The increase – identified from data between 2015 and 2022 - occurred alongside an overall drop in GP supply of 2.7% over the same period, due to falling contractual hours.

The Health Foundation funded study found the median contracted full-time equivalent (FTE) for each fully qualified GP fell from 0.80 to 0.69 between 2015 and 2022.

This reduction was driven primarily by male GPs, who have significantly reduced the hours they are contracted to work from 0.99 to 0.85 FTE.

However the figure for male GPs remains above the levels of their female counterparts, whose hours fell slightly from 0.67 to 0.65 FTE.

Practices in the most deprived areas had 17% more patients and 19% more chronic conditions per GP FTE, compared with the least deprived areas.

All regions reported more chronic conditions per GP FTE than London, which had less demand for GPs.

Lead author of the study published in the British Journal of General Practice today (17/09/24), is Dr Rosa Parisi.

Dr Parisi said: “The NHS in England is facing a year-on-year reduction of the total working hours by general practitioners.”

“This decrease is down to early retirement, high levels of GP turnover and low retention, insufficient number of newly trained GPs joining the workforce, and lack of overseas recruitment.”

“But reduction in working hours is also a major factor. We show that while GP supply decreased by 2.7% from 2015 to 2022 practice population increased by 9%, while the demand, as measured by the total presence of chronic conditions, increased by 32%.”

“The largest contributor to the overall decrease in supply was a fall of 8.7% in GP’s contractual hours of GPs, especially male GPs.”

“We’re not entirely sure why male GPs are reducing their hours, but policies are desperately needed to incentivise them to work longer.”

She added: “We fear GPs are likely to be unwilling or unable to face more of the intense day to day pressures in UK primary care.

“However, policies to reduce administrative workload, increasing support by allied healthcare professionals could incentivise GPs to increase their work hours.

Senior author Professor Evan Kontopantelis said: “In 2015 and 2019, the Government promised 5,000 more GPs by 2020 and an additional 6,000 GPs by 2024, respectively.

“Though there was a rise in GP headcount of 5.9%, specifically 2,154 GPs between 2015 and 2022, the promised increase has not happened. That is why the change in working patterns of GPs makes the challenges facing primary care even more acute.”

He added: “Our results also highlight an existing disparity in GP supply between practices located in the least and most deprived areas.

“Practices in the most deprived areas had 17% more patients and 19% more chronic conditions per GP FTE, compared with the least deprived areas.

“So, in addition to policies aimed to recruit and retain more GPs, it is also necessary to incentivise GPs to work and remain in deprived areas to achieve more equitable levels of care – something easier said than done, we acknowledge.”

The paperGP working time and supply, and patient demand in England in 2015–2022: a retrospective study"., published in the British Journal of General Practice is available here.

The study of over 160 million consultation events from 12.3 million patients, in 845 general practices between 2000 and 2019 showed four out of ten of the workload at GP clinics were with frequent attenders.

Frequent attenders were patients making a disproportionately higher number of visits to GP clinics each year, defined as more than 90% of all other patients in the same practice.

The study, published in BMJ Open also found that among frequent attenders, consultations at GP clinics have doubled in the last 20 years.

Consultations with GPs increased from a median of 13 in 2000 to 21 in 2019 and consultations with all staff members of GP clinics increased from 27 to 60.

Also, according to the study, face-to-face GP consultations were relatively stable over the study period, whereas other forms of consulting such as telephone or online consultations have become more common.

In 2018/19 there was an average of 3.3 face-to-face consultations per patient per year with GPs. However. the number rose to 8.7 consultations with GPs, including non-face-to-face, like telephone and online.

That means, say the researchers, that GPs are consulting more with patients but using a variety of means.

Frequent attenders, though, are an exception because their face-to-face consultations continues to increase over time.

The findings show the traditional model of patients consulting with GPs face to face is being replaced by a new model of work in general practice: increasing numbers of consultations are conducted by other staff members, rather than GPs, using alternative means to face-to-face consultations.

Co-author Professor Evan Kontopantelis from The University of Manchester said: “This is the first study to show that frequent attenders, the top 10% of consulters, have largely and progressively contributed to increased workload in general practices across the UK over the last 20 years.”

Co-author Professor Aneez Esmail from The University of Manchester said:  “Our findings show that frequent attenders account for an increasing proportion of face-to-face consultations with GPs and are responsible for nearly 40% of consultations fairly constantly over time.”

Co-author Dr Maria Panagioti from The University of Manchester said: “But these findings may also suggest the increase in multi-disciplinary staff working in general practices is perhaps the only solution for sustaining a viable primary care.

“Indeed, the large increase in the general practice workload over the last 20 years means having extended multidisciplinary teams is necessary to meet a wide range of patient needs through a range of ways such as remote consultations.”

Professor Kontopantelis added: “We feel the increasing demand for consultations from frequent attenders also needs to be evaluated in the context of the COVID 19 pandemic.

“Frequent attenders also may have special health and social care needs but for a variety of reasons we do not yet fully understand how best to meet them.”

In addition, they found that:

• All consultations by GPs per person increased from a median of 5 to 8 pr person per year and all consultations by all staff increased from 11 to 25.
• However, face-to-face consultations by GPs and face-to-face consultations by all staff remained static and may even have decreased.
• Distribution of face-to-face consultations with GPs was highest in Scotland and the distribution of face-to-face consultations with all staff was highest in Northern Ireland.
• There was little evidence of regional variability elsewhere in the attribution of all consultation types in study, across all categories of consulters.

 Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices is published in BMJ Open

The figure was 63% in GPs over 50.

Even among younger GPs (under the age of 50), more than one in every ten (11%) said they were planning to leave.

These figures show a slight decline since 2017, but this remains a concern, and intentions to quit within 5 years in those over 50 have increased from 62% in 2017.

The mean level of overall job satisfaction, measured between 1 (extremely dissatisfied) and 7 (extremely satisfied), increased by 0.24 points from 4.25 in 2017 to 4.49 in 2019, with more than half of the respondents (59%) stating that they were satisfied with their job overall.

Mean levels of satisfaction increased between 2017 and 2019 to varying degrees in all nine domains of job satisfaction, although this remains lower than the peak of satisfaction found in 2005.

Overall hours of work showed a slight decline, and respondents indicated a slight decline in negative job attributes and an increase in positive job attributes since 2017.

The GP Worklife Survey is a longitudinal survey which has been assessing job satisfaction and job stressors amongst GPs in England since 1999.

A sample of GPs are asked to complete a questionnaire which asks them to rate their job satisfaction and the aspects of their jobs which they find particularly stressful or satisfying, as well as their intentions as regards their future work.

The survey has run approximately every two years since 1999, and so provides evidence about changes over time.

The evidence it provides is used by the Department of Health and Social Care to inform their evidence to the Doctors’ and Dentists’ Pay Review Body.

The survey was run for the 10th time in 2019.

The survey, carried out by the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning, has run approximately every two years since 1999, and so provides evidence about changes over time.

It analyses two samples in 2019: 605 GPs responded to a random sample of 4976 people and 772 responded (out of 1917) after being followed up having responded to the 2017 survey.

Professor Kath Checkland, who led the study said: “It is encouraging to see that there was a small increase in job satisfaction between 2017 and 2019, but the high levels of GPs planning to leave patient care even before the pandemic hit is very concerning. We are now carrying out a further round of the survey to try to capture changes in job satisfaction driven by the pandemic. It is really important that we get as many responses as possible, and I would encourage all GPs receiving a link to the survey to respond, so that we get as complete a picture as possible.”

The Tenth National GP Worklife Survey was carried out by the Health Organisation, Policy and Economics (HOPE) research group at The University of Manchester on behalf of the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm). PRUComm is funded by the Department of Health and Social Care Policy Research Programme.

This report is independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm's length bodies, and other Government Departments