Scotland: Falling GP numbers 'massive wake up call'

A continued decline in GP numbers would make it increasingly difficult for patients to secure timely appointments.

Dr Andrew Buist, chair of the BMA's Scottish GP committee, said: “We are often told GPs are the bedrock of the NHS – but on this evidence the bedrock is crumbling, and it is patients seeking access to their GP who will suffer as that becomes more and more difficult.

“At our recent [local medical committee] conference, the Cabinet Secretary made positive noises about prioritising primary care, but that needs to be backed up now by urgent action – including crucially increased direct investment into practices to allow them to focus on meeting the needs of local communities and recruiting the staff they need.

"Without that, I cannot see these figures getting any better and the idea of recruiting extra GPs anywhere near the 800 target will remain at best a distant prospect with increasing under-doctored areas and widening health inequalities."

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The workforce statistics show that the number of GPs by headcount - excluding registrars who are still in training - fell by 40, from 4,514 in 2022 to 4,474 in 2023.

Counted by whole-time equivalent (WTE) - which adjusts for part-time working to gauge the size of the workforce in real-terms - the number of full-time family doctors has dipped by around 15.5, to 3,478.4 in 2023.

Compared to a decade ago, Scotland's GP workforce has lost the equivalent of 197 full-time, fully-qualified doctors.

This is partly due to a steady increase in female GPs, who are more likely to work part-time, and changes in working patterns among younger GPs - who are also more likely than those in their 50s to work part-time.Counted by whole-time equivalent, Scotland's GP workforce is continuing to shrink (Image: Turas/NHS)

Workload stress and burnout has been blamed for an increase in the number of family doctors reducing their days - or "sessions" - and quitting GP partnerships in favour of working as a salaried or locum GP instead, a trend which puts the 75-year-old independent contractor model for general practice under threat.

The workforce survey also found that practices now rely on the equivalent of 342 full-time locums to plug vacancies in their staff - the second highest number since the survey began in 2013.

Dr Buist added: “These figures – which show falling GP numbers on both headcount and crucially WTE - back up the experience of our members who have consistently reported the huge challenge of meeting growing demand without the GPs needed to maintain good patient access.

"They are more evidence that not only are we not on track to meet the Scottish Government’s commitment for 800 GPs, when GP registrars are excluded, we are actually going backwards.

"This should be a massive wake up call to the Government. Last year’s figure was the lowest WTE figure seen for GPs since the workforce survey began and this year it has fallen further. Since 2013, the GP WTE workforce has fallen by 5.35% - a fall of 196.7 WTE GPs.

"In that same time period, the number of practices has fallen by 9%, average list sizes have increased by 18%, and the total patient population has increased by 7%.

"Some 42% of practices reported at least one GP vacancy and that there were a total of 3,813 vacant weekly GP sessions.

"All this shows that it is no longer feasible or plausible to think we can simply go on as we are, believing we are on course to grow the GP workforce as required to care for the people of Scotland."

In 2017, then-Health Secretary Shona Robison pledged to increase GP number by 800 within the decade.

Audit Scotland warned earlier this year that progress was "not on track".

GP trainees are usually excluded from official statistics for the GP workforce, but once included overall numbers are up by 271 since 2017 (Image: Turas/NHS)

Health Secretary Michael Matheson insisted that once GP trainees are included in the statistics the ambition remains "broadly correct".

On this basis, total GP numbers are up by 271 - to 5,168 - since 2017.

However, trainees are not usually included in official workforce counts as they require supervision, not all trainees will qualify, and not all those who do will remain in Scotland.

They also spend a large portion of their training based in hospitals, rather than GP practices. 

Mr Matheson added: "While it is welcome that the headcount of GPs is now sitting consistently at over 5,000, there is clearly more to do with our partners.

"Training new GPs is key to our approach and this takes time. There are currently, just over 1200 trainee GPs in Scotland and we have expanded GP Specialty Training, adding 35 places this academic year and a further 35 places next year.

"We also invest over £1 million per annum in a range of recruitment and retention initiatives so that becoming a GP remains an attractive career choice.

"While growing Scotland’s GP workforce requires continued and concerted effort, it is important to recognise that we have a higher number of GPs per head of population than the rest of the UK.

"Further plans will be set out in the New Year relating to how we strive to continue growing our GP workforce and support hard-working GPs to stay in practice.”