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)
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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Follow Us:

Just published

Whitehall street sign

NHS officials doubled in two years as GP workforce dropped

Staff employed by NHS England and the DHSC doubled in two years from the start of...

Child coughing

NICE traffic light tool that helps GPs spot seriously ill under-5s 'unreliable'

NICE's 'traffic light' system - intended to help GPs identify risk of serious illness...

Pregnant woman receives COVID-19 vaccine

COVID-19 vaccine uptake in pregnant women rising but stark inequality remains

More than half of pregnant women are now double vaccinated against COVID-19 as uptake...

Vaccination tracker

UK COVID-19 vaccination programme tracker

GPs across the UK have led the largest-ever NHS vaccination programme in response...

GMC sign

Overseas-graduate GPs fare worse in medical tribunals due to lack of legal help

UK GPs who graduated overseas face worse outcomes in GMC cases because they are far...

Woman using HRT patch

Practical advice for GPs on prescribing HRT

GP menopause specialists Dr Louise Newson and Dr Olivia Jones provides an overview...