Fewer GP Surgeries, Longer Waits: The Growing Strain on Patients

The 20% reduction in GP surgeries in England over the past decade is having a significant impact on patients, as revealed in a recent study published in BMJ Open.

With the number of practices dropping from 8,044 in 2013 to 6,419 in 2023, fewer GPs are left to serve an expanding patient population. The average practice list size has surged by 40%, with each GP practice now caring for an average of 9,724 patients, up from 6,967. This surge is leaving patients waiting longer to access essential care.

For those living in areas affected by practice closures, the impact is particularly acute. Practices that remain open often struggle to absorb the additional patient load, leading to longer waiting times for appointments. According to the study, patients report lower satisfaction as a result, and GPs are increasingly finding it difficult to meet patient needs. This is especially concerning in regions where single-handed practices, which have been closing at a faster rate, once served smaller, more localized communities.

As list sizes grow, the ratio of full-time equivalent (FTE) GPs to patients is shrinking. The study found that the number of FTE GPs per 1,000 patients has decreased by 15% in the last decade, which means fewer doctors are available to deliver care for a rising number of patients. While the total GP workforce has increased by 20%, this growth has mainly been in administrative roles and other practitioners, not GPs themselves. The result is a healthcare system that is increasingly reliant on non-GP staff, potentially affecting the quality of care.

Elderly patients, in particular, are feeling the strain. The study noted that the proportion of patients aged 65 and over has increased from just over 16% to 18% since 2013. This demographic often requires more frequent and complex medical attention, further exacerbating the challenges faced by overstretched GP practices. For these patients, longer waits for appointments can have serious consequences for their health and wellbeing.

The growing size of GP practices also poses challenges. The number of surgeries serving over 20,000 patients has risen sharply, from just 1% of practices in 2013 to 6% in 2023. While larger practices may offer more resources and multidisciplinary teams, patients often experience a loss of continuity in care. Many now face the frustration of seeing different healthcare professionals during each visit, with fewer opportunities for a consistent relationship with a single GP.

As fewer GPs take on the role of partners in practices, the traditional model of GP-led care is shifting. Researchers highlight that the role of GP partners, once centred on running smaller practices, is now evolving into the management of large, complex organizations. For patients, this means GPs are increasingly tied up with administrative responsibilities, limiting the time they can spend on direct patient care.

There are concerns about the safety of introducing new roles within GP practices without sufficient supervision. Patients might encounter physician associates or other healthcare professionals instead of seeing a fully qualified GP, leading to worries about the quality of care. This shift, combined with mounting pressure on GPs, could create a tipping point where most appointments are no longer delivered by GPs themselves.

Ultimately, patients are facing unprecedented challenges in accessing timely and high-quality care. The decline in GP numbers, coupled with rising workloads and patient dissatisfaction, underscores the urgent need for government action. Experts are calling for a renewed focus on GP recruitment and retention to alleviate pressures and ensure patients receive the care they need when they need it most.

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