A quarter of GP practices could close because of workload pressures, warns Royal College of GPs

General practice is on a cliff-edge with one in four practices at risk of closing, warns the Royal College of GPs as it launches a new report highlighting the current workload and workforce pressures facing GPs and their teams, and the impact these are having on patients.

GPs and their hard-working staff carried out 4.6 million (9%) more appointments in December 2022 and January 2023 compared to in 2019, however, the number of fully qualified full-time-equivalent GPs has dropped by 843 in the same period.

The Royal College has published Fit for the Future: GP Pressures Report 2023, setting out recommendations for Government to tackle the workforce and workload crisis in general practice, and support GPs and their teams to meet the healthcare challenges of the 21st century.

Based on a survey of more than 2,600 GPs and other practice team members from across the UK, the College’s new report acts as a snapshot of what frontline staff have faced during one of the most difficult winters experienced in the NHS, and what they think needs to happen to make general practice more sustainable. Respondents describe a profession in crisis, with unmanageable workload and workforce pressures fuelling an exodus of fully qualified GPs.

As a result, more than a quarter (26.7%) of respondents told us they feared their practice would be forced to close, with almost 90% citing unmanageable workload pressures as a reason; while 65% said it was because of a GP partner leaving and 63% said it was because of a shortage of salaried GPs.

Last autumn, the Government made emergency funding available to support general practice through the winter. However, more than half (57%) of respondents to the survey said they have not accessed winter support and funding because of a lack of flexibility in what the funding can be used for, and 35% had not due to the arduous form-filling involved in applying for it.

Outdated technology and ineffective booking systems are wasting doctors’ time and making it harder for patients to choose to see the same GP or the next available member of the team. Over half (55%) of GP staff said that at least one of their appointment booking systems, either via phone or online, were not fit for purpose. Improving GP practice booking systems and IT is not a silver bullet, but can make a big difference to patient experience.

Last year, the Government announced that it will publish a primary care recovery plan for England in 2023, in addition to the long-awaited NHS long term workforce plan. In today’s report, the Royal College says these plans must tackle the challenges facing primary care in both the short and long-term. Urgent measures should include:

• A commitment to a properly funded plan to enable general practice to respond to surges in demand as they occur.
• Investment in GP practices’ IT and telephone systems, and the support they need to implement upgrades.
• The urgent roll-out of new and improved, properly funded retention schemes that halt the decline in the GP workforce.
• A reduction in unnecessary box ticking requirements and unnecessary workload to free up GPs’ time for patient care.
• A new public education campaign designed by patients and healthcare professionals to advise patients when and how to self-manage illness and when to access general practice or other services.

Professor Kamila Hawthorne, Chair of the Royal College of GPs said: “It is hard to think of a more challenging time in general practice, too many GPs are now finding their position untenable and are feeling too stretched to guarantee patient safety. I've certainly heard of colleagues of mine becoming so stressed during their days of work that they're developing chest pain and needing to be seen themselves. Many are also needing to take time off, due to stress at work. If you're seeing 40 to 60 patients a day and making that number of clinical decisions, it is extremely stressful because each one of those clinical decisions is important.

"We are seeing more patients than we've ever seen before – and a greater proportion of our patients suffer with multiple chronic medical conditions - we are really busy and getting busier. Yet we have fewer doctors because GPs are leaving the profession due to the intolerable workload and workforce crisis that we're under. So, we're now 843 fewer full-time equivalent GPs since 2019, and the numbers are going down and down and down. That's all extremely worrying."

“We need a sustained increase in funding for general practice, without the caveats and inflexibility that often come attached. As GPs, we know our patients best - we know what they need, and we need to be supported to deliver it. We need to see efforts not only to recruit more GPs, but keep the ones we have in the profession longer - and not just those considering retirement, but those earlier in their careers, as well. We need better IT systems to help patients book appointments more easily, and we need significant cuts to the bureaucracy that takes us away from patient care. We need to empower patients, not only how to look after themselves when it's appropriate, but also in terms of how best to navigate the NHS so they receive the most appropriate care for their health needs.

"Without general practice, the NHS won't survive. We see a vast number of the patients that come to the NHS, and we deal with most of what people need from the health service. If we're not there, secondary care services will just be completely overwhelmed.”

Further information

The 2022 RCGP Infrastructure Survey was carried out between 9 December 2022 and 13 January 2023. It received 2,649 responses from a range of staff working in general practice, including GPs, practice managers, and other clinical and non-clinical staff. Respondents were from England (86.5%), Scotland (7.3%), Wales (4.4%) and Northern Ireland (1.3%).

RCGP Press office: 020 3188 7633
press@rcgp.org.uk

Notes to editor

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.