What is being done to alleviate GP workforce problems

There are structural problems around recruitment that affects what practices can do. Commissioners, primary care networks and practices themselves are all implementing ways to support the general practice workforce. But, it seems, circumstance trumps all such initiatives, finds Jaimie Kaffash

GP practices are limited in what they can do to address workforce problems. As we have seen, there are structural issues that have a great effect on staffing levels – specifically around funding and deprivation. But it is not just practices that struggle – there are few initiatives at national, ICB and PCN level that seem to have any effect.

We asked practices, PCNs and ICBs what is being done to alleviate recruitment problems, and we have summarised their answers below, as well as looked at some national initiatives.  

Practices

GP practices have even more limited scope to put in place measures to increase recruitment. Some have started campaigns with their patients – for example, a town in Cornwall organised a flash mob and produced a music video to attract GPs to its surgery – and succeeded in finding a new GP. Across the county border, a patient participation group at a GP surgery in Devon put out an advert for a GP, promising ‘a great “lifestyle” choice for any doctor who thrives on the great outdoors and all the fabulous natural wonders this area has to offer.’ Meanwhile, a patients’ group in Shropshire looked to buy its local GP surgery building, to save it from closure and make it more attractive to new doctors.

These cases are, of course, uncommon. For most GP practices that responded to the Management in Practice and Pulse and surveys, the keys to successful recruitment were being a training practice, longstanding reputations and structural factors, such as being in affluent, convenient locations. 

An anonymous practice manager in the North East says: ‘We benefit hugely from being a well-regarded practice, in a modern building, in a popular market town within commuting distance of a major city and being a training practice. Half of our GPs were registrars here. So basically we are in a good position for recruitment and feel very lucky. I think beyond that we have a good team and fair working conditions. I don’t feel we have had to do anything special when it comes to recruitment.’

One GP principal and trainer in Kent tells a similar story: ‘We have been doing well in terms of recruitment, primarily because we tend to retain our resident doctors. We are in an area of high growth – in 2012, we were at 12,500 patients on our list but now it’s 21,000 and we have had to consistently recruit as the list size has gone up. The ST3 year is pretty much a one-year interview that results in the residents staying.’

Berkshire GP Dr Rupert Woolley says his practice has a full complement of doctors. ‘We have been very lucky with our staffing over the years. I think one of the big things is being a training practice. The last four appointments are doctors who trained here. Having trained here they know what to expect when they join and we know what we are getting. It also means they are people who are fairly settled and want to stay around here.

‘We are a dispensing practice and own our building, so we are financially stable which makes it a more appealing prospect for partners. And the salaried doctors know there is a prospect of partnership as and when retirements happen.’

One point they all agree with is that they have benefited from happenstance. Dr Woolley says: ‘I realise we have been lucky, I imagine a lot of practices have previously had similar stable models but it only takes one or two unexpected departures, through ill health or other personal reasons, to destabilise a situation and lead to a downward spiral where life is harder for the remaining team. This increases the likelihood of further doctors leaving and a reputation of high turnover or a difficult working environment makes it harder to recruit.’

The GP principal in Kent says: ‘If we were not a training practice, things would probably be more challenging.’ And the practice manager in the North East says: ‘Other practices won’t have those advantages and may struggle through no fault of their own.’

PCNs

Since the addition of newly qualified GPs to the ARRS, some PCNs have been taking a longer-term view. Retention is one of the major problems for the GP workforce, and some PCNs are offering more responsibilities for newly qualified GPs who want this, such as helping them develop a speciality area, running a population health project or shadowing the PCN’s clinical director.

Then there are initiatives to take the pressure off the existing workforce. For example, some PCNs are using ARRS-funded GPs to support practices that have a heavy care home workload by providing cover at the surgery. PCNs are also responsible for running enhanced-access clinics outside normal hours, which are open to all practices within the PCN allowing them a number of extra appointments at more flexible times.

There are also softer measures that are in part designed to place GPs back at the heart of their communities. Some PCNs are using link workers to support patients with dementia cafes, or similar initiatives to alleviate loneliness. PCNs also run community wellbeing days offering health education and proactive, preventative care that, in time, should ease the burden on general practice. They support group consultations, with ARRS staff seeing 20-30 patients across a longer appointment session, and use care coordinators to manage patients with particular conditions to prevent exacerbations or decline. PCN pharmacists carry out structured medication reviews, while digital and transformation leads develop practice systems to increase automation and save time on tasks such as pill checks.

National level initiatives

The majority of plans revolve around training, as we have discussed in the previous articles, but there are a few others.

Retention

There is a National GP Retention Scheme in place, which provides additional funding to both the practice and the GP. It sets three criteria: first, the GP is seriously considering leaving the profession for personal reasons, is approaching retirement, or requires greater flexibility; second, that a regular part-time role won’t meet the GP’s needs; and third, that practices ensure making time for educational supervision for the retainee.

The GPs themselves are given expenses allowances worth £1,000 per year for every weekly session they undertake, up to £4,000, so a GP working three sessions per week will receive £3,000 per year. The practice is eligible for £76.92 per session, up to four sessions a week, worth up to £16,000 a year. This funding is available for five years per doctor. But as helpful as this scheme is, seven years after its introduction in 2017, only 289 GP retainees were practising in England as of October 2024.

The previous government’s big idea around changing the taxation rules has had an effect, but not enough. BMA Pensions Committee deputy chair Dr Krishan Aggarwal calls the changes ‘welcome but not a long-term fix’. He says the annual allowance has not been indexed to inflation, and there has been no ‘meaningful’ reform of the tapered annual allowance, which, in effect, ‘is leaving senior doctors with an immediate risk of paying to work’.

Other measures in the NHS Workforce Report tend to focus around cultural changes, such as diversity and whistleblowing. Yet these are much more apt for secondary care than general practices.

For nurses, the situation is bleaker. NHS England last year cut funding for a fellowship scheme designed to improve retention. Instead, ICBs will need to find this funding. At the time, Queen’s Nursing Institute chief executive Dr Crystal Oldman said:

‘There is a plethora of evidence of the benefits of the GPN fellowship in recruiting and retaining registered nurses in general practice, which should make continuing the funding via an ICB irresistible to the commissioners.’

Staff and associate specialists

Over the past few years, NHS England have been pushing the idea of staff and associate specialist (SAS) doctors – predominantly sub-consultant doctors who are not working towards a Certificate of Completion of Training – working in general practice. There is also a high proportion of international medical graduates (IMGs) in this group.

The GMC originally floated the idea of these doctors entering general practice to alleviate workforce issues in 2022. The workforce plan committed to ‘ensure that doctors other than GPs are more easily able to work in primary care’, adding that the medical workforce ‘is expected to change over the next 15 years’, with more SAS doctors and doctors in training choosing different career paths including general practice.

NHS England denied there were pilots involving SAS doctors in general practice, after the BMA’s GP Committee England chair Dr Katie Bramall-Stainer claimed they were ‘colluding in the demise of the [GP] profession]’ by promoting the idea of ‘primary care doctors’ in July 2024. So far there have been no further developments.

Other NHS England initiatives

There are other initiatives, such as the fellowship programme, which encourages portfolio working; locum pools, which allow ICBs to ‘deploy local GPs flexibly in an ongoing way’; a returners scheme that offers ‘flexible, streamlined and personalised pathways built around the individual needs’ of GPs who have left the profession to go abroad, start a family, or for any other reason; and a mentoring scheme that aims to retain experienced GPs at the same time as encouraging the next generation.

Although, it has just been announced that NHS England is stopping its ‘golden handshake’ scheme that offers £20,000 to GPs who take partnerships in hard-to-recruit areas.

ICBs

NHS England and successive governments have emphasised that ICBs have the scope to improve recruitment and retention in general practice, despite not managing the contract. So what exactly are they doing? We asked every ICB in England to provide on-the-record details of what funding, schemes and challenges they have in regard to the GP workforce.

There are a few things that come out of their responses. First, very few have particularly innovative schemes – or at least ones they were willing to share. Most emphasise training hubs, but these tend to simply facilitate GPs coming into the system, not necessarily finding ways of boosting recruitment.   

Second, those who have focused on general practice with targeted schemes seem to be seeing some limited success. This includes Devon, where they have succeeded in GP locums moving into substantive posts, and Coventry, where schemes around parental leave and their locum workforce have significantly improved staff-patient ratios.

Third, while many ICBs stressed that growing the general practice workforce is a priority for them – retention as well as recruitment – a minority responded that they didn’t know where the shortages are. For those who were able to identify shortages – or a lack of roles to recruit to – GPs remained the most in-demand role, followed by practice nurses. Several ICBs told us they had developed schemes and put in place specific support to address an ageing practice nurse workforce.

Of course, they too are suffering funding squeezes. Humber and North Yorkshire ICB had schemes in place around paramedic rotation, GP fellowships, supporting mid-career GPs to develop special interests to improve retention, and an international GP scheme in partnership with health authorities in Kerala, India among others. But GP and primary care workforce lead Dr Kevin Anderson says: ‘Unfortunately, due to well-publicised financial pressures in our system and wider NHS, some of the funding for primary care workforce we had been able to access in 2024 is unlikely to be available in 2025, which is disappointing given our achievements over the past 12 months. Sadly, this means many of our schemes may not have the funding to continue or have already ended.’

It seems practices are not the only health organisations whose workforce plans are scuppered through underfunding.