Retention remains one of the biggest problems within general practice, and this looks unlikely to change. Only 55% of GPs surveyed by sister title Pulse said they expect to be working in UK general practice in five years. It is a similar case for nurses – just 36% said they see themselves in general practice in five years’ time. Practice pharmacists are content, in comparison.
GPs
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.
Another measure the previous Government enacted was changing rules around the taxation of pensions for doctors. The previous situation had seen GPs refusing shifts or retiring because working would have cost them money due to having exceeded either annual or lifetime tax-free pensions allowances.
This change 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 plan focused on cultural changes – aimed at making the NHS more inclusive for staff who are overseas graduates, or strengthening the freedom to speak out. Laudable though these initiatives are, they largely targeted the NHS as an employer – which, in general practice, it is not.
For example, an emphasis on the ‘freedom to speak out’ is very different for small organisations like general practices compared with the wider NHS as an employer.
These measures do not appear to have been developed with the important goal in mind of stemming the flow of leavers from general practice.
Nurses
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.’
Provisions for retention of practice staff were included in the May 2022 ‘Fuller Stocktake’, led by Dr Clare Fuller, a GP who is now a medical director at NHS England – this was referenced in the workforce plan. The focus in the Fuller report was on the configuration of general practice, integrating services and improving same-day access. But there were a few recommendations around retention. It called for the ‘NHS staff survey’ – which at the time was being piloted – to be rolled out nationwide to general practice. The first results were obtained by sister title Pulse, but were not published nationwide.
Only 22 of the 42 ICBs participated, but the results showed that GP practices scored highest of all NHS bodies on their ‘compassion and inclusivity’.
However, the main problem with GP retention is burnout. The GMC’s Completing the Picture report, cited in the RCGP’s September 2022 Fit for the Future: Retaining the GP Workforce report, found it was the second most common reason for GPs leaving the profession (43%) – not far off the proportion citing retirement (56%).
The same is true of practice nurses. One ANP responding to sister title Nursing in Practice’s September survey described how their workload had increased and become more complex, making it hard to take their unpaid lunch break. They now plan to take early retirement 15 months early due to stress and burnout and said they will be ‘financially worse off ’ following this.
This was acknowledged by the Fuller report. It called for ‘parity of access to system staff health and wellbeing hubs and occupational health services’. There is an established service for GPs seeking mental health support – the NHS Practitioner Health programme. It was originally for GPs only, but was later opened up to secondary care doctors and dentists. The programme is not open to staff in general practice and it looks unlikely to be extended any time soon – last April, NHS England withdrew funding for secondary care staff, despite the workforce plan’s emphasis on wellbeing. While NHS England reversed that decision, there are no signs it will widen access to the programme in the near future.
But treating the symptoms of burnout is not enough. What is most necessary is addressing the causes. This can only be done by making the jobs more tolerable, which will involve boosting workforce numbers. This may be a Catch-22, but it does suggest that retention will be improved once there are more of the right healthcare practitioners working in general practice.
The ICB role in GP retention
ICBs are limited with what they can do to boost primary care recruitment. They don’t negotiate the national contract, and they don’t directly employ the workforce. However, despite these significant parameters, NHS England and successive governments have emphasised that they have the scope to improve recruitment and retention in general practice.
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. Most are supporting practices through their training hubs. These training hubs are, on the whole, responsible for workforce issues in the ICBs, and are funded through both the local commissioners and NHS England.
The hubs themselves help to support fellowships to help retain staff, support practices with Tier 2 visa applications, support apprenticeship recruitment directly, respond with advice when asked, aid newly qualified GPs in finding work, provide mentorship as well as upskilling existing staff.
For example, Cambridgeshire and Peterborough ICB said their two-year fellowship programme for new GPs and nurses – run in conjunction with the training hub – has ‘had a strong impact on retention’ and has helped them retain staff at levels that are higher than peers across the region.
Those who have focused on general practice with targeted schemes seem to be seeing some limited success, such as Devon and Coventry. The focus in Devon on recruitment and retention of GPs has seen a shift in GP locums moving away from locuming in favour of seeking substantive posts, while Coventry has been building on its relationship with Warwick medical school and has developed programmes to support GPs on parental leave and locum workforce – this has helped them achieve some of the best staff -patient ratios in England.
In Kent and Medway, a community educator facilitator team is based in each PCN – so far 125 practices and 17 PCNs have taken up individual workforce planning support and have used their population health data to make sure that each practice has the right workforce plans.
Black Country put in place a portfolio careers scheme which supported 93 individuals between 2018 and 2024. An evaluation conducted in early 2024 showed demonstrable impact on staff satisfaction (72% agreed) and retention (76% agreed). Others including Manchester are focusing on flexible careers.
In Shropshire, Telford and Wrekin, a small team of GP leads support newly qualified GPs in finding work, and provide networking/resilience support for other cohorts of GPs, including female GPs, older GPs and GP partners. Other ICBs have talked about nurse support from experienced colleagues.
While many ICBs stressed that growing the general practice workforce is a priority for them – retention as well as recruitment – a minority seem unclear what their primary care staff requirements are locally. Some 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. But a high number identified a shortage in practice nurses – both in recruiting new nurses and retaining experienced staff. Several ICBs told us they had developed schemes and put in place specific support to address an ageing practice nurse workforce.
Funding pressures
Finally, of course, there is the issue of funding. ICBs themselves are strapped for cash, and are often under pressure to fund secondary care. The funding given to ICBs through service development funds (SDF) is additional to their baseline allocations from NHS England and is meant to be spent on primary care.
There are pots of ringfenced funding, including: £44m for general practice fellowship and supporting mentors schemes; £5m for ‘new to partnership’ payment schemes; and £13m for GP IT infrastructure and resilience.
There is also £127m available for ‘primary care transformation’. But this now incorporates funding that had previously been ringfenced itself for general practice workforce issues, including local GP retention, training hubs, and recruitment and retention. The funding for digital-first primary care has also been included in the transformation fund.
Funding pots to ICB to support general practice
| Primary care transformation (includes funding previously ringfenced for local GP retention fund, training hubs, recruitment and retention and digital first primary care) | £126.9 million |
| Additional centrally held funding for ARRS for ICBs to draw-down when needed | £534 million |
| General practice fellowship and supporting mentors schemes | £44.3 million |
| New to Partnerships Payments Scheme | £5 million |
| International GP recruitment programme (IGPR), return to practice programme (RTP) and international induction programme (IIP) | Funding available as part of broader workforce budgets |
| GP IT infrastructure and resilience | £13 million |
Yet the transformation fund is not targeted on wider workforce issues – it specifies ‘tackling the 8am rush and reducing the number of people struggling to contact their general practice [and] for patients to know, on the day that they contact their general practice, how their request will be managed’. Many ICBs said they would continue to use this funding for workforce issues (and ensuring general practice has adequate staff is clearly key to meeting aims around access). But crucially, this funding does not necessarily need to be spent on workforce.
In the case of Humber and North Yorkshire ICB, funding squeezes are having an effect on attempts to improve the general practice workforce. It 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.
GP and primary care workforce lead Dr Kevin Anderson says the ICB has ‘created a supportive and collaborative system for innovative workforce development’. However, he adds: ‘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.’
W hat ICBs say they are doing for the general practice workforce
For this report we asked all 42 ICBs in England about the general practice workforce in their region: initiatives they have put in place, dedicated funding and particular challenges. All provided an answer. Many focused on standard programmes, such as training hubs and the ARRS.
| ICB | What ICBs say about particular problems, solutions and funding |
| Bath and North East Somerset, Swindon and Wiltshire | Third highest FTE GP staff per weighted 10,000 patients • Upskilling administration staff to support care navigation • ARRS roles utilisation is at 98% • Supply of newly qualified nurses wishing to be GPNs is higher than vacancies available in the ICB area |
| Bedfordshire, Luton and Milton Keynes | Invested £197k to support recruitment, retention and education • Provides recruitment advice and advertising support, health and wellbeing resources, and a range of training, fellowships • Ringfenced CPD allocation from NHS England of £121k for nurses and AHPs. |
| Birmingham and Solihull | Shortages in direct patient care roles in general practice, including nurses • Provides enhanced support for newly qualified GPs • Uses national general practice flexible staff pools scheme, GP mentors, New to Partnership payment scheme and GP retention scheme |
| Black Country | Lowest leaver rate for GPs nationally, and eighth highest rate for GPs joining the workforce. Shortages include paramedics, general practice assistants and physician associates • Direct patient care staff now outnumber qualified GPs • Portfolio careers scheme supported 93 individuals between 2018 and 2024 • Still using SDF (service development funding) for primary care workforce initiatives |
| Bristol, North Somerset and South Gloucestershire | Struggling with recruiting practice nurses • Recently launched an 18-month project to review and improve non-clinical staff training • There is no formal funding for core general practice training or a general practice learning and development ‘department |
| Buckinghamshire, Oxfordshire and Berkshire West | Works with partners to scope, review and prioritise support offers for primary care workforce • Fully utilises emerging national, regional and local support offers, such as GP improvement programme, GP retainer scheme, coaching and mentoring, flexible pool for nurses and GPs two-year new to practice fellowship programme and PCN learning environments |
| Cambridgeshire and Peterborough | FTE GP numbers are above target, with an increase of 4.4% FTE in last 12 months and 11.4% since 2019 (compared to regional growth at 4.7%) • Two-year fellowship programme for new GPs and nurses has had a strong impact on retention and has helped retain staff at levels that are higher than peers across the region • Using ARRS budget to train, recruit and retain patient-facing staff in primary care |
| Cheshire and Merseyside | Currently 44 GPs on the National GP retention scheme • 148 GPs currently on two-year fellowship programme, supported by 25 GP mentors • 56 nurses on fellowship programme • New cohort of 25 nurses commenced on nurse preceptorship programme |
| Cornwall and the Isles of Scilly | The Cornwall Training Hub, delivered in partnership with Kernow Health CIC, receives primary care transformation funding through an SDF and utilises this to facilitate clinical and non-clinical workforce support across general practice |
| Coventry and Warwickshire | Above-average number of GPs per 1,000 patients, partly due to high number of GP trainees. Strong relationships with Warwick Medical School has supported high retention • ICB continues to use SDF funding of £460k and further budget of £700k to commission support services including First5, last five, induction, wellbeing, mentorship and retention schemes • Comprehensive and integrated primary care workforce people plan with senior clinical and managerial input is being finalised to drive future work programme |
| Derbyshire | All primary care professions have struggles. Dedicated budget around £1.6m, it is majority ringfenced and is delegated to the training hub • All of the national retention schemes are in place and the training hub offers a range of practical and wellbeing support to ensure staff can continue in their roles. Has an ‘excellent’ induction programme for new starters in the area |
| Devon | Focusing on recruitment and retention of GPs. There has been a shift in GPs returning from locum service to look for substantive posts • There is a general practice nurse strategy with plans in place for a legacy mentoring scheme and other pilot schemes to aid retention and to support those new to general practice • Supporting recruitment by attending key recruitment events and careers fairs, and promote working in Devon |
| Dorset | Shortages across all primary care workforce, scoping work being done – focus on pharmacy and optometry • Already in place are a GP retention scheme, a GP fellowship offer, a community of practice to provide peer support and education to GP nurses and ACPs, and looking to reinvigorate one for FCPs |
| Frimley | Shortages of GPs and practice nurses • Comprehensive and integrated primary care workforce strategy with senior clinical and managerial input • SDF from NHS England is ringfenced. Projects include extensive fellowship programme |
| Gloucestershire | GP partner numbers remain high compared with regional average, and practice nurse numbers are above national average Some of ICB SDF allocated to the training hub to deliver programmes including practice nurse measures and GP retention Local GP and GPN Fellowship scheme to replace the NHSE scheme, branded ‘Spark’ locally |
| Greater Manchester | Reducing barriers for nurses entering general practice (pilot launched in Oldham) • Flexible, inclusive recruitment models at all levels and adopting hybrid roles • Equitable access to training and development • Created a central careers page for Greater Manchester • More support for international GPs to stay in practice |
| Hampshire and the Isle of Wight | Comprehensive and integrated primary care workforce strategy with senior clinical and managerial input • Annually allocate a ringfenced portion of the SDF for workforce-related programmes. This includes a continued commitment to fund the new to practice fellowship scheme |
| Herefordshire and Worcestershire | ICB working closely with Herefordshire and Worcestershire Training Hub to invest in local workforce attraction and retention schemes such as First5, partnership development programme, nurse attraction and practice manager leadership |
| Hertfordshire and West Essex | Primary care training hub activities include: developing strong relationships with universities and colleges; working with NHS England to support the international recruitment programme; offering practices support with gaining a visa sponsorship licence; running/attending primary care careers fairs; commissioning primary care careers and the National Association of Sessional GPs to support practices with recruitment • Range of GP fellowship programmes plus support (including conferences, networking, career conversations) for GPs and practice staff at various stages of their career and aspiring educators scheme for experienced GPs. Protected time to learn events in GP practices to set aside time for staff development |
| Humber and North Yorkshire | Workforce and training hub was one of the first in the country • Examples of sustainable models for new roles (which don’t destabilise other parts of the system) such as paramedic rotation scheme • Catalyst GP fellowship programme has vastly improved GP recruitment in the region • Phoenix fellowship programme designed to support mid-career GPs to develop special interest, improving retention and preventing burnout • Commissioned mentor programme for GPs, practice managers, nurses and other practice staff. Since 2021 this has provided more than 700 course places to practice staff and supported 225 mentees • Working with partners in Kerala, India to develop an international UK GP fellowship programme • However, schemes may be cut due to cost pressures – ‘which is disappointing given achievements over the past 12 months’ |
| Kent and Medway | A large older population with multiple comorbidities and high under-14 population which places burden on primary care ‘It is the role of primary care contract holders to tailor their workforce to meet the needs of their patients depending on local needs. The ICB supports them in identifying and fulfilling their workforce needs through the Kent and Medway Primary Care Training Hub.’ To date, 125 practices and 17 PCNs have taken up individual workforce planning support • Funding for the skilled worker visa scheme has been provided and 61 practices now hold a sponsorship licence; 21 GPs, three paramedics and three pharmacists recruited so far |
| Lancashire and South Cumbria | Below-average numbers of GPs, but PCNs have been more successful in appointing to ARRS roles than other ICB areas The ICB funds retention and training of primary care staffing through the combined funding (with NHS England) of a training hub, whose remit is to deliver various workforce projects |
| Leicester, Leicestershire and Rutland | Locally funding GP fellowships, mentorships and mentors for GP fellows • GP practices can widen their candidate search by utilising the LMCs’ recruitment channel • Currently working up a local offer of support for newly qualified GPs following the cessation of the national fellowship scheme in March 2024 |
| Lincolnshire | Struggling to recruit clinical pharmacists, practice nurses, practice receptionists • Two subgroups looking specifically at retention and engagement for all multidisciplinary staff – introduced schemes such as the GP assistant programme |
| Mid and South Essex | Range of schemes to recruit, upskill and retain the wider primary care team, including GP fellowship schemes, increasing the number of training practices, expanding the number of healthcare roles working in primary care, GP partnership courses, structured clinical leadership support and other learning and development opportunities |
| Norfolk and Waveney | Shortages in nursing, physician associate and pharmacy roles, but improvements in GP training numbers • Additional budgets are utilised as part of workforce strategy, but these are not ringfenced and are aligned with broader system-wide priorities |
| North Central London | People strategy includes dedicated primary care workstreams for training, recruitment and retention of general practice staff Retaining SDF funding for training hub development, GP retention and nursing measures, despite ringfence being removed |
| North East and North Cumbria | Two PCNs hosting People Promise managers as part of the national improving staff experience programme • Career start nurse and GP programmes in many areas, as well as GP trainer schemes, clinical skills training and other local retention schemes • Support practices to become training practices for medical students • Protected learning time for practice teams including PCN staff, with a range of training options • Active support for healthcare assistants who wish to become nurse associates and potentially registered nurses • A £35m three-year plan to improve health in most deprived areas is supporting steps to attract and retain more GPs to work in deprived areas, with extra training and support to encourage trainee doctors to build their careers in these practices |
| North East London | Expanding approved training environments and placements • Supporting career development across all ages • Offering a wide range of training and educational opportunities |
| North West London | Particular focus on practice nurses. Overall initiatives include SPIN fellowships; advanced clinical skills training; peer support networks; coaching; mid-career and health inequality fellowships; preceptorship programmes to support newly qualified GPs; mentorships and leadership training • Onboarding fellowships to support the PCNs in their embedding and training of GPs hired under the ARRS • Workshops to support development of the ICB’s new workforce strategy |
| Northamptonshire | ‘Dedicated budget, which is made up of national funding’ |
| Nottingham and Nottinghamshire | Local new to practice offer for GPs to replace national scheme, which is stopping • Local new to practice offer for practice nurses GP mid-career fellowship scheme • Multi professional support unit for ARRS staff |
| South East London | Primary care workforce lower than national average as is the case across London. GP partners reducing year on year Development, recruitment and retention initiatives in place for primary care led by the workforce and development hub |
| Shropshire and Telford and Wrekin | Small team of GP leads support newly qualified GPs in finding work and provide networking/resilience support for other cohorts of GPs including female GPs, older GPs and GP partners • Anecdotally, many practices unable to recruit to GP vacancies due to financial pressures. Some challenges in recruiting experienced practice nurses |
| Somerset | As part of broader primary care recovery strategy, there is a dedicated workforce plan but ICB is currently undertaking a detailed review of it • Alongside funding from NHS England, the ICB has commissioned a training hub for specific primary care workforce initiatives, investing £370,000 in 2024/25 |
| South West London | Alongside funding from NHS England, the ICB has commissioned a training hub for specific primary care workforce initiatives, investing £370,000 in 2024/25 |
| South Yorkshire and Bassetlaw | Training hub delivers a number of programmes to support roles in general practice, including a local fellowship programme, aspiring practice manager programme and nurse vocational training scheme |
| Suffolk and North East Essex | Training hub delivers award-winning programmes, including fellowship programmes for GPs and nurses, and preceptorship for nursing associates • Programme for student nursing placements – a hybrid model of taught sessions and clinical placements to relieve pressure on supervisors and estate • GP support hub provides recruitment support, peer support, coaching, mid-career development, education and training for all GPs in the region • Currently developing immersive training programme for key clinical system priorities including chronic pain, dementia delivered via VR headsets, laptops or mobile phones |
| Surrey Heartlands | Has the largest GP FTE population per 100,000 patient, and has doubled GPs in training grades since March 2019. But the practice nurse population is lower than the regional average • Set up GP nurse forums, allowing them space to learn and share best practice, leading to increased job satisfaction and the safe delivery of quality care for the local population • Working with higher education institutions to promote general practice careers • Appointed a lead role for apprenticeships placed within the training hub |
| Sussex | Primary Care Workforce Plan was published in November 2024, one of the first in the country • Best performing area on GP numbers with 11% increase in two years. Ratio of patients per GP, has fallen from 2,370 to 2,172 • The training hub runs initiatives such as mentoring services, fellowship and development opportunities, groups to support retention, and the new to primary care programme for newly qualified doctors and new clinicians. The latter scheme has so far supported 148 GPs and has expanded to the wider primary care workforce to include nurses and other patient-facing staff |
| Staffordshire and Stoke-on-Trent | Two clinical workforce ‘champions’ in place at ground and system level to drive initiatives that support engagement, recruitment and retention of GPs • Six local GP retention initiatives in place • Collaborating with Staffordshire Training Hub to launch an ‘innovative’ General Practice Nursing (GPN ) School • Developing a Staffordshire and Stoke-on-Trent general practice workforce strategy by 2024 looking on how to make their system an attractive place to work to ensure recruitment and retention |
| West Yorkshire and Harrogate | Support has included fellowship programmes, mentorship for general practice staff, wellbeing education, group consultation training and maintaining access for West Yorkshire GP practices to a digitally enabled GP flexible pool |
This chapter is based on a major new white paper from the publishers of Healthcare Leader, Cogora, on the changing general practice workforce in England, in conjunction with the Rebuild General Practice campaign group. Alongside our sister titles – Pulse, Pulse PCN, Management in Practice, Nursing in Practice and The Pharmacist – we have surveyed around 2,500 general practice professionals, interviewed more than 100 frontline practitioners, analysed hundreds of data for every practice in England and brought together all the editorial expertise within our titles.
Download our General Practice Workforce White Paper here.
