Workforce
Over the four years to September 2019, the full-time equivalent (FTE) GP workforce grew by 433 to 34,862 - a 1.3% increase.
However, this figure includes registrars - and rising numbers of GP trainees over the period mask a sharp drop in numbers of fully-qualified GPs. Since September 2015 - the starting point from which former health secretary Jeremy Hunt promised to increase the workforce by 5,000 GPs - the fully-qualified FTE GP workforce has fallen by 1,088, a 3.7% drop.
Numbers of GP partners fell faster still over the four-year period, dropping 16% to 18,303 in September 2019. And despite record numbers of GPs in training and a promise from the newly-elected government to increase the number of training posts available per year to 4,000 from the current 3,500, a significant proportion of the workforce is likely to retire soon.
Nationally, around a quarter of GPs are aged over 55 - but in some areas more than two in five GPs are in this age category. And as existing GPs continue to reduce their working hours in the face of rising pressure, polling shows that among trainees just one in 20 plan to work full time.
Meanwhile, punitive taxes on pensions have forced thousands of GPs to reduce their working hours or refuse extra shifts - adding to pressure on the workforce.
Workload
While GP numbers are in decline, the opposite is true of the patient population. Since April 2014, the number of patients registered with GP practices in England has risen by around 7% from 56.4m to 60.2m.
The population is ageing, too - increasing the complexity of cases that the primary care workforce is dealing with. Compared with April 2014, there are nearly half a million more patients aged over 75 registered with GP practices in England - an 11% increase.
Official data on the number of appointments delivered in general practice have only been collected and published over the past couple of years - but this data shows a sharp rise in workload. GPonline revealed earlier this year that GP practices in England delivered 2.7m more appointments in the first six months of 2019/20 compared with the same period in 2018/19 - and October saw a record high for appointments in a single month.
Meanwhile, analysis by GPonline has shown that GPs in some parts of England are dealing with nearly twice as many patients each as their counterparts in other areas - and that nationally the number of patients per FTE, fully-qualified GP has risen sharply from 1,653 in September 2015 to 2,119 in September 2019.
Funding
Under the five-year GP contract that kicked in from April, GP funding will rise by around £1bn by 2023/24, with a further £1.8bn available to support the formation of primary care networks (PCNs). Much of this funding is intended to ease pressure on general practice through recruitment of additional staff to support primary care - although many GPs are yet to be convinced.
Despite increased funding promised through the NHS long-term plan and the five-year contract, the BMA has warned that the share of overall health service spending allocated to general practice is too low.
And over the past decade, GP income has dropped sharply in real terms compared with the peak after the landmark new GMS contract deal in 2004/5.
Research published earlier this year in the BJGP linked the drop in real-terms income with the growing recruitment and retention problem in general practice.
Performance
Despite the pressure on general practice, patient satisfaction remains high - with 83% of patients satisfied overall with their experience of GP services.
Meanwhile, an overwhelming 95% of GP practices are rated good or outstanding by the CQC - a far higher proportion than any other service assessed by the watchdog - although in some areas there are clusters of poor ratings, as GPonline's CQC ratings map reveals.
Wider NHS pressure
Pressure on health and social care as a whole have had a significant knock-on impact on general practice. The King's Fund said this week that the NHS was running 'red hot' after the latest health service operational statistics showed that around 95% of hospital beds were occupied - well above the recommended safe level.
The BMA warned earlier this year that the NHS was facing its toughest-ever winter in 2019/20 because pressure on the hospital sector had not eased off through summer in the way it has in the past. With waiting times for hospital care at record levels, GP practices are supporting patients through long delays for treatment.
Practice workload has also been pushed up by cuts to social care over the past decade as well as in recent months by rising shortages of medicines.
Changing landscape
Another source of pressure for GPs comes from rapid change in the environment in which they are working. More than 1,000 GP practices have closed or merged in the six and a half years since NHS England became operational in April 2013 - pushing up the average list size of a GP practice in England by 28%.
GPs are also adapting to working together in PCNs - 99% of practices are now part of networks, with more than 1,250 of the groups formed within just months of the five-year GP contract taking effect in April 2019.
Pressure is also on practices to adapt to new technology such as video consultations - and competition from a new breed of digital first providers, in particular the controversial GP at Hand, which has registered tens of thousands of NHS patients - most of them aged between 20 and 39 years old.
