What is the latest GP workforce pledge?
With campaigning for the UK's first December general election since 1923 underway, the Conservatives have promised to increase the GP workforce by 6,000 by 2024/25, and to deliver an extra 50m GP appointments a year. It's difficult to know exactly what the pledge means, however - because the party has yet to confirm whether its 2019 promise relates to FTE GPs, or simply a headcount figure.
The Conservatives have also promised to increase the number of GP training posts available each year by 500 from 2021/22, taking the total to 4,000. This comes just weeks after health and social care secretary Matt Hancock told the RCGP annual conference in Liverpool that the NHS had recruited 3,538 GP trainees in 2019 - above the target figure of 3,500, and a record number for the second year in a row.
In addition to an increase in GP numbers, the party has promised an extra 6,000 nurses, physios and pharmacists in primary care - on top of the 20,000 promised through primary care networks.
What was the 2015 pledge?
The Conservatives' latest promise to boost the GP workforce comes just over four and a half years on from a similar pre-election pledge in 2015 from then health secretary Jeremy Hunt.
Mr Hunt promised to increase the GP workforce by 5,000 FTE GPs by 2020/21, using September 2015 workforce data as a baseline. Mr Hunt appeared to soften the target just weeks after the May 2015 general election, saying it was the 'maximum' achievable - but the government at the time insisted it would honour the pledge.
BMA chair Dr Chaand Nagpaul - then chair of the association's GP committee - said at the time that the 5,000-GP target was unrealistic, arguing that 'delivering 5,000 extra GPs in five years when training a GP takes 10 years was a practical impossibility that was never going to be achieved'.
How has the GP workforce changed since September 2015?
Dr Nagpaul's warning proved accurate. In September 2015 there were 34,262 FTE GPs in England, according to NHS Digital. The latest figures, for June 2019, show that the current FTE workforce is 34,114 - 148 FTE GPs less than there were when the clock started ticking on the pledge.
The number of fully-qualified FTE GPs in England has fallen faster still over the period, and numbers of partners are in sharp decline.
In late 2018, Mr Hancock dropped the 2020/21 deadline for his predecessor's 5,000-GP pledge as it became clear it would not be achieved - but the government remained committed to delivering the extra doctors 'as soon as possible'.
What are the factors undermining the GP workforce?
Heavy workload has been a key factor undermining the GP workforce over the past decade, with rising bureaucracy from CQC checks, QOF targets, revalidation and other factors adding to soaring clinical workload driven by an ageing population with an increasing number of chronic conditions.
A GMC report earlier this year found that half of GPs feel unable to cope with their current workload - twice the proportion of all doctors who report feeling this way.
Pay, meanwhile, has been in decline with real-terms income for partners down 10% between 2008 and 2017 after adjusting for sessions worked, according to a BJGP study published earlier this year.
Along with a pension tax crisis that has hit the entire NHS medical workforce hard in recent years, this has damaged GP retention - bringing down GP numbers even as trainees coming through are on the rise.
What efforts have been made to improve recruitment?
In addition to an expansion of GP training posts in recent years, an international recruitment scheme and GP retention initiatives were rolled out as part of the drive to achieve the 5,000 extra FTE GPs promised by Mr Hunt.
The NHS promised to recruit 'at least 2,000 suitably qualified overseas doctors into GP practices by 2020' - but NHS England and Improvement board papers from September this year showed that its international GP recruitment programme had brought in just 140 doctors to date.
Meanwhile, although the number of GP retainers listed in NHS Digital figures has more than doubled since September 2015, there were still only 171 in June 2019.
What do GP leaders say?
BMA GP committee chair Dr Richard Vautrey has welcomed the promise of 6,000 more GPs - but said GPs would 'wait with some trepidation to see if this latest promise can deliver' after the previous promise fell 'way short of its target'.
He highlighted 'punitive pension regulations, inadequate premises, archaic IT systems and overly burdensome admin still proving a serious barrier to doctors choosing and remaining in general practice'.
Dr Vautrey added: 'The lack of detail as to exactly how all these promises will be made good, particularly with no firm commitment for full reform of the ridiculous pension taxation system, means it remains to be seen whether these long overdue and very necessary improvements will be achieved.'
The RCGP too welcomed the promise of extra GPs, but also highlighted the need for a greater focus on retaining existing GPs. The college called for 'urgent action – both funding and extra staff - to support the GPs who are currently keeping general practice afloat, but are grappling with unmanageable workloads'.
Ultimately, how effectively they can retain existing GPs will be the true test of any future government's ability to deliver an increase in GP numbers - as the past four and a half years show, record numbers in training make little difference if even more GPs at the other end of their careers are heading for the exit.