General Practice Workforce - 30 June 2021

GP workforce statistics, we always advise that any comparisons are made across a full year, for example September to September, rather than from one quarter or month to the next. This is because data is affected by seasonal variation. For example, September is the main intake and rotation period for GPs in training, which can result in a higher number of these GPs joining the practices than leaving. Similarly, some GPs in training may leave, or rotate away from practices, over the subsequent months.

The time series of these statistics begins in September 2015 when the workforce Minimum Data Set (wMDS) was first collected. For the first three releases, we collected and published data biannually for September and March. In December 2016, we introduced a quarterly collection for GPs only, which we extended to the other three staff groups in December 2017.

From July 2021, we are collecting and publishing these statistics monthly. However, for the first year, great care should be taken when considering the new monthly data series, and until we have a full year of monthly data it will not always be possible to make comparisons with figures from earlier years. For example, it will not be possible to make comparisons of data collected for July until 2022 when you will be able to compare those figures with the first monthly collection of July’s data from 2021.

We collected and published monthly figures for October and November 2020, but due to data completeness and quality concerns these figures were withdrawn and are not included in the Excel Bulletin tables and the Practice-level and Individual-level CSVs are not available for those months.

Many primary care staff work in more than one practice, CCG, ICS, STP, or region. When we refer to ‘headcount’, we mean the number of distinct individuals working at the practice, CCG, or other area/regional level. Headcount figures tend to be higher than FTE figures because we may count the same person several times depending on their job role as well as where they work, and because the working hours of part-time staff members are added together when reporting full-time equivalent figures. For example, three staff members may each work 25 hours per week, and would be included separately in the headcount figures. However, we sum working hours when calculating FTE and with a total of 75 hours per week, these three individuals would contribute two in terms of FTE.

We calculate headcount separately for every reporting level, for example, GP practice, CCG, ICS, STP, region, and England-level and higher-level headcount figures cannot necessarily be calculated by simply adding together the lower-level GP practice counts. This is because if the quality of the data is good enough, we can see when an individual is working in more than one organisation, and ensure that at the higher reporting levels, we count them only once. However, if the data is of lesser quality and a record is missing the necessary identifiable information, we may not be able to identify all the places that the individual works and as a result, some duplicates will be in the total figures.

Headcount – example 1

For example, a staff member works full-time across two practices within the same region, spending one day (20% of their time or 0.2 FTE) at Practice A and four days (80% of their time or 0.8 FTE) at Practice B. Because the data quality is good, we can identify that the same person is working in both practices even though they hold two distinct roles or contracts as illustrated in Table 1.

Table 1: Headcount methodology – same region

Since we know that both roles are held by the same person, we can deduplicate the data, which means that although they are included in the headcount for both practices, at a regional and England-level, we count them only once.

Headcount – example 2

If, however, the two practices in example 1 are in different regions but of good data quality, we can still identify that the same individual holds these two roles. In this example, we include them in the headcount figures for both GP practices also for the applicable regions, but we count them only once at England-level as shown in Table 2.

Table 2: Headcount methodology – different regions

Headcount – example 3

The first two examples apply to a staff member who holds the same type of job role in different practices. However, an individual could also work in different job roles and in such cases, we count them once in each staff group as well as in the overall totals.

For example, a GP works three days as a salaried GP in Practice A and two days as a locum GP in Practice B.

At an England-level, we include this GP in the headcount figures for both Salaried and Locum GPs, but only once in the overall total GP headcount as illustrated in Table 3.

Table 3: Headcount methodology – different job roles

Full-time equivalent (FTE) is calculated based upon a 37.5 hour working week. For example, a staff member working 15 hours per week would be 0.4 FTE while someone working four 7.5-hour days would be 0.8 FTE and so on.

The contract/role count in these table represents the total count of specific posts held/worked by that individual in a given organisation; some GPs and other staff members can have multiple roles within or across organisations.

Early in 2017, we issued additional guidance to practices about recording information on locum GPs. In March, 2017, the reported locum FTE and headcount figures were considerably higher than in March the previous year at 1,187 FTE compared to 670 in March 2016 and with a headcount of 3,072 in March 2017 compared to 1,592 the previous year.

There is some anecdotal evidence that use of locum GPs was generally increasing during the early years of this collection. However, we believe that the large increases in locum FTE and headcount recorded in March 2017 are primarily due to improvements in how the data was recorded because of the new guidance, rather than being indicative of a sudden rise in locum usage.

After comparing the data submitted for March 2017 with the historical data, and following a consultation with stakeholders, we calculated FTE estimates for the locum GP workforce to account for records that should have been submitted in earlier collections. These FTE estimates are included in figures between September 2015 and December 2016 and mean that figures are comparable across the years. However, we do not calculate these estimates by personal characteristic such as gender or age so caution should be used when considering such breakdowns in earlier reporting periods.

We believe that some of the increase in FTE identified in March 2017 resulted from practices reclassifying some GPs from other job roles, for example Salaried GP on a Fixed Term Contract. To avoid double-counting them, we did not calculate estimated records for these GPs, as they were already included in counts of non-locum GPs prior to March 2017.

Although there is still a small ‘step change’ between December 2016 and March 2017, nonetheless, the overall counts of GP FTEs are believed to be consistent and comparable.

The nature of the GP locum workforce is complex. Some work full-time while others work only a few sessions as locums and may hold other roles within the GP workforce. As a result, while we can calculate FTE estimates for locum GPs, it is not possible to produce reliable headcount estimates. For example, a week’s GP absence at a practice could be covered by a single locum working full-time or by multiple individuals each covering one or more sessions and these working patterns cannot be predicted. Therefore, when we produced the FTE estimates, we did not calculate estimated headcount figures and there is an unavoidable break in the locum headcount time series meaning that headcount figures after March 2017 are not comparable with earlier figures.

We are advised that some GP locums are based in a practice to cover long-term absences such as maternity leave or a vacancy while others may cover one or more sessions on a planned or regular basis such as every Wednesday. In these cases, these ‘regular’ locums have consistent and generally predictable working hours and their presence in the workforce is expected on a planned and/or ongoing basis. Details about these regular locums are collected in the main part of the National Workforce Reporting Service (NWRS) collection tool in the same way as permanent practice staff.

However, there is another cohort of locum GPs with less predictable working patterns. We refer to these sessional GPs as ‘ad-hoc locums’, and we collect and publish different information about them as described below.

Ad-hoc locums

In addition to details of permanent GP practice personnel, we also collect information about the ad-hoc locum GP cohort (formerly referred to as infrequent locums). Please note that the concept of an ad-hoc locum is an artificial construct implemented for data collection and publication purposes. GPs do not consider themselves to be “ad-hoc locums” per se, but the nomenclature can help to understand how these sessional GPs interact with practices.

Ad-hoc locums are locum or sessional GPs who typically work briefly at practices to cover for short-term or unexpected absences. Depending upon the practice’s needs, these GPs may work as little as a single one-off session in the entire period covered by the data collection or may be employed several times to cover multiple sessions. In some cases, practices will employ the same ad-hoc locum GP whenever they need temporary cover for sessions, while in other situations, the ad-hoc locum may work at a given practice only once.

We introduced this ad-hoc locum category in the autumn of 2017 and published the first figures for this group in the December 2017 release. Until the introduction of this category, we were able to capture information on these ad-hoc locum GPs and their working hours only if they were employed by the practice at the time of the snapshot, (i.e., on the date of the data extract). This means that we were not able to reflect the entire contribution of this subset of the GP workforce, because GPs working on other days in the month, and the hours that they worked, could not be captured. This was exacerbated for months when the snapshot date was at the weekend or on a public holiday as many practices are closed on these days and their usage of ad-hoc locums was minimal.

To allow us to better understand the ad-hoc locum workforce and its contribution to the general practice workforce, we changed the data collection and issued new guidance to practices. Instead of providing information for a snapshot of the ad-hoc locum workforce, since December 2017 practices have used a special section in the data collection tool to tell us the name, GMC number (General Medical Council professional registration number) and the total number of hours that ad-hoc locums have worked during the reporting period; this is a subset of the data that we collect for the permanent practice staff, so we know less about this cohort than we do about the main practice workforce. Nonetheless, it has greatly enhanced our understanding of the sessional GP workforce.

The fact that the ad-hoc locum figures are calculated differently means that the FTE and headcount figures are not directly comparable with the snapshot of the main workforce.

Some ad-hoc locums work exclusively as sessional GPs providing short-term, short-notice or other temporary cover as described. However, some hold other roles within the general practice workforce in addition to acting as ad-hoc locums. For example, they may work in long-term locum placements in another practice, fixed term contracts or as salaried or other GPs. However, when interpreting the ad-hoc locum headcount figures, it is important to note that most ad-hoc locum GPs work only a few sessions during a reporting period, and many of these GPs have no other role in the primary care workforce i.e., they do not appear elsewhere, for example as salaried GPs.

For example, between July and September 2020, 1,765 distinct individuals were identified as working as an ad-hoc locum GP. However, of these GPs, 1,213 worked in no other roles in the general practice workforce and most worked very few hours during the quarter. As a group, they therefore contributed 1,213 to the headcount figures, but accounted for only 45 of the total FTE. This means that the inclusion of ad-hoc locum figures in the GP headcount totals carries a risk of distorting our understanding of the figures.

It is also important to bear in mind that the ad-hoc locums are not necessarily providing additional resource for the general practice workforce as they tend to work in practices to provide temporary, short-term cover for short periods of sickness or other absence. (GP absences of longer duration, such as for maternity or paternity leave, or long-term sickness are likely to be covered in a different fashion, such as with a GP on a fixed-term contract.)

While it is important to understand and quantify the scale of the contribution of ad-hoc locums to the general practice workforce, there is a risk that including them in the main workforce totals artificially inflates our understanding of the figures, as in most cases they are not increasing capacity within the workforce. For example, a GP working 37.5 hours per week who is absent due to sickness for a week is still a member of the practice’s workforce and is counted in the statistics with an FTE and headcount of one. At the same time, an ad-hoc locum providing cover would also contribute one to the headcount figures and a pro-rata’d amount to the FTE total. This means that two people would be counted for the week in question, but with only one available to work, thus distorting the figures.

Due to some issues with the data quality in the last quarter of 2020, the ad-hoc locum FTE figures for December 2020 include some estimates.

Until June 2021, we included information about ad-hoc locums in the main publication figures. However, because the nature of the ad-hoc locum cohort is different to the rest of the practice workforce, and since the measures are calculated differently, from June 2021 we have removed information about ad-hoc locums from the overall totals and publish figures about this cohort only in Annexes B and C of the Excel Bulletin. From July 2021 onwards, this series will be published monthly rather than each quarter. We expect there to be a slight delay in the availability of ad-hoc locum-related data so the monthly figures in Annexes B and C will be updated somewhat in arrears.

Annex B in the Excel Bulletin also includes headcount figures for the additional roles that some ad-hoc locums hold in general practices. We recommend that these figures be treated with caution. While adding the ad-hoc locum FTE figures to the FTE totals in the Excel Bulletin can give a clearer picture of the level of service delivered by general practices, it is not appropriate to simply add the ad-hoc locum headcount figures to the totals in the main bulletin.

For more information, please refer to the Methodological Change Notice.

GPs in training, formerly referred to as “GP registrars” are fully qualified and registered physicians who are undergoing further training specifically for general practice. There are several categories of training grade including Speciality Training (ST1-4) and Foundation Training (FT 1-2).

We have been using Health Education England’s (HEE) Trainee Information System (TIS) as the source of our GPs in training data since June 2018 as it is more timely and complete than our original data sources which were:

• Extracts from NWRS and the four Health Education England regions which were still providing separate data submissions
• Information about medical trainees delivering primary care services whose data was held in the Electronic Staff Record (ESR)

As it was evident that counts of GPs in training for earlier periods were incomplete, we compared data from our original sources for June 2018 with the TIS data and calculated an uplift measure to apply to all pre-June 2018 figures.

We calculated that adopting TIS as the primary data source for GPs in training increased the June 2018 FTE count by 8.8% and the headcount figure by 6.0%. It is unusual for FTE figures to be higher than headcount figures and occurs in this instance because GPs in training typically work a 40-hour week whereas we define FTE as 37.5 hours. Therefore, every full-time GP in training accounts for 1.067 FTE in our figures.

We used these percentages to calculate England-level estimates for each of the training grades and applied them to the earlier figures. This should make FTE and headcount figures for GPs in training comparable across the years although some caution should be used when making such comparisons. In addition, as these estimates were calculated only at England-level, regional figures from June 2018 and later are not comparable with figures from earlier years.

More information is available in the Methodological Change Notice in https://files.digital.nhs.uk/EB/7A75BC/GPWMethChangeNotice%2CApr19.pdf and data quality statement available at https://files.digital.nhs.uk/EE/A67297/GPWDQStatement%2Crevised.pdf

We collect information about the general practice workforce directly from practices using a live, online collection tool. The completeness and coverage of the data collection has improved since we first collected wMDS in September 2015, but nonetheless there are still some data quality considerations.

In some cases, practices provide valid records about their staff but do not include information about their working hours. In these cases, we retain the record and calculate estimates for their working hours and full-time equivalence based upon the national averages for the job role. We refer to these figures as ‘partial estimates’, and the scale of these estimates varies by staff group. Annex A in the Excel Bulletin tables shows the percentage of partially estimated figures for each staff group.

Since July 2019, all GP practices in England have had the opportunity to join one of around 1,250 Primary Care Networks and the vast majority have taken the opportunity to do so. PCN member organisations, which include GP practices, and other health, social care, mental health, and voluntary sector providers, deliver accessible and integrated care to local communities.

These PCNs have their own distinct direct patient care workforces which can be tailored to cater for the specific needs of each PCN’s local patient populations and data relating to these staff was collected for the first time on 31 March 2020. We published a helpful overview of PCNs in the March 2020 release and the entire series of Official Statistics is available. 

Most staff working in PCNs will be in DPC roles although there should be some administrative support. In addition, all PCNs should have a suitably qualified clinical director – often a GP, nurse, or other clinician – although this responsibility may be shared by several individuals.

Some staff, particularly clinical pharmacists and pharmacy technicians originally employed by a general practice, will have transferred some or all of their working hours to the PCN which means that all practices can benefit from their expertise. However, this means that while the PCN staff numbers may increase, there could be a corresponding decrease in the practice-level FTE and headcount figures for these job roles. Although this effect will be most noticeable for pharmacy-based roles, other DPC and administrative roles may also be affected as some practice-based staff begin to work full or part-time for PCNs.

To help you to understand more about PCNs, we include details of each practice’s PCN in the practice level CSV file. However, when considering these general practice statistics by PCN, please take note of the following points:

• Aggregating from GP practice to PCN to CCG may not replicate the CCG figures as PCN membership is not mandatory and some practices have not taken the opportunity to join a PCN.
• While PCN boundaries are generally expected to align with CCG boundaries there are some exceptions, notably where effective and successful cross-CCG collaborative working was already in place. In this instance, a responsible CCG is identified for PCN-data reporting purposes even if some GP practice members belong to a different CCG.

There is some evidence to suggest that the completeness and coverage of the data extracted from the NWRS for March and June 2020 were adversely affected by the COVID-19 pandemic which should be taken into consideration when considering the figures for these two quarters.

The publication includes some experimental analysis of joiners and leavers. These tables are not available with every publication – please consult the Publication content, analysis, and release schedule for more information.

We calculate the leavers and joiners over complete years, for example from September to September rather than from one month or quarter to the next as seasonal variation may otherwise distort the figures. We identify GPs whose ‘identifying information’ was present in the data set at the end of the applicable reporting period but not at the beginning as joiners. Similarly, leavers are GPs whose identifying information was present in the data set at the start of the reporting period but was not in the data set at the end of that time.

‘Identifying information’ for this analysis can be:

• GMC registration number
• National insurance number
• forename, surname and date of birth
  or
• first initial, surname and date of birth

As this analysis relies upon being able to identify the same person in different data sets, it is especially sensitive to data quality and there may be a risk that the joiner and leaver counts are under or overestimated.

Until September 2019, we published high-level figures on staff absence and vacancies. However, the completeness and coverage of the data were very low, and in March 2020 this analysis was suspended for a review of the data.

We are not currently collecting information on staff absence or practice-level vacancies and will be consulting with stakeholders about the possibility of reinstating these elements of the data collection and the potential for future analysis.

We have done our utmost to remove breaks in the time series to enable counts to be comparable across years. When considering the time series, it is important to note the following important points:

• We urge you to make comparisons only on a year-on-year (whole-year) basis and not to make comparisons from one quarter or month to another. This is because seasonal variation affects workforce figures. For example, there are two intake periods for GPs in training, one in September with a smaller intake in February.
  • From July 2021 we will be publishing this series of Official Statistics monthly rather than each quarter. However, for the first year, there will be no comparable historical figures for publications of January, February, April, May, July, August, October and November data and care should be taken when considering these figures. Although we initially published some monthly figures for October and November 2020, due to data quality considerations, these figures were withdrawn, and have not been revised or included in the current time series.
• The completeness and coverage have been improving since the first data collection which enables us to have greater confidence in the figures. When we first collected the wMDS in September 2015, we received data from 88.1% of practices whereas this percentage had reached 99.6% by June 2021.  
  • However, as we have withdrawn estimated records for missing data, care should be taken when making comparisons across time periods. The apparent increases, particularly in the earlier years may be due to improved data completeness rather than actual increases although this effect will be lessened in more recent years when higher percentages of practices submitted data. Annex A in the Excel Bulletin table provides details of the number and percentage of practices submitting data for each period.
• We have calculated some England-level estimated figures for GPs in training for September 2015 to March 2018. However, we were not able to produce these estimates by region and allocated these estimates to an “Unknown” region.

These estimates are also not available by personal characteristic such as ethnicity.

• We were not able to calculate estimated headcount figures for GP Locums between September 2015 and December 2016 so there is an unavoidable break in the headcount time series
  • We calculated estimated FTE figures for GP locums for September 2015 to December 2016 at England and CCG-level. However, these estimates are not available by gender, age or other personal characteristics which should be taken into consideration.
• Information about Nurses may be compared across whole-year time periods. However, we recommend that you use caution when considering the nursing figures at job-role level, as District Nurses were re-categorised as Practice Nurses from June 2019.

The overall figures for the Direct Patient Care and Admin/non-Clinical staff groups can be compared with previous whole-year figures back to September 2015. However, the data is not fully comparable at a job-role level. This is because some roles have changed, while other roles have been added since the collection began. In addition, in the early collections, some records did not include job role information for staff in these groups.

Accompanying this publication are the following additional files and tools to enable further analysis:

England-level figures, September 2015 onwards:

• FTE and headcount by gender and job role
• FTE and headcount by staff group
• FTE work commitment (up to 15 hours, 15-37.5 hours and more than 37.5 hours per week) by staff group
• GP headcount by country of qualification
• Counts by staff group per 100,000 registered patients

Regional figures for current reporting period only

• Regional (STP and CCG) FTE and headcount by job role
• Regional headcount by ethnicity and staff group

Figures published in the regional tables are mapped against the regional hierarchy as of 1 April for the current financial year.

Annex A

• England-level data quality, September 2015 onwards
  • Data submission rate
  • Percentage partially estimated records by staff group

Annex B

• Total ad-hoc locum FTE and headcount, December 2017 onwards
• Headcount of ad-hoc locums in other roles within general practice

Annex C

• Regional FTE and headcount ad-hoc locum figures December 2017 onwards

These publications include two zipped files containing CSVs:

• The Individual-level CSV is comprised of a row for each role held by a staff member working in general practice
  • Information is included about the CCG each individual works in, but no practice-level details. The file also contains any estimates for working hours if these are calculated due to poor data quality or missing values.
  • A pseudonymised ID number (labelled UNIQUE_IDENTIFIER) is assigned to each individual, so if a staff member works in multiple roles – in the same or different CCGs – they will be allocated the same UNIQUE_IDENTIFIER for every role. This means that accurate headcounts can be calculated for each group, CCG and at England-level by counting distinct instances of the UNIQUE_IDENTIFIERs.
    • The UNIQUE_IDENTIFIER numbers are reassigned for each publication and therefore cannot be used to track individuals over time and across different publications; this is intentional to protect anonymity.
• The Practice-level CSV provides aggregated FTE and headcounts for each job role. We also note for each staff group whether the working FTE figures have been calculated from provided data or whether we have created estimates for some working hours due to poor quality or missing data (labelled as “Partial estimates”).

Figures published in the regional tables are mapped against the regional hierarchy as of 1 April for the current financial year.

We re-map and revise the historical Individual-level and Practice-level CSVs as soon as we are able following the CCG restructures that take place each April, and are revising all these CSVs as part of this release.

Every six months, for extracts of March and September data, we also produce

• Regional tables for the current reporting period presenting:
  • FTE work commitment by staff group
  • FTE by staff group per 100,000 registered patients and patient counts by age bands
  • Interactive pre-set pivoted tables for the current reporting period and guidance in how to use the files

Until September 2019, we also published information about staff vacancies and absences. However, the completeness and coverage of the data have always been a concern, and analysis of these data items has not been viable since that time. We are not currently collecting information on staff absence and practice-level vacancies but will be consulting stakeholders to understand their current and future requirements.

• Experimental analysis showing:
  • annual counts of joiners to and leavers from the GP workforce (excluding GPs in training and locums) – FTE and headcount
• Practice information (contract type and dispensing status) in a Comma Separated Values (CSV) file

We are keen to ensure that our reports are as useful and relevant as possible for our users and are continually working to improve the quality of the data and analysis. Changes can include improving the coverage, completeness, or accuracy of the data, amending the data collection and its guidance, or revising aspects of the methodology. All changes are made in consultation with colleagues and stakeholders, including the Department of Health and Social Care (DHSC), NHS England and NHS Improvement (NHSEI) and Health Education England (HEE).

Details of previous and future releases in this series are available.

We welcome feedback from all our users, and you can contact us at PrimaryCareWorkforce@nhs.net, please include "GP Workforce" in the subject line of your email.