GP practice list size up nearly 50% since 2004 contract

The average GP practice list in England has increased by almost half since the new GMS contract took effect in 2004, analysis by GPonline reveals.

Patient list sizes increasing (Photo: Robert Johns/UNP)

Data on patients registered with GP practices in England show that on 1 December 2018, a total of 59.6m patients were registered with 7,017 practices - making the average practice list 8,490.

This is 44% higher than when the QOF was implemented in April 2004 - the year after new GMS replaced the old Red Book contract - when the average practice list in England was just 5,891 patients.

A total of seven GP practices in England are now listed as having more than 50,000 patients, with the largest - the Princess Street Group Practice in south-east London showing a patient list of 73,525.

Large practices

Just over 50 GP practices in England now have more than 30,000 patients, and 2,214 have more than 10,000 patients. A significant proportion of GP practices are still small, however - the latest figures reveal that just under 2,000 practices have fewer than 5,000 patients.

Family Doctor Association (FDA) chair Dr Peter Swinyard told GPonline that the figures confirmed the 'continuing demise of smaller practices'.

He pointed out that larger practices were also failing - GPonline reported this week on a 12,000-patient practice forced to hand back its contract after a significant service charge hike - but warned that the impact was falling disproportionately on smaller practices.

'It is terribly sad,' Dr Swinyard said. 'You can’t recreate these things once they are gone. The current trend to dragoon us into larger practices is having this effect.'


The FDA chair said his own practice, which had around 5,000 patients, had been forced to amalgamate with several others and would soon become part of a 55,000-patient practice.

'We had to amalgamate or I would have personally gone bankrupt,' he said. 'We had decreasing income, impossibility of recruitment, I was doing the GP-ing and the practice management because I couldn't afford a practice manager, so when the opportunity to amalgamate came I had to do it - it means I actually get paid every month, which is a wonderful novelty.'

Dr Swinyard said losing small practices would not benefit patients because of the potential that continuity of care would be undermined - although he recognised that 'micro teams' within larger practices could reproduce the advantages of small practices to a degree.

For small practices, the complexity of GP funding streams had become almost impossible to manage, he added. 'There are lots of time limited little pots of money - you have to have a very efficient practice management model to find and get all of these or your practice will go under fairly quickly. You can’t afford that at small practice level - and it's increasingly difficult to make smaller practices viable.'

GPonline reported earlier this year than more than 1,100 GP practices had closed or merged since NHS England became operational in April 2013.

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