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GP retention is in long-term decline, finds major study

by Caitlin Tilley
23 August 2021

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GP turnover saw 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’.

It found:

  • 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.’

The study also found that:

  • The 75th percentile for turnover was 11% in 2009, increasing to 18% in 2014 and then decreasing to 14% in 2019.
  • There was high regional variability in average turnover rates in 2007 and their changes over time. 
  • The biggest increase and highest levels in 2019 (from 6% to 12%) was reported by practices in the (former) NHS West Midlands strategic health authority.

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, professor 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, 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 LMCs chief executive Peter Higgins said the study ‘resonates with our experience’. 

He said: ‘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 really needs to develop a robust strategy to address this problem and stop doing isolated one off initiatives that cash strapped CCGs find hard to fund.’

The study, published today in BMJ Open, was part-funded by the Health Foundation think-tank through the Efficiency Research Programme.

It comes as Pulse reported that GP vacancy rates remain high, with one in seven posts unfilled.

The survey of almost 400 GPs – carried out in May – uncovered 301 full-time equivalent (FTE) posts are vacant, out of the 2,142 that respondents said their practices require.

Earlier this week, researchers urged the Government to address GP shortages, after a University of Cambridge study found that GP practices based in deprived areas have significantly fewer full time-equivalent GPs per 10,000 patients than those based in more affluent areas.

And a workforce study by the BMA found that each outgoing GP partner may need to be replaced by three new GPs due to shifting working patterns.

The BMA report said that nearly three salaried and sessional GPs were needed to replace the hours of one GP partner between March 2020 and March 2021, due to a ‘shift in GP working patterns’ combined with the loss of partners. 

The BMA recently accused the Government of being ‘disingenuous’ over its publication of the latest official figures, which showed the GP workforce had allegedly increased over the last 12 months.

This story first appeared on our sister title, Pulse.