Spending on general practice in England has grown in the past four years, following a slight decline. Estimates suggest that GPs’ workload has risen faster than spending – that suggests they have become more efficient, for example by pooling resources between practices and making more use of telephone consultations.
But lengthening waits for appointments show that these strategies have not been enough to allow GPs to keep up with rising demand.
For full citations and further details see the general practice chapter from Performance Tracker 2018. This analysis is drawn from Performance Tracker, produced by the Institute for Government in partnership with CIPFA.
1. Spending on general practice has increased by nearly 17% in real terms since 2010/11.
- After a drop in spending to 2012/13, spending on general practice has increased. In 2017/18, almost £10.9bn was spent on General Practice in England.
- But general practice still receives only a small proportion of NHS funding. In 2017/18, only 7.2% of commissioning funds were allocated to general practice.
2. Population-level demand for consultations grew by 8% between 2010 and 2017.
- We estimate that demand for general practice services is likely to have risen faster than the population is growing. The population of England grew by 5.7% between 2010 and 2017.
- We have not had good data on GP consultations. The number of consultations increased by 38% between 1995 and 2008 (from 217m to 300m), but have not had good national data since then.
- Nevertheless, we think GP workloads have increased faster than our estimate of demand would suggest. The King’s Fund estimated that general practice workload increased by 16% between 2007 and 2014; a second study from The King’s Fund estimated 15% more consultations took place in 2014/15 than in 2010/11.
Several things might explain this faster increase in workload:
- Patients have more complex needs, and that means more work for GPs. An analysis of one practice by The Health Foundation in 2017 found that, of frequent GP attendees (those that attended twice a week), 53% had attended A&E more than twice the previous year, 69% had a long-term condition, 43% had been diagnosed with depression and 33% were over the age of 60.
- Other parts of the health system have been cut. Public health saw a 17% real-terms reduction in spending between 2014/15 and 2018/19, and the number of community nurses has dropped by 15% between September 2009 and May 2018 (to 35,221).
- Better access might have led to supply-induced demand. Although improved access to GP services might prevent unnecessary use of expensive secondary care services, it might also encourage patients to visit general practice to seek assurance for complaints that might not require medical intervention.
3. The number of GPs fell by 5% (to 32,370) between 2015 and 2018.
- But the number of full-time equivalent GPs (excluding locums) has been falling since 2015. This is despite the Government’s commitment to recruit 5,000 GPs between 2015 and 2020, and a 6.2% increase in GP numbers between 2010 and 2014.
- The number of locums has increased, but not by enough. Although the number of locums in general practice peaked in September 2017 (at 1,029), the total number of practitioners fell by 4.1% between September 2015 and March 2018.
4. There was a 13% drop in job satisfation among GPs between 2010 and 2018.
- GPs are stressed. The GP Worklife Survey showed a rise in all the stress factors it surveyed, with the factors cited as causing the most stress being increased workloads, insufficient time to perform work and paperwork.
- And lots of them say they want to leave general practice. In the 2017 GP Worklife Survey, 39% of GPs expressed an intention to leave direct patient care within five years (up from 22% in 2010).
5. There has been a 34% increase in professionals in general practice who are neither doctors nor nurses.
- General practices are increasingly employing different types of staff to provide services. This includes health care assistants, physiotherapists and phlebotomists
- Other practice staff numbers have also increased. The number of general practice nurses increased by 3% from September 2015 to June 2018; administrative staff numbers grew by 2% in the same period; but the number of GP practice managers declined by 6.3%, likely driven by the trend towards fewer, larger practices.
6. In 2018, 9% of patients reported having a GP consultation over the phone.
- This is up from 5.5% in 2012. This is just one of the ways that GP services are changing.
- More patients are booking appointments online. Between 2012 and 2017, the proportion of patients who had booked an appointment online in the previous six months increased from 6.8% to 8.9%. In response to a slightly different question asked in 2018, 12.9% of patients said they had booked an appointment online in the previous year.
- Practices are increasingly pooling their resources. Between 2010 and 2018, the share of practices with only one GP fell from 15% to 11%, while the proportion with five or more GPs increased from 41% to 47%. The overall number of practice numbers fell by 13%, to 7,271.
- They are also collaborating more. The Nuffield Trust estimated in 2017 that 81% of practices were part of a collaboration, up from 73% in 2015.
7. In 2018, 84% of patients rated their overall experience as 'good' or 'very good', down from 88% in 2012.
- Overall satisfaction with GP services has declined in recent years. 65% of respondents to the British Attitude Survey in 2017 were satisfied with general practice, compared with 77% in 2010; this saw general practice drop form the most popular part of the NHS to the second most popular (behind outpatient treatment).
8. But patients still overwhelmingly trust the care they receive.
- In 2018, 94.8% of patients reported that their needs were met to some extent during their last appointment
- And most practices are still rated highly. As of May 2017, CQC rated 90% of practices as ‘good’ or ‘outstanding’ (although only 85% of practices achieved these ratings for ‘being safe’). In March 2018, no out-of-hours GP services were rated as inadequate by CQC, with 89% scoring ‘good’ or ‘outstanding’.
9. The proportion of patients being seen a week or more after requesting an appointment has risen substantially.
- The proportion of patients being seen a week of more after requesting an appointment rose from 13% in 2012 to 20% in 2017.
- However, same-day appointments have increased slightly. The proportion of patients seen on the same day as requesting an appointment has been broadly flat between 20012 and 2016, with a slight rise in 2017 to 38%. This dropped to 33% in the 2018 survey (after a methodological change). That suggests GPs are prioritising patients with the most urgent needs.
- The number of practices closing their lists (not registering new patients) has increased, but so has the number of list closures being refused by NHS England. In 2012 there were 40 applications for list closures, with 20% refused. In 2016/17 there were 230 applications, with 37% refused.
10. The British Journal of General Practice reported a 27.5% decline in the continuity of care between 2012 and 2017.
- The percentage of patients with a preferred GP who saw them ‘always, or almost always, or a lot of the time’ fell from 65.3% to 50.2% between 2012 and 2018.