeners that she was not surprised by the figures.

Waiting lists

“As a nation we are unhealthy and sick,” she said.

“There are one in nine of us waiting for treatment at the moment, and I don’t think there are any quick fixes.

“I know about the suffering and the difficulties our patients are having, and not just the patients but their families and their carers around them.

“When we have these problems, it starts to put pressure on the rest of the health service because a problem initially then creates problems with pain and depression and other things.

“People have to go somewhere with those issues so you can see how things quickly escalate.

“I’m glad this is a top priority for the government, and it needs to be.

“If we can bring waiting lists down I am convinced we will reduce some of the pressures on the acute parts of our services.”

Dr Toberty said the government should look at investment in the NHS as an investment in the wider economy.

“This needs investment,” she said “They need to pay overtime, and we need to get this down.

“This is an investment in our health service, in our economy, in getting us well and back on our feet again.”

Listen again to Dr Toberty’s interview on the DAUK page on X.

Become a member of DAUK and support our work.

The Doctor’s Association UK have written to Prof Lord Darzi of Denham, ahead of his planned review of the NHS, to highlight the key issue within General Practice. Read our letter in full below and add your support by clicking the links.

Dear Lord Darzi

We understand that you have been appointed to lead an investigation into the performance of the NHS.

As an independent group of grassroots GPs, we would like to bring a number of facts about the GP crisis to your attention:

1. There are 1,790 fewer full-time equivalent GPs working in the NHS since September 2015. (https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services)

2. A single full-time GP is now responsible for an average of 2,292 patients. This is 354 more than in September 2015. (https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services)

3. Despite this, GP practices are offering record numbers of appointments for their patients. (https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice)

4. More than 90 percent of a patient’s direct experience of the NHS is through primary care and their GP practices (https://www.gov.uk/government/news/gp-practice-data-available-for-first-time)

5. Despite growing demands for GP appointments, 6 out of 10 job-seeking GPs have struggled to find a vacancy to apply for over the past year (https://www.rcgp.org.uk/news/member-research-jobsearch-struggle)

6.  A recent BMA survey showed that 84 percent of locum GPs in England cannot find work, and 33 percent of GPs have already made definite plans to change work or career paths. This makes no sense when we have patients desperate for appointments but no money for practices to pay for these doctors (https://www.bma.org.uk/bma-media-centre/over-80-of-locum-gps-struggle-to-find-work-finds-bma-survey)

7. 64 percent of GP practices report concerns over short and long-term viability. 57 percent have experienced cashflow issues in the last 12 months. And 54 percent report that these cashflow challenges adversely affect their day to day performance (https://www.bma.org.uk/bma-media-centre/gp-patients-likely-to-suffer-unless-government-improves-inadequate-gp-contract-offer-warns-bma)

8. Over 1,000 GP practices have closed since 2015. This amounts to an average of one practice closure every three days. (https://www.bma.org.uk/bma-media-centre/gp-patients-likely-to-suffer-unless-government-improves-inadequate-gp-contract-offer-warns-bma)

9. GP core funding is just £107.57 per patient per year. https://threadreaderapp.com/thread/1812879378612908310.html

10. Schemes aimed at reducing GP appointments such as Pharmacy first, the Additional Roles and Reimbursements Scheme actually cost more money to run https://www.pulsetoday.co.uk/news/practice-personal-finance/redirect-arrs-and-pharmacy-first-funding-to-core-gp-says-dauk-manifesto/

11. US Data shows that care provided by non-physicians providers is ultimately more expensive and leads to higher rates of emergency department use https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope

12. Independent research from Carnall Farrar shows that for every £1 invested in community or primary care, there is up to a £14 return back into the local economy. (https://www.nhsconfed.org/news/extra-investment-out-hospital-care-can-reap-billions-wider-economy)

All these factors have impacted the workforce morale and greatly compromised the standard and continuity of care. Supporting general practice now, will in turn reduce the burden and cost on secondary care in the long run, as well as being an essential part of helping people feel well again.

However we really cannot continue to run on fumes. We need a commitment from NHSE and the government to significantly uplift core funding and continue to do so in line with inflation.

We, the undersigned, ask that you take these facts into consideration whilst conducting your investigation.

Yours sincerely,

Dr Shan Hussain
Dr Ellen Welch
Dr Lizzie Toberty
Dr Sarah Jacques
Dr Steve Taylor
Dr Rosie Shire

In an open letter to Mr Streeting, DAUK’s GP committee said general practice could not keep up with current demand because it had been underfunded for almost a decade.

Referring to its pre-election manifesto for general practice, the committee said: “To restore levels of real terms funding last seen in 2015, would cost the equivalent of £3 per patient per month.

“The reason general practice cannot keep up with current acute demand is because we are trying to function in 2024 after almost a decade of underfunding.

“We do not need wholesale reform, we need to be funded.”

The committee offered to meet Mr Streeting to discuss the issues in general practice and to work with him to help resolve them.

And it cautioned against ‘the implementation of policies which seek to separate acute and chronic care’.

“This is unevidenced and, most importantly, patients have not been asked if this is what they want,” the committee said.

“Furthermore, it is at odds with the idea of a family doctor, where every interaction helps build the bigger picture of the underlying causes of each patient’s presentation.

“Disrupt this model, and care will be fragmented, more expensive and less efficient.”

Read the letter in full.

Become a member of DAUK and support our work.

The Prime Minister was speaking at general election rally in Wiltshire when a GP questioned him about changes to funding available to recruit staff.

The GP, understood to be Dr Jane Lees-Millais, said the NHS was ‘disintegrating’ and said that she was one of 2,500 GPs in the country currently unemployed because of the Government’s policies.

“The country is not stupid,” she said. “They know when lesser qualified people are being used to conduct consultations which are massively complex.”

Mr Sunak responded by saying his dad was a GP and mum a pharmacist, and that he understood primary care.

He said he was ‘making it easier for people to see other primary care practitioners to get the treatments they need’.

General practice funding

Dr Shire, of the Doctors’ Association UK GP committee,  told national radio listeners that GPs were not allowed to spend funds from the Government on hiring GPs or practice nurses.

Speaking to Vanessa Feltz on LBC, Dr Shire said: “There’s concern within general practice that the demand is increasing and yet we have 2,000 fewer GPs than we did in 2015.

“Although they are putting money into primary care, unfortunately, that money is ring-fenced so it can’t be used for GPs and practice nurses.

“It can only be used for other patient care roles, such as pharmacists or physios, which is great and they definitely play a part in primary care, but we have GPs coming through the system, they’re trained up, they want to work, and they can’t get jobs.

“We have patients who want to see GPs but they haven’t got that choice anymore.”

She said that allied healthcare professionals had an important part to play in Primary Care, but that GPs ‘trained for much longer and have that depth and breadth to see the person as a whole’.

“As people get older they’re going to have more health conditions and that then does cause more complexity,” Dr Shire said.

“Healthcare professionals who aren’t medically trained perhaps won’t be able to look at that as a whole and understand the depth of what might be going on.

“It’s having that picture as a whole and making sure people are seen by the right person, and a GP is able to look at that in one go.

“If people see a physician, that costs less than seeing a non-physician such as a patient care role that isn’t a GP or a nurse.”

Is the NHS broken?

Asked by Vanessa Feltz whether the NHS was ‘disintegrating’, Dr Shire said: “We’re worried it might be broken. It’s definitely not doing well at the moment.

“People are becoming more unwell. We have more people needing care.

 “If we can get people the healthcare they need earlier, we can get them back on their feet and working again.”

Dr Shire added: “I think a lot of GPs and a lot of doctors are starting to feel demoralised and dispirited.

“You train to become a doctor because you want to help people, you know what that person needs and you can’t give them that.

“That is really hard and I think we’re seeing more and more GPs burning out and struggling themselves.

“The services that support GPs and doctors with their mental health are struggling because we’re struggling ourselves.

“But we keep going back because you want to do what you can and you want to do your best.

“If you can’t do that, it doesn’t feel very nice.”

Become a DAUK member and support our work.

DAUK is holding a briefing for prospective MPs on Wednesday 19 June to discuss the crisis in general practice and things that could be done to tackle it.

The briefing, Why Can’t I See My GP? The Great British Paradox, is based on the book Why Can’t I See My GP?, a copy of which DAUK sent to all 650 MPs in March.

The briefing will be held members of DAUK’s GP committee, including its chair Dr Lizzie Toberty, past DAUK co-chair Dr Ellen Welch, and members Dr Steve Taylor and Dr Sarah Jacques.

DAUK is asking people to invite the candidates standing in their constituency to attend the briefing. Find out the candidates in your constituency at https://whocanivotefor.co.uk/

Find out more about the briefing.

We invite all MPs and MP candidates to join the Doctors’ Association UK (DAUK) on Wednesday 19 June (10am to 11am) for an online briefing:

Why Can’t I See My GP? The Great British Paradox

Listen to four NHS GPs share their thoughts on the problems, the solutions, and just why general practice is worth saving.

Based on the book Why Can’t I See My GP?, a copy of which we sent to all 650 MPs in March, we ask our leaders to join us ahead of the general election to ensure GP teams are at the heart of their manifestos.

We need YOUR help.

An MP is much more likely to attend if a constituent asks them to, so we’re asking you to take two minutes to click the buttons below to tweet and email your MP to ask them to attend. Thank you!

The feature explores how medics are disproportionately likely to die by suicide and highlights the immense strain family doctors are working under.

Dr Sarah Jacques shares her personal story, which she hopes will amplify the growing issue of adverse mental health in the NHS workforce.

She said: “‘Medicine is a vocation. You don’t stop being a doctor, it’s so much a part of you and when you don’t feel you’re doing it well you feel worthless.”

Our former co-chair, Dr Ellen Welch, author of Why Can’t I See My GP?, talks about the reasons behind plummeting morale among GPs.

“People have gone overseas, for example to Australia, where the salary can be almost triple what it is here and doctors have more time with their patients,” said Dr Welch.

Dr Lizzie Toberty, our GP lead, discusses how workloads can be managed with better triaging.

She concluded: “I do get stressed because you are holding so much risk and responsibility, but because I work with great people and I know I’m supported I still enjoy it. It’s a great job.”

Read the feature on GPs in crisis.

Sign up to be a DAUK member and support our work.