Four in five NHS regions fall short of recommended GP-to-patient ratios, exposing deep regional disparities and raising questions about whether current workforce plans can keep pace with rising demand.
Study: GP deserts: Data show chronic shortage of family doctors in England. Image credit: Nick Beer/Shutterstock.com
A new BMJ analysis of physician-patient ratios in the National Health Service of England shows that four-fifths of integrated care boards (ICBs) would need to at least double their number of full-time equivalent (FTE) GPs to meet the British Medical Association’s (BMA) recommended safe level of one GP per 1,000 patients, highlighting persistent regional “GP deserts” in parts of England.
National GP staffing falls far below benchmark
The BMA advises the equivalent of one full-time GP per 1,000 patients to ensure that workloads remain manageable and patients are served safely. Full-time equivalent is a standardized method for converting the total working hours of all GPs in a given practice or area into the equivalent number of full-time staff, thereby adjusting for part-time work rather than relying on simple headcount.
However, the national-level ratio is one full-time equivalent (FTE) GP per 2,200 patients. This ratio counts full-time equivalent fully qualified GPs, rather than simple headcount, which can overestimate capacity when many doctors work part-time.
Commenting on this situation, Katie Bramall, chair of the BMA’s General Practitioners Committee, spoke of “patient demand far outstripping GP capacity.” The chair of the Royal College of General Practitioners, Victoria Tzortziou Brown, added that as a result, “The pressures on general practice are clearly far beyond what is safe or sustainable.”
In reply, a Department of Health and Social Care (DHSC) spokesperson told the BMJ that government measures had resulted in the current number of fully qualified GPs being the highest since 2015 or earlier. In fact, FTE GPs have increased by 2.3 % over the last six years, with a total of 648.1 GPs having been added during this period. However, this must be set against a rise in patients of 3.69 million, or 6.1 %. The growth in patient numbers has therefore outpaced workforce expansion.
Regional disparities
The government promised, as a policy plank, to prioritize primary health care in its plan to revamp the NHS. Its ten-year program aims to shift care from hospitals into the community, but the current data suggest that this ambition has yet to be fully realised.
At the ICB level, regional disparities become obvious. The ICBs covering London, Bedfordshire, Luton, and Milton Keynes are the most understaffed, with doctor-patient ratios at one GP per over 2,700 patients. The highest was in North West London.
The chronic and pervasive nature of this understaffing problem is evident in the fact that, in December 2019, ICBs with the highest GP-patient ratios had 862 more patients per doctor than those with the lowest ratios. Six years later, in December 2025, the difference remains comparable at 875, suggesting little narrowing of the gap over time.
According to Tzortziou Brown, the most underserved areas are also the most deprived and the least likely to successfully recruit and retain GPs. As such regions often have high prevalences of chronic conditions, this perpetuates and worsens health inequities between regions.
Infrastructural constraints, such as buildings that are too small, hamper further expansion of practices in some cases, according to a North West London ICB spokesperson. A major underlying factor, they said, was that the ICB’s population increased by 3.5 % between 2023 and 2024, compared with a 3.2 % rise in FTE fully qualified GPs over the same period.
To address this issue, the ICB is training more GPs, many of whom could enter the NHS with the ICB once qualified. At the same time, with limited GP vacancies, the spokesperson acknowledged this could make it harder for trainees to secure posts once qualified.
This emphasizes the key difficulty with the GP staffing pattern. While qualified GPs are unable to cope with the increasing workload, the NHS does not have enough vacancies for newly qualified GPs. Practices lack sufficient funding to recruit more GPs, and GP leaders say government investment has failed to keep pace with inflation.
Describing its attempt to “reverse more than a decade of neglect of primary care,” the DHSC said it has recruited more than 2,000 GPs in the past year and that patient satisfaction with GP services is rising. Wes Streeting, Health and Social Care Secretary, also promised to train more doctors, saying thousands more GPs must be backed by a 10-year workforce plan.
However, the authors note that to meet the rising demand, GP training places would need to increase markedly. In 2025, each of 4,726 GP specialty training posts attracted a mean of five applicants, compared to just 1.34 applications per post in 2019, indicating a sharp rise in competition for available posts.
To address this, the government introduced a bill in January that seeks to regulate, by law, the proportion of international graduates who can enter specialty training, giving UK medical graduates an advantage. Tzortziou Brown underlined the need for better GP retention to ensure experienced GPs remain in the NHS.
GP appointments vs seeing the doctor
Currently, GP appointments are peaking compared to any time within the last six years. There were 10 million more appointments per month and about 1.7 million per day over this period.
Even in the most understaffed ICB area of Bedfordshire, Luton, and Milton Keynes, there were 1.65 million appointments during June to August 2025. This represents a 15 % increase over the same period last year, equal to approximately 220,000 additional appointments.
However, most of the increase was met by non-physician healthcare staff, including nurses and physiotherapists, health coaches, social prescribers, clinical pharmacists, and paramedics. Over the last six years, only 45 % of NHS appointments resulted in patients actually seeing a GP, down from 53 %, reflecting a growing reliance on multidisciplinary teams to meet demand.
The additional roles reimbursement scheme (ARRS) has helped expand the roles of other health professionals, while allowing GPs to do more with their practice time. For example, between 2023 and 2024, the North West London ICB expanded ARRS roles by 3.5 %, which the spokesperson said was not captured in the GP workforce statistics.
GP shortages strain wider NHS services
The high GP-patient ratio cascades down to affect other areas of NHS function. For instance, the inability to obtain primary care can drive an increase in emergency care use, which is far more costly and can place additional strain on hospital services. Bramall points out the need for long-term investment in infrastructure and GP practices, as well as in staff recruitment.
The government has said that GPs are at the heart of its healthcare transformation plan and will benefit from a growing share of NHS funding, though detailed workforce plans have yet to be set out.
Recruitment and retention key to NHS recovery
General practice is the bedrock of the NHS. With the right investment and meaningful initiatives to recruit and retain GPs we can ensure patients get the care they need, when they need it, wherever they live.
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