GPs in deprived areas responsible for almost 2,500 patients per head

GPs in deprived areas are now responsible for caring for a staggering 2,450 patients per head – over 300 more patients per GP than in more affluent areas of the country. 

New research published today by the Royal College of GPs ahead of its annual conference in Liverpool reveals that the number of patients per fully qualified, full time GP working in areas with the highest level of income deprivation has increased by an average of 260 in the past six years – a rise of 12% and nearly twice the rate of those in the least deprived areas.

The RCGP analysis found significant variation in the number of patients per GP across the regions in England, with London having the greatest number of registered patients per fully qualified GP at 2,560, whereas the South West has the lowest at 2,020.

Even in the areas with the lowest level of income deprivation, the number of patients per GP has increased by an average of 140 patients meaning that there are 2,130 patients under the care of every GP.

In her conference address to 1500 conference delegates later today, College Chair Professor Kamila Hawthorne will call out the ‘devastating inequalities’, warning that the rising patient per GP ratio means that patients in poorer areas - who tend to have more complex health issues - are less likely to receive the care they need as a result of decades of underfunding of the family doctor service.

Professor Hawthorne will say: “Our latest research reveals that GP practices with the highest levels of income deprivation have far greater numbers of patients to care for than in most affluent areas. More worrying, where the need is greatest, we have uncovered evidence of how much worse that GP to patient ratio has become.

“When I became a GP, it was normal to have a list size between 1,600-1,800 patients. The role was busy and challenging, but it was manageable. Our latest figures reveal that the average is now 2,300.

"All GPs work extremely hard, and we would argue that almost all areas are under-doctored, but it can’t be right that a GP in Kingston upon Thames looks after 1,800 patients while a GP in Kingston upon Hull, one of the most deprived places in England, is expected to cover twice that number.

“I have worked in areas of high deprivation, and I know how poverty leads to health inequalities... Surely, as a country, we cannot allow such inequality of health provision to continue to grow.

“It is more than 50 years since Dr Julian Tudor Hart, a fellow GP from South Wales, first defined the now-famous ‘inverse care law’ to describe how – perversely – people in deprived communities who need healthcare most, are least likely to receive it. How devastating that more than half a century later, we are still facing the same inequity.”

Professor Hawthorne will call on the new Government to take urgent action to meet its manifesto pledge to halve the gap in healthy life expectancy between different regions of England within ten years – starting with a review of all general practice funding streams so that more spending is channelled to areas of greatest need.

She will highlight the ‘indispensable’ work of GPs and their teams – over 1 million patients are seen every day in primary care and GPs are now treating chronic diseases like heart attack and stroke as the population ages and diseases become more complex.

However, she will emphasise that this is against a backdrop of desperate workload and workforce challenges in general practice and will call for a much greater share of NHS funding alongside robust initiatives to recruit new GPs and encourage existing GPs to remain on the front line of patient care.

The College’s most recent ‘GP Voice’ survey of its members revealed that:  

• Over 40% of GPs said they were planning to leave general practice within five years. Retirement was one of the reasons for people planning to quit, but the two biggest causes were work-life balance and stress.
• Almost 20% of GPs reported that most days they felt stressed and felt they couldn’t cope - more than 40% said they felt that way at least once or twice a week.
• Only 10% of those who took part in the survey are contracted to work 40 hours or more but 40% are putting in those hours regularly.

Professor Hawthorne will say: “At the heart of this is a workforce that hasn’t kept pace with workload. We are delivering 14% more appointments than we were five years ago, but we have fewer qualified GPs –16% fewer than other high-income countries relative to our population.

“Less than 10% of the total NHS budget in England is spent on primary care and as the Darzi Report confirmed, that share has been falling despite an increase in workload and the movement of extra services into the community.

“What does this mean in real life? It means too many patients crying out for appointments and dangerously high workloads for our members. Many colleagues tell me they choose to work part time contracts just so they have enough time to do the job properly. They use their days off to catch up on admin and to try to be on top of things. We cannot continue like this.”

Professor Hawthorne will add: “Investing in primary care makes sense for a government committed to the NHS, to financial responsibility and to economic growth. The new Health Secretary Wes Streeting is quite right when he describes us as the front door of the NHS, and we’re encouraged by the new Government’s commitment to primary care – but will we need more than fine words.

“We need action that starts right now. In return, we can deliver the reforms the Government is asking for – GPs have always been versatile and innovative, but the Government must work in partnership with us and allow us, ‘as eyes on the ground’, to contribute to the plans for the NHS.”

The Health Secretary, Wes Streeting, will speak at the conference on Friday 4 October.

Further information

Local authority and ICB level figures available.

Overview

The analysis estimates the number of registered patients per GP FTE. For each GP practice patient population a deprivation income score is calculated based on the deprivation of the neighbourhood where registered patients live. GP Practices are then split into four relative groups based on the distribution of these practice level income scores. This is all based on publicly available data, predominantly from NHS England and the Office for National Statistics. The findings are consistent with previous publications from these organisations and others e.g. The Health Foundation.

GP staff numbers

The number of patients per full-time equivalent staff member (GP and fully-qualified GP) was calculated by aggregating the number of patients in a certain category (using practice-level data) and the full-time equivalent of staff members in that same category (for example, practices based in London). The number of patients was divided by the number of staff to produce the number of patients per full-time equivalent staff member in that category.

GP registration data

GP registrations data are collected and published monthly by NHS-Digital. The data are extracted each month as a snapshot in time from the Primary Care Registration database within the National Health Application and Infrastructure Services (NHAIS) system. Data for each month are representative of patients registered on the first day of the month. There are a number of quality issues that any users of the GP registrations data should be aware of. These include, but are not limited to:

• under coverage of certain parts of the population, for example, members of the armed forces or recent migrants to the UK are less likely to be registered with a GP
• over coverage of the population: this is where patients who will no longer need to access GP services remain registered, for example people who emigrate overseas
• internal migration within the UK can also lead to over-coverage in some areas and under-coverage in others
• registration lags: people who move house may take some time to register with a new GP, while groups such as mothers with young children or people with existing health concerns are more likely to register quickly
• accuracy in patient registrations varies across local authorities in England; areas that are more densely populated, such as cities, tend to be less accurate

Deprivation

Deprivation analysis was carried out using the English Indices of Deprivation, last updated in 2019. We replicated the ONS 2022 analysis and calculated an overall income deprivation score for the patient population of each GP practice. Then, GP practices were grouped by their overall score and the number of patients per full-time equivalent staff member was considered. The groups of GP practices are based on quartiles by deprivation level and are described as:

• highest levels of income deprivation
• moderate levels of income deprivation
• lower levels of income deprivation
• lowest levels of income deprivation

References and data sources

• Registered patients and GP FTE, NHS England
• Income deprivation at Local Authority, ONS
• MSOA lookup file, ONS
• GP and GP practice related data, NHS England
• Trends in patient-to-staff numbers at GP practices in England: 2022, ONS
• Integrated care systems: what do they look like? The Health Foundation Trends in patient-to-staff numbers at GP practices in England: 2022
• LSOA to Parliamentary Constituency lookup, ONS
• LSOA (2011) to LSOA (2021) lookup, ONS Geography
• LSOA (2021) to SICBL to ICB to LAD (April 2023) Lookup, ONS
• Sub ICB Locations to Integrated Care Boards to NHSER Lookup, ONS Geography

GP Voice survey

Research by Design was commissioned by RCGP to deliver the survey, it was in field between 13 May 2024 and 10 June 2024, and it received a total of 2,190 complete responses from across the UK.

RCGP press office: 0203 188 7659
press@rcgp.org.uk

Notes to editors

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.