How bad is the GP workforce shortage in England and what should be done about it? The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health and Health Education England to conduct an in-depth review of the general practitioner (GP) workforce in England in 2012. This presentation gives our preliminary assessment - but for those interested, I recommend you read the final report published in July 2014. It can be found here: http://webarchive.nationalarchives.gov.uk/20161007102824/http://www.cfwi.org.uk/publications/in-depth-review-of-the-gp-workforce Note: The Centre's contract with the Department of Health ended in March 2016. Some of its analysts and functions were brought in-house by DH. The Centre's website is archived here: http://webarchive.nationalarchives.gov.uk/20161007101116/http://www.cfwi.org.uk/

1. The GP in-depth review
NHS England primary care strategy workforce group
Thursday 8 August 2013
The CfWI produces quality intelligence to inform better workforce
planning that improves people’s lives

2. 2
Our workforce planning framework

3. 3
Macro-level
research
Horizon
scanning
Scenario
workshops
Parameters
defining
possible futures
Workforce
model
Forecast
supply and
demand
Sensitivity
analysis to
identify critical
parameters
Workforce
data and
assumptions
Delphi
Micro-level
research
Policy
interventions
Our horizon scanning work aligns with
wider scenario generation and
workforce modelling. Our outputs
inform later research activities to
produce workforce intelligence.
The framework in detail, from horizon scanning to final report

4. 4
Scenario generation workshop

5. 5
Our medical workforce supply model
medical
school
Foundation
1
Career post
Foundation
2
Core
training
Run-
through
training
GP training GP
Higher
specialty
training
Hospital
consultant
Consultant
to GP
training
Not shown but modelled
• Attrition from stocks
• Exits out of system
• Inflows from overseas and
rejoiners
• Resits
1. Highly configurable
2. Ageing in one-year bands
3. Migration can be modelled (but
we lack data)
4. SAS doctors data and modelling
need improving

6. 6
What is our review seeking to address...
Considering the likely changes to service delivery
and the role of GPs over the next 20 years, how do
we ensure sufficient supply for the future general
practitioner workforce?

7. 7
How are we addressing this?
 Review current workforce capacity issues in general practice
 Assess the current GP recruitment target for England and review
options for GP training and recruitment targets beyond 2015
 Understand the likely impact of possible future shifts in care in the
medium and long term
 Develop and refine the CfWI’s GP system dynamics model
 Make recommendations, if appropriate, on GP service delivery models
and affordability of different options

8. 8
Sources: HSCIC 2006a, 2006b and 2012a
26.96%
12.55%
7.11%
51.51%
1.88%
GPs (excluding retainers and registrars)
Practice nurses
Direct patient carers
Admin and clerical
Other
The general practice workforce
0
1
2
3
4
5
6
7
8
0
5,000
10,000
15,000
20,000
25,000
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
RatioGP:practicenurse
Numberofpracticenurses
Year
Practice nurses
headcount (left
axis)
Practice nurses
FTE (left axis)
Ratio GP:
practice nurse
(right axis)

9. 9
Source: NHS HSCIC 2012a and ONS (2012a and 2012b
*Excluding GP registrars and retainers
The GP workforce 1995-2012
0
20
40
60
80
100
120
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
GPsper100000population
NumberofGPs
Year
GPs (headcount) per
100,000 population
(right axis)
GPs (FTE) per
100,000 population
(right axis)
GPs, headcount
basis* (left axis)
GPs, FTE basis* (left
axis)

10. 10
Source: NHS HSCIC 2012
GPs by age band and gender
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Under 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Unknown
GPheadcount
Age
Men
Women

11. 11
Source: GP National Recruitment Office (2012), Health Education England (2013a)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
0
1,000
2,000
3,000
4,000
5,000
6,000
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
Competitionratio
GPtraineenumbers
Recruitment year
Applicants (right axis)
Vacancies (right axis)
Accepted offers (right
axis)
Competition ratio (left
axis)
GP postgraduate trainee recruitment
(left axis)
(left axis)
(left axis)
(right axis)

12. 12
• CfWI analysis points to a GP workforce under strain. GP
workforce numbers need to be lifted to more sustainable levels.
• If the recruitment target of 3,250 GP trainees per year in England
is achieved by 2015 and maintained it will result in an increase
of about 14,704 GPs (headcount) by 2030 compared with 2012
levels.
• If this boost in GP training is coupled with other measures to
improve supply and manage demand, it may be sufficient to meet
expected patient demand to 2030.
Key findings I

13. 13
• By 2030, we expect a younger workforce (with the number of
GPs in their thirties doubled) and women to be the majority of
the GP workforce.
• Extended GP training and increased retirements will have an
impact on supply.
• There are fewer ‘singlehanded’ practices; very large practices
now see around one in seven patients and are growing
rapidly.
• There has been a shift towards more salaried GPs and fewer
GP partners, which is likely to continue.
• There is considerable local and regional variation in GP
supply and access.
Key findings II

14. 14
Source: NHS HSCIC (2011) and the CfWI system dynamics medical workforce model for England
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79
NumberofGPs
2000 2010 2020 2030
Age of GPs - 2000 to 2030

15. 15
Regional variations I

16. 16
Regional variations II

17. 17
Source: CfWI system dynamics medical workforce model for England
GP supply and demand baselines
D baseline
S baseline
30,000
32,000
34,000
36,000
38,000
40,000
42,000
44,000
46,000
48,000
50,000
2012 2015 2018 2021 2024 2027 2030
Full-timeequivalent
Year
Demand - baseline
Supply - baseline

18. 18
• Scenario 1: ‘Happy GPs, excellent patient care’
• Scenario 2: ‘GPs good, commissioners bad’
• Scenario 3: ‘Right plan, but wrong tools’
• Scenario 4: ‘Meltdown in care’
• Scenario 5: ‘Technology through regulation’
• Scenario 6: ‘Rise of the machines’
The six scenarios

19. 19
Source: CfWI system dynamics medical workforce model for England
With demand scenarios added...
D baseline
D1
D3 - D4
D2 - D5
D6
S baseline
30,000
32,000
34,000
36,000
38,000
40,000
42,000
44,000
46,000
48,000
50,000
2012 2015 2018 2021 2024 2027 2030
Full-timeequivalent
Demand - baseline
Demand - scenario 1-6
Supply - baseline

20. 20
Source: CfWI system dynamics medical workforce model for England
…and supply scenarios
D baseline
D1
D3 - D4
D2 - D5
S baseline
S1
S2
S3 - D6
S4
S5
S6
30,000
32,000
34,000
36,000
38,000
40,000
42,000
44,000
46,000
48,000
50,000
2012 2015 2018 2021 2024 2027 2030
NumberofGPs(full-timeequivalent)
Year
Demand - baseline
Demand - scenario 1-6
Supply - baseline
Supply - scenario 1-6

21. 21
• Work is needed to achieve the recruitment target for England of
3,250 GP trainee places per year by 2015 and to maintain training
at that level.
• A substantial share of this workforce increase should go towards
improving support for under-doctored areas.
• Other measures to improve workforce supply and manage
demand.
• Regular reviews of the GP workforce at least every 3-5 years.
• More frequent data on GP activity and consultation rates.
Recommendations I

22. 22
• Action needed to improve the attractiveness of general practice
and to retain the existing workforce.
• Mitigating actions needed to address short-term supply issues
caused by the extension of GP training.
• More flexible and open-ended medical career pathways.
• NHS commissioners to encourage more innovative and
collaborative approaches to primary care delivery.
Recommendations II

23. Preliminary findings
• We look forward to hearing the views
of GPs, other health professionals,
professional bodies, employers,
patients and the public.
• Please email your views or evidence,
or contribute to our LinkedIn online
forum:
• http://www.linkedin.com/groups/Friends-
Centre-Workforce-Intelligence-CfWI-
4274008
• The Preliminary findings report can
be downloaded from:
http://www.cfwi.org.uk/publications/gp-in-
depth-review-preliminary-findings

24. Centre for Workforce Intelligence
209 – 215 Blackfriars Road, London SE1 8NL
General enquiries E enquiries@cfwi.org.uk www.cfwi.org.uk 24