Workforce trends in primary care have highlighted the need for  “robust but flexible alternatives” to fixed site GPs, particularly if health inequalities are to be tackled, according to a senior GP.

A study from the University of Manchester has shown GP turnover has increased across England over the past decade and deprived areas hardest hit.

GPs leaving their positions rose steadily in almost all NHS regions between 2007 and 2019 but it was up to ten per cent higher in areas suffering from deprivation compared to more affluent areas.

With poorer areas often suffering greater chronic health conditions and lower life expectancy, this is a significant blow to those trying to combat inequalities within healthcare.

According to the study, the proportion of practices where between ten and forty per cent of GPs leave a practice within a year almost doubled across the time period and became steadily worse in the later part of the data set.

In 2009, 14 per cent of practices were classed as having a ‘high turnover’ almost doubling to 27 per cent in 2019.

The findings indicated a deeper problem for those practices where almost half of GPs leave in a year outside of the nationwide trends in general practice with the number remaining steady at around eight per cent. Practice-area deprivation was moderately associated with turnover rate, with practices in the most deprived areas having higher turnover rates compared with practices in the least deprived areas.

These findings tally with previous analysis showing a decline in the number of GP partners by 3.1% in the last year.

Major Crisis

‘We already know the GP workforce in England is going through a major crisis,” said the report’s co-author Professor Evan Kontopantelis.

“Rates of early retirement are increasing, as are intentions to reduce hours of working or leave their practice in the near future.”

‘We reveal worrying trends in GP turnover. 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.’

Dr Jay Verma, GP Partner in North West London said the findings ‘demonstrate a need for flexible working solutions to help those in deprived areas.’

‘On top of the existing work pressures within primary care, there is the humanitarian issue of people who already have to go without many things others take for granted being deprived access to a GP and other primary care professionals.

‘The need to change how we are working as a profession in order to make positive changes to population health is clear and I believe centres around developing robust but flexible primary care teams who can work remotely or on site, linked by software designed to work specifically in that environment.”

But Dr Verma also added the need for engagement with patients to explain how the many different clinicians in primary care can help – and how it may be quicker to be signposted to them without having to see a GP first.

‘The different roles within a primary care network have expanded significantly – from clinical pharmacists who can manage chronic condition and medicine reviews and who have years of training at university – through to paramedics, physios and mental health practitioners.’

‘The huge array of skills available for patients is something they should take advantage of without feeling like they are being fobbed off by not seeing a GP first. It’s about signposting them to the correct practitioner at the get-go and there is always the option to refer back to a doctor for a face to face appointment if it is needed.’

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