Thousands of new GPs could be unemployed this summer, warns BMA

10 comments

1. Thousands of newly qualified GPs could be unemployed this August due to a ‘nearly non-existent’ job market in some areas, the BMA has warned.

   Speaking at the UK LMCs conference last week, chair of the union’s GP registrars committee Dr Malinga Ratwatte warned that of the 4,000 registrars achieving their CCT over the summer, many may struggle to find work.

   Pulse understands the areas most affected by GP unemployment are in the Midlands and northern England.

   Dr Ratwatte blamed the Additional Roles Reimbursement Scheme (ARRS) which does not allow practices to hire GPs with the funding.

   ‘A ring-fenced funding pot such as ARRS that cannot be used by practices to hire staff such as GPs is unhelpful, arbitrary and restrictive,’ Dr Ratwatte told Pulse.

   He continued: ‘The question to the Government is this: Now that these 4,000 GP registrars are weeks away from being fully trained and ready to work, how will practices afford to hire the GPs that patients so desperately need?’

   Pulse has reported on several examples of GPs struggling to find work or redundancies in recent months, and the BMA GP Committee for England has recently noted [that general practice has moved from a recruitment to an employment crisis.](https://www.pulsetoday.co.uk/news/practice-personal-finance/gps-now-in-employment-not-recruitment-crisis-says-gpc-chair/)

   Dr Ratwatte added: ‘We potentially have a situation where thousands of GPs will be unemployed come August, with those on temporary visas being forced to leave the UK permanently, should they not be able to secure employment.

   ‘This is a complete failure of retention strategy and workforce planning and will leave patients with even poorer access to GPs.’

   The inclusion of GPs in ARRS had been [a ‘red line’ for GPCE in 2024/25 contract negotiations](https://www.pulsetoday.co.uk/analysis/contract/what-might-the-next-gp-contract-look-like/) but NHS England declined the request [on the basis that GPs are core, rather than additional workforce](https://www.pulsetoday.co.uk/news/2024-25-gp-contract/nhs-england-will-not-add-gps-to-arrs-because-they-are-not-additional/) in practices.

   But this has led to increased competition for the fewer salaried GP vacancies that are available, [with some recent job adverts receiving over 40 applications](https://www.pulsetoday.co.uk/news/workforce/gp-salaried-roles-receive-over-40-applications-amid-employment-crisis/).

   GP leaders in Lancashire and Cumbria have said the job market is ‘looking really dire’ for the GP registrars who will qualify this summer, with one trainee reportedly ‘trying not to pass because of the fact they won’t then have a job’.

   GP practices have also been forced to make GPs redundant due to the changing financial situation.

   In Surrey, [a practice made three GPs redundant](https://www.pulsetoday.co.uk/news/breaking-news/practice-makes-gps-redundant-in-favour-of-arrs-staff/), citing ‘new ways of working’ including virtual appointments and the use of ARRS staff. Pulse later revealed that the GP partners had been [unable to take any drawings](https://www.pulsetoday.co.uk/news/breaking-news/gp-redundancy-practice-partners-unable-to-pay-themselves-for-a-year/) in the previous year since the practice was ‘running at a loss’ and needed to save £350,000 per year.

   Up to 80 members of staff at a Plymouth GP provider could soon lose their jobs following a redundancy process aimed at reducing the number of clinicians who work remotely.

   And Pulse reported in March that as many as 150 clinicians working for eMed, the new owner of GP at Hand, [could be affected by a large-scale redundancy consultation](https://www.pulsetoday.co.uk/news/breaking-news/swathes-of-gps-at-risk-of-redundancy-as-gp-at-hand-owner-announces-consultation/), said to be affecting ‘mainly GPs’.

2. So soon be a min wage job then with this much saturation

3. I’m genuinely impressed by the government .

   The gov may provide the funding , but it’s the primary care partnerships that are doing this .

4. This is **absolutely** on the past 14 years of tory policies.

   There ***is*** central funding to support the hiring on physician associates and other “not doctor” roles the government has created and shovelled money into, there ***isn’t*** money available for the hiring of actual doctors.

   Genuinely shocking, but hey, some Tory donor is getting rich off it.

5. They’re just going to leave the country, they are highly skilled, it’s the most logical and reasonable thing to do.

6. We are desperate to see GPs and yet we have a bunch of them struggling to find employment.

   Perfect example of the complete mismanagement of our healthcare system.

7. GP partner here, the problem is as follows.

   GP’s are independent contractors who sign up to a contract to provide primary care services for the NHS. Those who hold the contract are called partners, are self-employed and are usually, but not exclusively, qualified GP’s. We are funded via a few different revenue streams however by far the largest (circa 90% for us until recent years) is via what’s called the Global Sum which the contract pays out based on the number of patients we have and their demography (there‘s a complex formula which is not important for this discussion). Until recently the next largest funding source was effectively a performance-related payment. Everything else is small fry for most surgeries (doing private work like insurance reports, small stipends for training GP’s and a bunch of other things). Surgeries are run like businesses in that all the costs of the business – with staff costs being by far the single largest, which includes salaried (i.e. employed) GP‘s and locums – are subtracted from the income and what is left over is shared by partners as their income.

   In recent years a “new“ revenue stream has been created which allows us to recruit basically any type of clinical professional except doctors, the ARRS as referenced in the OP. This includes nurses, physios, pharmacists, paramedics and loads more. The quote marks are there because in fact overall funding doesn’t appear to have increased in real terms but has mostly been cannibalised from other revenue streams. Case in point, the increase in GMS contract income has increased by circa 2% per year for the last few years when inflation has been running at double digits. So whilst our costs have increased, like everyone else’s, by 20-40% since 2021, our core income has effectively stagnated.

   Therefore there is a massive incentive to address the well-documented rise in demand for primary care appointments by employing people who aren’t doctors via the ARRS, because the scheme is ring-fenced, is effectively a “use it or lose it” pot and from which we cannot employ GP’s by design. The money to employ more doctors has to come from core funding but as I pointed out, in real terms core funding is down massively, so partners are left with the options of employing GP’s and taking a huge hit to income or not taking the hit but accepting ever increasing workloads. You could of course argue that fat cat GP partners ought to take the hit, but this ignores the reality that partners do a lot more non-clinical work than salaried or locum GP‘s and if it gets to the point that partner income is no better than locum income, then why wouldn’t we all just become locums?

   I was always sceptical of the notion that the government are trying to systematically dismantle the NHS but I’m now convinced it’s true. Doctors cost more than the other staff mentioned above because of the training and breadth of knowledge required. The government have chosen to not pay for the numbers required but instead to fill primary care with bodies. They can thus claim to be holding up their end of the contractual bargain whilst hanging GP partners out to dry when the system inevitably fails.

   I love my job but I have a plan to retire young. I’ve no interest in forlornly trying to prop up a system being set up to fail.

8. So we gotta hope they don’t go to Canada and Australia before the election.

9. There are 2 doctors in my surgery to cover over 8000 people and I feel that this understaffing played a part in my mum’s death.
   My mum wasn’t a well woman, she had MS and was bed bound, had carers coming in to see her 4 times a day and after my dad passed in November the rest of the time it was just me to take care of her and I failed her. For the last few months of her life she had constant UTI’s and was in a constant state of confusion with them. No doctor came out to see her despite my having to phone the practice every other week and a couple of times an advanced nurse practitioner came out. One morning I had to phone 999 as I couldn’t get her to wake and ended up having to perform chest compressions on her. Long story short I had to leave her after a few hours as my sister was taken into hospital that same day and almost passed that night due to sepsis. I thought I was leaving her in good hands and I needed to help my brother in law with my nephews. Anyhoo 6 hours after being taken she was discharged. A subsequent conversation with the advanced nurse practitioner as my mum was found eating tissue paper I mentioned she had just been in hospital and this practitioner said she wouldn’t have been discharged if there was anything wrong and asked me if I wanted her in hospital. I said I just wanted what was best for my mum. She gave my mum a once over and said she could only treat what was in front of her despite me saying that my mum wasn’t one to be snacking on fucking tissue paper. Anyway another antibiotic was prescribed as it was probably just another UTI. Five days later my mum passed due to sepsis.

10. Whether deliberate or not – I suspect not because this isn’t forcing locums to take substantive posts and solving the GP problem, there are just fewer jobs – this has been the consequence.

    However, some caveats. We need to remember that the Additional Roles scheme was brought in because so many practices could not recruit GPs who were actively choosing to Locum instead. Now that’s fine, of course, but this is what happens when the market turns around.

    Secondly, many ARRS roles are not patient facing, so although practices might use some specific clinical roles to supplement GP time, it is a fallacy to say that a load of pharmacists have suddenly just replaced GPs (they do different things).

    ARRS has been running for 5 years now so although it feels convenient for locums to blame the scheme, it is only partly responsible for this situation.

    The biggest contributing factor has been the onset of the Modern GP programme since last April. Practices are now operating almost exclusively online, with better triage, better signposting and much better capacity/demand analysis. This means that we just don’t need to replace expensive GP sessions like for like. If we have 20 fewer appointments that day, we use them more intelligently and change the proportion rather than pay a Locum £600 for usually a reasonably poor service.

    So although I have great sympathy for the trainees coming through, there is nothing we can do without more space to put people and more funding to pay them.