TURNOVER in General Practice doctors has seen a steady increase over the last decade, according to researchers, who have warned policymakers that support measures must be put in place to improve retention.
The University of Manchester study used NHS data from all English GP practices, which totalled 8,085 in 2007 and 6,598 in 2019.
The study assessed changes in turnover, since high turnover is a marker of poor fiscal and organisational ‘health’.
- The proportion of practices with high turnover (between 10% and 40% within a year) ‘almost doubled from 14% in 2009, to 27% in 2019’;
- The number of practices with continued high turnover over at least three years grew from 2.7% in 2007 to 6.3% in 2017;
- However, the proportion of GP practices with ‘very high turnover’ of above 40% stayed stable at roughly 8%.
GPs in the most deprived areas suffered ‘higher turnover rates’ than practices in the least deprived areas.
Practices in the most deprived areas had turnover rates that were up to 10% higher compared to practices in the least deprived areas, even when accounting for differences across NHS regions, the researchers said.
The report concluded: ‘GP turnover has increased in the last decade nationally, with regional variability.
‘Greater attention to physician turnover is needed, in the most deprived areas in particular, where GPs often need to deal with more complex health needs.
‘There is a large cost associated with GP turnover and practices with very high persistent turnover need to be further researched, and the causes behind this identified, to allow support strategies and policies to be developed.’
Co-author of the study Professor Evan Kontopantelis said: ‘We already know the GP workforce in England is going through a major crisis.
‘Rates of early retirement are increasing, as are intentions to reduce hours of working or leave their practice in the near future.
‘Though in 2015, the government promised 5,000 more doctors in primary care by 2020, the number of full-time equivalent GPs per 1000 patients continues to decline.’
Professor Kontopantelis, head of data science and health services research at the University of Manchester, added that the trends found by the study in GP turnover are ‘worrying’.
He said: ‘High levels may affect the ability to deliver primary care services; and undermine continuity of care which in turn may affect the quality of patient care.
‘And healthcare received from multiple GPs can lead to conflicting therapeutic treatments and fragmented care.
‘Differential turnover across practices and regions could also lead to a maldistribution of GPs, exacerbating retention problems and health inequalities.’
Commenting on the findings, British Medical Association (BMA) North West regional council deputy chair Dr Rob Barnett said: ‘The results of this study are very concerning.
‘High GP turnover has the potential to have a significant impact on the services that practices are able to provide, and ultimately patient care.
‘When an increasing number of GPs leave a practice it can be demotivating for colleagues who remain and therefore may undo previous retention efforts, but it can also mean patients lose the continuity of care which is so important to them and their health.’
He added: ‘If we continue to see disproportionate rates of GP turnover in practices in deprived areas this will inevitably exacerbate health inequalities.
‘As such, the government needs to understand the issues leading to this GP turnover and put a plan in place to improve General Practice for those working within it to retain GPs, while also increasing the number of GPs overall as a matter of priority.’
Lancashire and Cumbria LMC’s chief executive Peter Higgins said the study ‘resonates with our experience … We have more than our fair share of “difficult to doctor” areas, either through remoteness or deprivation.
‘It is difficult to attract doctors in the first place – we often don’t get the best outputs from the medical schools and those that do come are then faced with some really difficult and challenging patients particularly at the moment post-Covid. Doctors then struggle to cope and leave in the hope of a better experience elsewhere.’
He added: ‘Of course, GPs joining an already under-doctored area have an even tougher time and so the problem gets worse. NHSE (National Health Service England) really needs to develop a robust strategy to address this problem and stop doing isolated one off initiatives that cash strapped Clinical Commissioning Groups find hard to fund.’
Meanwhile, almost half of the public in England say if they could make one improvement to their GP practice, it would be to increase the number of doctors, according to a survey commissioned by the BMA.
These findings underpin a campaign launched by the BMA – ‘Support Your Surgery’ – encouraging members of the public to support the Association’s call for government investment in General Practice to provide better services.
As part of the campaign, a petition has been set up by the BMA for the public to sign, which calls on the Westminster government to fund improved buildings and source more GPs.
The campaign also explains the pressures on General Practice, and why it’s been difficult for patients to see their GP face-to-face over the last 18 months.
Demand on General Practice and its workforce increased hugely during the pandemic, as practices kept patients safe by introducing infection control measures which has limited the number of people GPs and their staff could see face-to-face.
Although 58% of the public surveyed support these measures, GPs know this has been frustrating – in fact, a recent BMA survey found that one-in-five GPs reported being threatened, and another 67% said their experience of abuse, threatening behaviour or violence had got worse in the last year.
60% of those surveyed felt that the government, local commissioning groups and NHS management were largely responsible for the backlog of care and lack of access to a GP, with just a quarter feeling that GPs and other healthcare staff in surgeries were to blame.
Dr Richard Vautrey, GP committee chair at the BMA, said: ‘This campaign is about being upfront and honest with our patients.
‘We know that Covid-19 has changed how GP services look and feel, and that it can be incredibly frustrating for patients who just want to see their doctor, face-to-face, without delay.
‘We, like the rest of the NHS, were ill-prepared for the pandemic – with decades of underfunding and seriously short on staff, and the consequences of the last 18 months have added significantly to these pressures.
‘They have also been understandably very stressful for patients and, sadly, this has resulted in poor behaviours, or worse, with some staff reporting cases of abuse and violence from patients.
‘This isn’t the way we want it to be. GPs and their teams are just as frustrated, and while the general practice workforce have done everything in their power to improve pressures in their own surgeries, we can’t make the changes we and our patients want to see without urgent government backing and funding.
‘It’s important that patients understand the reality of this crisis and that, despite the easing of lockdown, the pressures on general practice will only get worse if nothing is done.
‘Not only is Covid-19 still a threat, but GPs also continue to deliver the vaccine rollout; annual winter pressures and the flu season could make things worse; and the backlog of care is constantly growing.
‘General practice is at a crossroads and the route for general practice to get through this crisis isn’t guaranteed at the moment.
‘All doctors want to do is help their patients, but we need the right funding and resources to do that, and to the standard that our communities understandably expect.
‘We hope this campaign, with GPs and patients working together, is the beginning of not only giving general practice what it needs, but also what our patients rightfully deserve.
‘We therefore urge everyone to sign our petition calling on government to provide the funding we need for better services and more doctors. If you support your surgery, it means it can be there to support you.’
BritainThinks surveyed a nationally representative sample of 1,732 adults in England online between 6th and 8th August 2021.
‘1 If you could make one improvement to your registered NHS GP surgery, what would it be? If there is more than one improvement you would like to see, please pick the one that is most important to you personally.
- Increase in the number of doctors: 44%;
- Increase in the number of available phone lines: 14%;
- Increase in the number of healthcare staff (other than doctors): 10%;
- Increase in the number of practice nurses: 7%;
- Improved facilities: 3%;
- Increase in the number of admin or clerical staff: 3%;
- Extension to the existing practice buildings: 2%;
- Other: 5%;
- I would not make any improvement: 13%.
2. The coronavirus pandemic has meant that NHS settings including GP surgeries have had to make changes to how they work, including reducing the number of people in waiting rooms, limiting the amount of face-to-face appointments they provide, and maintaining mask wearing in NHS buildings.
These changes have been in line with guidelines set by government to limit the spread of the virus and protect patients, GPs and other NHS staff. On a scale of 0-10 (with 0 being strongly oppose and 10 being strongly support), how far do you support or oppose these measures:
- 7-10: 58%;
- 4-6: 28%;
- 0-3: 14%.
3. There is currently a significant backlog in routine face-to-face appointments in General Practice.
By routine appointments, we mean an appointment that is booked in advance.
Who do you believe is responsible for addressing this backlog in general practice?
If you feel there is more than one group who is responsible, please pick the group who you think has the greatest share of responsibility.
- Government: 27%;
- GPs and other healthcare staff working in GP surgeries: 26%;
- The people who are responsible for the management of the NHS as a whole: 19%;
- Local commissioning groups: 14%;
- Other: 1%;
• Don’t know: 14%.’