The number of GP practices in England fell by 20% in a decade, while average list size expanded by 40%, a new study has found.
The analysis, published in BMJ Open, found that between 2013 and 2023, the number of practices fell from 8,044 to 6,419 – an average loss of 178 practices per year.
Citing our sister title Pulse’s exclusive analysis on practice closures, the authors pointed out that the closures have ‘a negative effect on income and patient satisfaction’ in remaining local practices that absorb the population and that may struggle to meet patient needs.
The study used data from NHS England, the Office for Health Improvement and Disparities (OHID) and the CQC, showing a reduction of 18% in unique practice postcodes in the past decade.
Single-handed partnership numbers ‘are falling at a faster rate’ than other forms of general practice ownership, but still count for 11% of practices.
‘The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%,’ the paper said.
The study, which was led by researchers at the London School of Hygiene & Tropical Medicine (LSHTM) and University College London (UCL), also found that:
- The average practice list size increased by 40% from 6,967 to 9,724 patients between 2013 and 2024
- The average proportion of patients aged 65 and over rose from just over 16% to 18% in the same time period.
Meanwhile, their analysis of available workforce data found:
- The total general practice workforce grew 20% between 2015 and 2022, ‘as a result of increases in admin staff and other practitioners’
- But the number of full-time equivalent GPs per 1,000 patients fell by 15% in the same time period, when accounting for working hours
- And the total number of qualified FTE GPs fell from 27,948 to 27,321 (627).
The paper also highlighted that the number of practices with lists exceeding 20,000 patients ‘has risen noticeably’. In 2013, these only represented 1% of practices (81) but that increased to 6% in 2023 (355).
The authors concluded: ‘Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1,000 patients.
‘We recommend that the impacts of these changes on access, quality and costs are closely monitored.’
The authors also pointed out that it was not possible to distinguish between practices that physically closed versus those which merged or were taken over by another practice to become a branch surgery.
They warned that falling FTE GP numbers ‘could lead to a tipping point’ where most general practice appointments are no longer delivered by GPs – and that the impact of a shift towards larger practices remains uncertain.
Dr Luisa Pettigrew, lead author of the study, a GP and NIHR Doctoral Research Fellow at LSHTM, said the new government must prioritise GP retention.
She said: ‘While the headcount of GPs in NHS general practice has marginally increased, when you factor in reported working hours and the growing population the total number of full-time equivalent GPs per 1,000 patients working in NHS general practice has fallen.
‘Trends point to a changing role for the GP partner, from a self-managing owner of a small business to holding responsibility for the governance of a much larger organisation and multidisciplinary team.
‘General practice in England appears to be in a period of transition, from the smaller partnership-based model of general practice to that of larger organisations with more administrative and multidisciplinary staff but fewer GPs.
‘However, patients are struggling to get appointments; concerns have been raised regarding the safety of introducing new roles without adequate supervision; and we are now facing the lowest ever levels of public satisfaction with general practice recorded.’
UCL Professor of Epidemiology and Health Informatics Irene Petersen said: ‘Our study highlights the importance of integrating data from multiple sources to gain a comprehensive understanding of the situation in NHS general practice across England.’
RCGP chair Professor Kamila Hawthorne said that this study shows ‘the gravity of the crisis in general practice’.
She said: ‘We need to recruit more, but crucially we need to retain more in the profession for longer, delivering patient care.
‘When these intense workload and workforce pressures lead to practices having to close, it is an enormous concern for GPs, their teams, and their patients – to close a practice will be one of the most difficult professional decisions a GP partner will have to make, and only after all other options have been exhausted.
‘The new Government has recognised the importance of general practice and has announced positive short-term steps to address some current recruitment issues.
‘But this study shows the gravity of the crisis in general practice. It is clear that our service is in dire need of more investment, including into significantly increasing the GP workforce through recruitment and retention initiatives that will alleviate current pressures and ensure we can deliver the care our patients need.’
Pulse’s award-winning investigation into practice closures in 2022 revealed that 474 surgeries across the UK have closed in the previous nine years without being replaced. Notably, small practices on lower funding in more deprived areas were most likely to be affected.
A version of this story was first published on our sister title Pulse.
