Today, we’re speaking to Dr Luisa Pettigrew, a GP and Research Fellow at the London School of Hygiene and Tropical Medicine and Senior Policy Fellow at the Health Foundation.

Title of paper: Counting GPs: A comparative repeat cross-sectional analysis of NHS general practitioners

Available at: https://doi.org/10.3399/BJGP.2024.0833

There have been successive Government promises to increase GP numbers. However, the numbers of GPs in NHS general practice depend upon how GPs are defined and how data are analysed. This paper provides a comprehensive picture of trends in GP capacity in English NHS general practice between 2015 and 2024. It shows that the number of fully qualified GPs working in NHS general practice is not keeping pace with population growth and there is increasing variation in the number of patients per GP between practices. We offer research and policy recommendations to improve the consistency and clarity of reporting GP workforce statistics.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:01 .040 - 00:01:04 .810

Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate Editors of the Journal. Thanks for taking the time today to listen to this podcast.

In today's episode, we're speaking to Dr. Louisa Pettigrew, who is a GP and research fellow at the London School of Hygiene and Tropical Medicine.

Louisa is also a Senior Policy Fellow at the Health foundation and we're here today to talk about the paper that she's recently published here in the bjgp. The paper is titled Counting A Comparative Repeat Cross Sectional analysis of NHS GPs.

So, hi, Louisa, and thanks for joining me here today to talk about your work. And I guess just to set things out, it is really important to know how many gps there are working.

But I wonder if you could just talk us through what we already know about this. We know that there have been successive government policies and promises to increase the number of gps.

There are, as we know, different ways that gps could be counted.

Speaker B

00:01:05 .530 - 00:02:37 .470

So, yeah, as you rightly point out, there's been recurrent governance promises to increase GP numbers.

Not just our current Labour government, but the previous Conservative government too, and previous governments too, because they realize that, you know, having access to GP is important for the public and there's a shortage, a perceived shortage of them.

So the issue that we notice that there's different ways to count GPs who are working NHS General practice, and therefore depending on how you choose to count them, then that affects the trends and it affects your numbers.

So you can count a GP by headcount, whether they're working in NHS general practice or not, and you can count them by full time equivalent, so the actual reported numbers of working hours. You can also consider GPs to be fully qualified GPs alone, or you could include GPs who are fully qualified, plus what is categorized as GP trainees.

Now, that category includes GP trainees, but it also includes foundation year one and two doctors and any other sort of junior doctor that might be in general practice. And the other dimension to how you count gps is whether you take population growth into population size.

So in the UK, over the past, sort of between 2015 and 2024, which was a period of analysis of our study, there was about 12% increase in population size in England. So once you take population growth into account, that again, changes your trends and your current figures.

Speaker A

00:02:38 .510 - 00:02:46 .830

And in this paper you used a few different ways to calculate the number of gps. But just talk us through briefly the data sets that you used here to look at that.

Speaker B

00:02:46 .990 - 00:03:45 .590

So we use the nhs, England's GP workforce data set that provides both national figures and practice level figures.

So we use the national figures to look at the overall trends and then we looked at practice level figures to disaggregate and look at sort of the range, the median and the 95th and 5th percentile of patients per GP across practices in England. We also used the number of patients registered at jail practice to get our total number of patients, your denominator from the nhs.

But we also compared this to Office of National Statistics, Office for national statistics ONS figures of mid year population estimates between 2017 and 2023 to again compare how you know what your population is changes the number of patients per GP or gps per capita. You can calculate it both ways and.

Speaker A

00:03:45 .590 - 00:03:57 .920

I think just setting that out shows us why this is actually a really complicated area.

So there's lots of different ways to define a GP and how they're working, but there's also lots of different sources you can look to to count a GP as well.

Speaker B

00:03:58 .880 - 00:04:21 .140

Correct. And, you know, there's, there's nuance to this.

And the risk is that if we don't consistently count them and report them in the same way, then you end up having different figures and people end up speaking at cross purposes and people can pick and choose which figures to use depending on what's more convenient in terms of the story that one wants to tell.

Speaker A

00:04:21 .940 - 00:04:27 .980

Fair enough. Okay, so let's move on to what you found. So what were the numbers of total GPS if we were just doing a.

Speaker B

00:04:27 .980 - 00:06:05 .730

Headcount between 2015 and 2024? So we took quarterly data over that period and we saw that there was.

If you take headcount, so this is the absolute best case scenario, you take headcount and you include trainees, there was an 18% increase, so it rose from 41,193 to 48,758. That's raw number of GPs in NHS general practice. A separate question is GP's not in NHS general practice? But that's a different study, not this one.

But then if you consider working hours so full time equivalent and you exclude GP trainees on the basis that they are not equivalent to a GP because they might not be delivering the same amount of care, foundation union doctors may not choose to specialise in general practice. So therefore, arguably shouldn't be included in the overall numbers. So full time equivalent and no trainee, what we found is actually a 5% reduction.

So from 29,364 down to 27,966 between September 2015 and September 2024.

If then you take into account population growth and using NHS registered patients rather than ONS figures, what we actually see is only a 6% rise in the headcount plus trainees. So that's 6% rise versus an 18% rise. That's once you've taken population growth into account.

And when you actually take in population growth into account and consider true sort of working figures, which are full time equivalents without trainees, there's actually a 5% reduction in the number of GPS per capita. Yeah.

Speaker A

00:06:05 .730 - 00:06:16 .030

And I also wanted to touch about the range of patient to GP ratios across the country, because what you found here suggested that there's actually a big range between these ratios across England as well.

Speaker B

00:06:16 .510 - 00:06:55 .010

Yeah, that's right. So that was the next part of the analysis where we looked at practice level data.

So what we saw is that between the period of September 15 and September 2024, the gap, or the difference between, say, the 5% practice of the least number of patients per GP and the 95th percentile, practices with the greatest number of patients per GP, that increased. So there's a big difference.

So, and that's principally driven because the gap has increased, because those at higher end, those with more patients per capita, has increased that faster rate than those with less patients per capita.

Speaker A

00:06:55 .490 - 00:07:01 .250

And what does that mean on the ground for these practices in terms of the ratio of patients to GPs?

Speaker B

00:07:01 .970 - 00:07:49 .290

Well, the thing is, I guess we don't. We don't know the reason for this. So our study didn't examine the reasons for this. You might speculate there might be a variety of reasons.

So practices may have employment shortages, they might be in areas that are struggling to recruit, they may have made active decisions not to recruit for financial reasons, they may have less gps, but actually may have many other additional roles.

So other direct patient care roles, pharmacists, social prescribers, physios and so on, and therefore compensating their GP shortage, the relative GP shortage with other roles. But again, that was beyond the study and that's only, you know, what we can infer based on what's going on in just now.

Speaker A

00:07:49 .930 - 00:08:10 .920

Yeah, and I think this study is really interesting because it's kind of based around how all these things are defined. And you point out in the paper that depe