Deprived areas hit hardest by decade-long rise in GP turnover, study warns

Turnover of GPs working in practices across England has increased over the past decade, with deprived areas hit hardest, research shows.

GP surgery (Photo: Glyn Kirk/Getty Images)
GP surgery (Photo: Glyn Kirk/Getty Images)

GP turnover rose steadily in almost all NHS regions between 2007 and 2019, according to a study by University of Manchester researchers.

However, turnover rates in deprived areas were up to 10% higher than in more affluent areas, the study found - highlighting concerns that erosion of the GP workforce is driving up health inequality.

The proportion of practices with high turnover - where between 10% and 40% of GPs leave a practice within a year - almost doubled over a decade, rising from 14% in 2009 to 27% in 2019, the researchers found. Practices with 'very high' turnover - those where more than 40% of GPs change in a year - remained level at around 8%.

GP workforce

The study, published in BMJ Open, warns that high turnover of GPs can affect practices' ability to deliver high quality primary care services because of the impact on continuity of care.

The findings come after workforce data published this month showed a rise of just over 1% in the GP workforce over the year to June 2021 - although the workforce remains well below the level it was at around five years ago, despite a change in methodology that has angered the BMA.

Numbers of GP partners continue to fall rapidly, with analysis by GPonline showing a 3.1% drop over the year to June 2021 - after larger falls in the two previous years. 

Co-author Professor Evan Kontopantelis from the University of Manchester said: 'We already know the GP workforce in England is going through a major crisis. Rates of early retirement are increasing, as are intentions to reduce hours of working or leave their practice in the near future.

Continuity of care

'Though in 2015 the government promised 5,000 more doctors in primary care by 2020, the number of full-time equivalent GPs per 1,000 patients continues to decline.

'Quantifying GP turnover and understanding how it is distributed is fundamental to addressing challenges for the national health service, and for ensuring that quality and continuity of care are available to patients.'

He added: 'We reveal worrying trends in GP turnover. High levels may affect the ability to deliver primary care services; and undermine continuity of care which in turn may affect the quality of patient care. And healthcare received from multiple GPs can lead to conflicting therapeutic treatments and fragmented care.

'Differential turnover across practices and regions could also lead to a maldistribution of GPs, exacerbating retention problems and health inequalities.'

Profession at breaking point

RCGP chair Professor Martin Marshall said the study confirmed that the profession was at 'breaking point' and more GPs could be lost from the profession in the coming years unless steps were taken to address the workforce shortage.

He said: 'These figures are hugely worrying – not just for general practice but for patients and the rest of the NHS. Unfortunately, they only confirm what we have been saying for many years.

'Even before the pandemic, the job of GPs was largely undoable but the profession is now at breaking point. Consultation rates are at an all-time high and we do not have enough GPs to meet the needs of a growing and ageing population, with increasingly complex conditions, on top of managing the fallout and work backlog from the pandemic.

'Workload pressures and burnout are having a huge impact on GPs. The college’s own recent surveys show that six in ten GPs say their mental health has deteriorated in the last year. 34% of GPs expect to leave within five years – a quarter due to stress and burnout – meaning over 14,000 GPs could be lost from frontline patient care.

'We urgently need progress on the 2019 Conservative manifesto target of 6000 more full time equivalent (FTE) GPs in the next three years, and the recruitment and integration of at least 26,000 other members of staff into the general practice workforce by 2024.'

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