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What are the workforce issues?

Primary care is made up of a wide range of different staff. Here are some of the key issues about the primary care workforce.

How many people work in primary care in Wales?

The Welsh Government’s Primary Care Workforce for Wales Plan [open in new window] stresses the importance of a multi-disciplinary team approach in primary care. Despite that, our research suggests the majority of primary care workforce data focuses on GPs.

Click here for details of the primary care contracts covering NHS staff in Wales [Opens in new window].

The GP workforce

  • In 2016, there were 6.5 GPs per 10,000 population in Wales. The equivalent figure in England was 6.4 per 10,000. The most up-to-date figures for Scotland are from 2015 and show that there were 8 GPs per 10,000 population.
  • Between 2006 and 2016, the number of GP practitioners in Wales increased 7% to 2,009 (excluding registrars, retainers and locums).
  • Despite the increase in GP numbers, it is unclear if this has resulted in greater capacity. This is because we do not know which GPs are working full time or part time. Work is ongoing in Wales to improve this data.
  • The number of female GP practitioners has increased by 55% since 2006. In 2016 women accounted for 52% of the GP practitioner workforce.
  • The number of GPs under the age of 44 has increased by 15% between 2010 and 2016. GPs between the age of 45 and 54 have decreased by 8%. The greatest change has been in GPs over 65, having risen by 83% since 2006.
  • Train Work Live is a national campaign launched in 2016 to promote Wales as an attractive place to work for GPs and other doctors. Navigate to the Train Work Live [opens in new window] website for more details.

GP training

  • After medical school, potential GPs undertake a GP specialty training programme. Competition for GP training places has reduced in Wales. In 2012, 1.5 applications were made for every training place. In 2016, there were 1.2 applications for every place.
  • In recent years, Wales has struggled to fill GP training places. In 2016, 75% of places were filled. But in 2017, the fill rate increased to 91%. New financial incentives to attract applications appear to have had a positive impact on fill rates in Ceredigion, North West Wales, Pembrokeshire and North East Wales.

Morale and job satisfaction

  • According to the BMA and the RCGP surveys, morale of GPs in Wales is low. Survey respondents talked about an increasing workload, poor work-life balance, bureaucracy and financial pressures, particularly in partnerships.
  • 95% of GPs in Wales feel that morale has gone down in past 5 years (93% Scotland, 94% NI) (RCGP).
  • 61% of GPs in Wales say they do not have a good work life balance, with 58% saying it had got worse in the last year (BMA).
  • The majority of GPs (82%) are worried about sustainability of their practice, with workload pressures and recruitment difficulties cited as the two main reasons for their concerns (BMA).

Pay and costs for GPs

  • For most GPs in Wales (those employed under the General Medical Services contract) the average income before tax increased during the early 2000s but has since decreased slightly. This income rose from £65,007 in 2002-03 to £102,194 in 2005-06 but has since fallen to £93,400 in 2015-16 (UK £99,500).
  • To become a partner, many GPs have to buy into the partnership. This cost may prevent some GPs becoming partners, and the number of GP partnerships in Wales has decreased from 496 in 2006 to 441 in 2016.
  • An issue known as ‘last man standing’ is another barrier to buying into a partnership. This issue means that a single GP within a partnership can become financially liable for the practice and its property if all other partners retire.
  • High indemnity costs for GPs is another barrier. Indemnity covers costs for medical negligence claims and investigations. The First Minister has announced plans to tackle the problem and part of the increased uplift in the General Medical Services contract has been given to act as a short-term help whilst a longer-term solution is found.
  • In March 2018, a revised General Medical Services contract for 2018-19 was announced in Wales which included an interim 1% pay rise for GPs, a 1.4% increase in funding for expenses and funding to address rising indemnity costs.
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