GPs eye alternative careers, finds survey

One-in-five GPs in England say they have made plans to change their careers because they can’t find any or enough work as doctors.

A BMA survey* of more than 1,400 family doctors also found a further 47 per cent said they were expecting to make career changes.

Some 43 per cent of respondents had plans to take clinical jobs outside of the NHS, while two in five (40 per cent) are considering taking up GP opportunities abroad and 38 per cent are thinking about leaving healthcare altogether.

It is the BMA’s second survey on GP under- and unemployment. Last year the association found that locum GPs were struggling to find NHS roles, and The Doctor spoke to locum GPs who told of the ‘absurd paradox’ that many patients complain about a lack of access to family doctors while an army of GPs are desperate for work.

The BMA’s latest survey shows how ‘the crisis has spread from locums to other GPs’, mainly those who are salaried.

‘I can't see myself returning to the NHS at this point,’ says one GP, medical educator and appraiser who spoke to The Doctor.

A partner for 13 years until late 2019, they have since taken salaried and locum work alongside existing educational roles.

But ‘huge’ clinical workloads and expectations to work relentless unpaid overtime made life ‘increasingly difficult’ to the point where they say ‘it was not sustainable’ to work as a GP.

Locum shifts included lengthy commutes and salaried positions involved managing patient lists, so they felt like they were ‘basically working as a partner but paid as a salaried GP’.

The BMA says rising running costs and decades of underfunding in general practice have made it harder for practices to hire the staff they need.

The GP who spoke to The Doctor agrees, saying many GP partners are being forced to reduce their income to absorb increasing costs, most notably energy bills and salaries. They say many partners fear the upcoming increase in employer national insurance contributions will be ‘the straw that breaks the camel’s back’.

The BMA noted how funding has also been diverted into non-GP roles through the ARRS (additional roles reimbursement scheme) and says the Government’s move to expand ARRS to include newly qualified GPs, while welcome, will not fix the crisis.

This month, the Government said that by ‘cutting red tape’ it has helped primary care networks employ an additional 1,500 GPs, more than the 1,000 it promised when it announced the change to ARRS rules. But this does not help the many more experienced GPs who are waiting in the wings, struggling to find sufficient work.

The GP who spoke to The Doctor said many practices employ ARRS staff with good intentions for supervision but that 'some are better than others at providing protected time for that supervision'.

They believe non-GP ARRS staff can be ‘very useful’ but that most practices would ‘prefer to employ [experienced] GPs’ yet cannot afford to because of the real-terms decline in practice funding.

As a result, they observe, some practices are capping appointments and not taking on new patients because ‘there is no incentive’.

Meanwhile, GPs who can’t find regular or suitable work face desperate measures. ‘You hear stories of locums travelling from Birmingham to the south coast to get work,’ says the GP, who adds that many are going private, or seeking outside work such as compiling medical reports, to make ends meet.

‘A very experienced locum GP wrote to me to tell me she was struggling to find work, and a colleague I trained was leaving his partnership and wrote to say he can't find any work. I was involved in a surgery where three doctors were made redundant just before Christmas [2023].

‘Many of the trainees I was overseeing were expressing serious anxiety about finding a job and many were choosing not to be GPs or considering emigrating. Some did emigrate to get [their first GP] jobs.'

Other GPs to complete the BMA survey wrote of feeling ‘completely alienated and undervalued by the NHS’ and told of how they were preparing to move overseas for better job prospects, were ‘considering leaving [the profession] completely’ or had been subject to ‘enforced retirement’ because of the situation.

Mark Steggles, chair of the BMA sessional GPs committee, said: ‘At a time of immense pressure on the NHS, and patients waiting too long to be seen, it’s ridiculous that so many GPs can’t find work.

‘These [survey] findings confirm our worst fears. Not only is the issue spreading through the profession, but it’s also leaving many wondering why they should bother staying in the NHS at all, further depriving patients of the vital care they need.’

Dr Steggles said the expansion of ARRS – a ringfenced fund for hiring non-GP staff – to include newly qualified GPs is ‘not a long-term solution’.

‘All restrictions around the scheme’s funding must be lifted immediately and the money put into the core general practice contract, so practices have full control over who they recruit at a local, practice level,’ he said. ‘More generally, core funding needs to increase and premises refurbished to accommodate the staff we need to keep up with patient demand.’

The BMA has launched a Write to Your MP tool to encourage the Government to address the problem, urging it to first move ARRS funding to the centralised general practice pot so practices have full control over who they hire.

‘This is a really serious situation,’ said Dr Steggles. ‘We hope this survey, coupled with our Write to Your MP tool, prompts the Government to act.

‘If that doesn’t happen, we face a mass exodus of talented GPs and an even bigger waiting list that will just set the health service back once again.’

Health secretary Wes Streeting has said ‘rebuilding our broken NHS starts with fixing the front door’ and has confirmed that £82m of funding earmarked as part of the extension of ARRS will continue ‘past this year’.

He said that an extra £889m on top of the existing budget for general practice in 2025 to 2026 was the ‘biggest boost to GP funding in years’ but insisted it must come alongside reforms, such as enabling patients to request appointments online throughout working hours.

* The survey, which took place between 24 January and 17 February, was open to all GPs excluding registrars. The highest number of responses came from locum and salaried GPs (39 per cent and 36 per cent respectively)