GP turnover increasing over past decade in England

The majority of NHS regions experienced a steady rise in GP turnover between 2007 and 2019, according to a new study by University of Manchester academics.

During the period studied, the proportion of practices with high turnover (10% to 40% within a year) almost doubled from 14% in 2009, to 27% in 2019.

However, the proportion of practices with very high turnover (above 40%) remained stable at around 8%.

The study assessed changes in turnover, since high turnover is a marker of poor fiscal and organisational “health”.

Turnover costs are attributed to GPs leaving the profession, when it costs approximately £250,000 to fully train a GP, to the rehiring process, and to the length of time a GP needs to be familiarised with the processes and needs of a new practice.

The paper is published in BMJ Open and supported by the Health Foundation through the Efficiency Research Programme.

Practices in the most deprived areas had higher turnover rates compared to practices in the least deprived areas.

The team calculated turnover by rates and region using NHS data from all English general practices which numbered 8,085 in 2007 and 6,598 in 2019.

According to the study:

• The number of practices with persistent high turnover (at least 3 consecutive years) increased from 2.7% in 2007 to 6.3% in 2017.
• The 75^th percentile for turnover in 2009 was 11%, increasing to 18% in 2014, and coming back down to 14% in 2019.
• There was high regional variability in mean turnover rates in 2007 and in their changes over time. Practices in the (former) NHS West Midlands Strategic Health Authority reported the largest increase and the highest levels in 2019 (from 6% to 12%).
• Practices in the most deprived areas (quintile) had turnover rates that were up to 10% higher compared to practices in the least deprived areas, even when accounting for differences across NHS regions.

Co-author Professor Evan Kontopantelis from The University of Manchester said: “We already know the GP workforce in England is going through a major crisis. Rates of early retirement are increasing, as are intentions to reduce hours of working or leave their practice in the near future.

“Though in 2015, the government promised 5,000 more doctors in primary care by 2020, the number of full-time equivalent GPs per 1000 patients continues to decline.

“Quantifying GP turnover and understanding how it is distributed is fundamental to addressing challenges for the national health service, and for ensuring that quality and continuity of care are available to patients.”

He added: “We reveal worrying trends in GP turnover. High levels may affect the ability to deliver primary care services; and undermine continuity of care which in turn may affect the quality of patient care.

“And healthcare received from multiple GPs can lead to conflicting therapeutic treatments and fragmented care.

“Differential turnover across practices and regions could also lead to a maldistribution of GPs, exacerbating retention problems and health inequalities.”

A graph showing regional rates of turnover is available.

Rates of turnover among general practitioners in England between 2007-2019: a retrospective study is published in BMJ Open.

Turnover was defined as the number of GPs who leave a practice divided by the average of the number of GPs at the start and the number of GPs at the end of the year