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Exodus of Older GPs Threatens Government Plans to Boost Numbers

The NHS could be facing a demographic timebomb as latest figures show that around a third of GPs in England are approaching retirement.

A headcount by NHS digital published on Thursday showed that 37% of the 27,743 fully-qualified GPs are aged 50 and over, and almost 10% are 60 plus.

Almost one in every two GPs are over the age of 45, according to a recent analysis by the British Medical Association (BMA).

For the NHS as a whole, 42.3% of staff in 2019 were aged between 46 and 65, official figures showed – a proportion that had grown slightly since NHS Digital's previous survey in 2016. At the same time, there were fewer younger staff members, with a decrease in the same period of those aged between 26 and 35.

Doctors Are Retiring Earlier

As for GPs, they are heading for the surgery exit earlier, with an average retirement age of 59 in 2020-21, compared with 61 in 2007-08, according to research by The BMJ. The clock is ticking to a substantial erosion in the number of experienced doctors.

Neither is there an indication that a younger generation of GPs are taking their place in the consulting room. Only 2858 fully qualified GPs in England were aged under 35 in April, compared with 3347 4 years earlier – a 12% reduction.

The overall trend has been a slow decline in qualified GPs, reaching back to the first figures available from NHS Digital in 2015. The size of the qualified GP workforce has fallen by 5.4% over the last 7 years, the latest published figures to April this year indicate. That is "incredibly worrying" to Dr Samira Anane, the BMA's GP committee workforce policy lead, who commented that "the number of GPs leaving the profession is in steady but sustained decline, with the equivalent of 1622 fewer fully qualified GPs since September 2015, despite the fact that patient demand remains high".

'Working to Their Absolute Limits'

Each departure augers badly for the dwindling number of family doctors left to cope with an average of 23.7 million appointments attended each month, based on figures for 2021 provided by NHS Digital. In April 2022 alone, GPs dealt with an estimated 25.3 million appointments.

"These latest figures show that GPs and our teams are working to their absolute limits," said Prof Martin Marshall, chair of the Royal College of GPs (RCGP).

The Government made a manifesto pledge to boost the workforce with an additional 6000 full-time equivalent GPs by 2024-25. But giving evidence to the Health and Social Care Committee in November, England's Health Secretary, Sajid Javid, admitted candidly that he was "not going to pretend that we are on track when clearly we are not".

The BMA and the RCGP have persistently warned about the deteriorating situation.

Last October, a survey of RCGP members revealed that 8% of respondents planned to leave in the next 12 months, 15% in the next 2 years, and 34% in the next 5 years. Of those, around half would be retiring but taken together, it could equate to patients losing 3000 GPs in 2022 and 6000 by 2023, it predicted.

Stress and Job Dissatisfaction

Stress and burnout, exacerbated by the COVID-19 pandemic, has taken a toll on today's workforce. The BMA says medicine remains a popular career choice, but doctors frequently find working in today's NHS "too taxing on their work-life balance, health and wellbeing, particularly as they age, causing many to seek early retirement".

An analysis by the Nuffield Trust found that burnout was a key issue for GPs but so too were job satisfaction, including time spent on tasks they considered to be unimportant, and physical working conditions.

Then there is the controversial issue of pensions taxation. Older, more experienced doctors can face what the BMA calls "punitive" tax bills if they breach their annual allowance and lifetime allowance. In a recent poll carried out by the doctors' union, 43% of GPs said that the impact of pension taxation would be a "high influence" in any decision over whether to leave the health service. For them, it may be time to get out the calculator to see whether staying in the job adds up, or whether it would be better to call it a day, claim their pension, and avoid a nasty shock from the Inland Revenue.

Offering Support for an Older Workforce

A BMA report in January this year, Supporting an ageing medical workforce, called for older doctors to be valued for their experience and skills. While in workplaces across the UK many employees were choosing to defer retirement, encouraged by their employers who appreciated what they had to offer, "the NHS is seeing the opposite happen". They "have much to offer to the health service in terms of skill, expertise and knowledge", it said, as well as acting as "role models" and contributing to the supervision of trainee doctors and medical students.

"Employers and policy makers must focus on the needs of older workers in the health service and support more doctors to stay in work or return from retirement," it argued.

The report identified offering flexible working arrangements as the most important way in which employers could persuade doctors to remain in clinical practice beyond retirement age.

"We're seeing good work happening, with success, to encourage medical students to choose general practice," said Prof Marshall, "but we urgently need to see more being done to encourage GPs to stay in the profession, including by addressing 'undoable' workload."

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