The proportion of general practices with a high turnover rate has almost doubled in ten years, a new study has shown.
Academics from the University of Manchester examined GP turnover rates from 2007 to 2019. They found that most NHS regions saw a steady rise in turnover during this time, with the proportion of practices with a high turnover (10% to 40% within a year) rising 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 research, supported by the Health Foundation through the Efficiency Research Programme, has been published in BMJ Open.
The study used NHS data from all English general practices to assess changes in turnover, as high turnover is a marker of poor fiscal and organisational ‘health’. 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.
Turnover comes with a range of associated costs, including the approximate cost of £250,000 to fully train a GP, the rehiring process, and the length of time a GP needs to familiarise themselves with the processes and needs of a new practice.
Major regional differences
In the study, the researchers noted 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%). They also found that practices in the most deprived areas had higher turnover rates than practices in the least deprived areas, even when accounting for differences across NHS regions.
These socioeconomic findings follow a recent study from the University of Cambridge that found that there was continual shortages of GPs in disadvantaged areas in England. The study findings showed clear local-level inequalities in GP distribution in areas such as West, North and East Cumbria, Humber, Coast and Vale, and Coventry and Warwickshire STP (Sustainability and Transformation Plan) areas. The Cambridge researchers suggested that this uneven distribution could be due to a number of reasons, including the opening and closing of practices in such areas.
Commenting on the significant findings from their study, the University of Manchester researchers warned that the rates are worrying.
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.
“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.”