Where are all the European GPs?

Problem

The Royal College General Practitioners estimates that over 2000 GPs providing care for more than three million patients could be lost to the National Health Service if their status is not protected during Brexit negotiations. This represents 5% of the workforce in England at a time when overall workload has increased by 16% and real-time funding for primary care has decreased by 6% in the last decade. The GP Forward View has pledged 5,000 more GPs by 2020. NHS England commenced their International GP Recruitment Programme in April 2017 which aimed to recruit at least 500 GPs from the European Economic Area (EEA) to England by 2020.

This study aims to explore the characteristics of practices with GPs from the EEA over an 8-year period from 2009/10 to 2016/17.

Approach

We constructed a longitudinal database of descriptive data for all general practices in England covering the period 2009/10 to 2016/17 (n= 8,278 practices in 2009/10). Practice characteristics were linked to GP workforce data including headcount of GPs who hold their primary medical qualification from a non-UK EEA institution. The ratio of the number of European qualified GPs to UK qualified GPs in each practice was calculated across all years.

Statistical analysis was performed using panel regression methods to explore the effects of deprivation (analysed as quintiles), region (four categories: North, Midlands, London and South), list per full-time equivalent (FTE) GP (quintiles), prevalence of long-term limiting illness (LTLI) (quintiles), contract type (General Medical Services (GMS), Personal Medical Services(PMS) or Alternative Provider Medical Services (APMS)) and training practice status. P-values of less than 0.05 were regarded as statistically significant.

Findings

There has been a 6% drop in the number of European trained GPs over the period 2009/10 to 2016/17 (1,424 vs 1,343). A random effects model demonstrated that a higher proportion of European GPs were found in practices with higher levels of deprivation, based in London, a greater list size per FTE GP, a greater prevalence of LTLI, and non-training practices.

Further analysis for the 2016/17 year found that European trained GPs were more likely to be working in practices with greater levels of deprivation (regression coefficient B, 0.04, p<0.001), in London (B 0.02, p<0.001), a greater list size per FTE GP (B 0.04, p <0.01), a greater prevalence of long-term limiting illness (B 0.01, p<0.001), APMS practices (B 0.06, p<0.01) and non-training practices (B 0.09, p <0.001).

Consequences

This work demonstrates the contribution European GPs make to general practices in England, often in areas of greater deprivation, clinical need and with an under-supply of GPs. The policy implications of this study include focusing general practice recruitment of European GPs into areas which have been underrepresented previously such as practices outside London and training practices.