Stress in general practice threatens promise to increase GP numbers

A new report from the Health Foundation – Stressed and overworked – paints a grim picture of the state of UK primary care. The analysis is based on a Commonwealth Fund survey of nearly 10,000 GPs in 10 high-income countries including the UK, France, Germany, New Zealand and the United States.

A majority of GPs in all the countries surveyed are dealing with higher workloads following the pandemic and many have experienced greater stress. But GPs in the UK reported higher levels of emotional distress and bigger rises in workload than GPs in nearly all other countries. Many are considering leaving the profession altogether, the Health Foundation said.

Nearly three quarters of GPs said their job was ‘extremely’ or ‘very’ stressful – similar to stress levels in Germany but higher than in all the other countries. And this represents an 11 percentage point increase in the numbers reporting high stress compared with 2019. UK GPs also reported the lowest levels of satisfaction with practising medicine – with just one in four declaring themselves ‘extremely’ or ‘very’ satisfied. Half of UK GPs taking part in the survey said that the quality of care they provide is worse now than it was before the pandemic.

However, the survey did highlight some of UK general practice’s core strengths. GPs saw themselves as well prepared to manage long-term conditions and mental health needs and were more confident with managing dementia than in most other countries. The UK also came out well in terms of online access to services, using electronic patient records and using data to inform care.

The findings come in the context of government commitments to increase the number of GPs. The foundation said that despite these pledges, the number of full-time equivalent, fully qualified GPs in England has fallen since 2015. According to the latest statistics, published this week, the number of fully qualified GPs, excluding regular locums and GPs in training, now stands at 26,631, almost 2,000 fewer than in September 2015.

The foundation also highlighted its previous research suggesting that the NHS already had a GP shortage of 4,200 in 2021/22 and that this could grow to 8,800 by 2031. (The government points to an increase in all GP numbers in the last three years, which includes GPs in training.)

Hugh Alderwick (pictured), director of policy at the Health Foundation, said the findings should ring alarm bells for the government. ‘Decisive policy action is needed to improve the working lives of GPs – including to boost GP capacity, reduce workload, and make use of wider primary care staff,’ he said. ‘The government has promised that its much-delayed workforce plan for the NHS will be published shortly, but the promise of new doctors will be little good if the NHS cannot retain the ones it already has.’

Ruth Rankine, director of the NHS Confederation's primary care network, said that the workload and stress levels would get worse unless the staffing crisis was addressed. ‘In the short term, the government must be honest with patients about what primary care and our dwindling pool of GPs can deliver and, in the long-term, work to boost their numbers,’ she said. ‘A fully funded, fully thought-out workforce plan cannot come soon enough for primary care leaders, who will be concerned about the chances of successfully delivering recovery plans with a currently understaffed and overwhelmed workforce.’