General Practice Workforce, 31 October 2022

For General Practice 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, August 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.

Many primary care staff work in more than one practice, Sub-ICB Location, ICB or region. When we refer to ‘headcount’, we mean the number of distinct individuals working at the practice, Sub-ICB Location, 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, general practice, Sub-ICB Location, ICB, region, and England-level and higher-level headcount figures cannot necessarily be calculated by simply adding together the lower-level general 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 general 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

The contract/role count in these tables 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.

Full-time equivalent calculations

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.

Practices are asked to submit the number of contracted weekly hours for an individual, but also have the option to submit average weekly hours worked across the period (which since July 2021, is a month), separately. This option is of particular importance where contracted hours would not be relevant for an individual (for example, where the staff member is on a zero hours contract).

We calculate the full-time equivalence (FTE) for each record based on these fields. For the majority of staff we use contracted hours in the first instance, only using working hours if contracted hours is missing or zero. If both fields are missing or zero, we estimate the FTE for the individual (see Partial Estimation).

The exception to this rule is those individuals on either a zero hours contract, or a partner (zero hours) contract. For these staff, we calculate FTE based on their working hours in the first instance, but use contracted hours if working hours is missing or zero. If both fields are missing or zero, these individuals are excluded from the analysis and do not count towards headcount or FTE figures.

Changes in 2017

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. 

Different types of locums

'Regular' locums

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 general practice personnel, we also collect information about the ad-hoc locum GP cohort (formerly referred to as infrequent locums). 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.

Introduction of ad-hoc locums into the collection

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.

Ad-hoc locums who hold other roles 

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. This means that the inclusion of ad-hoc locum figures in the GP headcount totals would carry a risk of distorting our understanding of the figures.

Provision of additional resource

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.

Changes due to the introduction of monthly collections

Since July 2021 onwards, this series has been published monthly rather than each quarter. There is a delay in the availability of ad-hoc locum-related data so the figures presented for the two most recent months in Annexes B and C are marked as provisional and are updated in subsequent months. Users should always refer to the most recent publication for the most up-to-date ad-hoc locum statistics.

Annexes B and C in the Excel Bulletin also include 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.

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  and data quality statement available. 

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.

Full Estimation

Estimates are made for both headcount and full-time equivalent (FTE) for those practices which did not provide any valid data for one or more of the four staff groups (or in the case of practices providing no valid direct patient care (DPC) data, DPC estimates are only made for those practices also failing to provide valid data for at least one other staff group). The absence of data for a staff group could be due to poor data quality or no submitted data. For these practices, Sub-ICB Location-level estimations are made. 

Partial Estimation - estimated working hours and full-time equivalence

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.

For a detailed explanation of the estimation methodology, see Estimates in the the Background Data Quality Statement.

Annex A in the Excel Bulletin tables shows the percentage of practices with full and partial estimations for each staff group. Tables 1a to 2b, and Annex A, show the percentage of FTE and headcount that is estimated, for all staff and each staff group.

Almost all Practices are now aligned to a Primary Care Network (PCN). PCN member organisations, which also include other health, social care, mental health, and voluntary sector providers, deliver accessible and integrated care to local communities.

Each PCN has their own distinct direct patient care workforce which can be tailored to cater for local populations and data relating to these staff was collected for the first time on 31 March 2020. We published an 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 hich means that all practices can benefit from their expertise. Users of the data should be aware that the movement of staff between PCNs and Practices may impact both the FTE and Headcount figures being reported.

To aid understanding 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, users should consider that aggregating from general practice to PCN to Sub-ICB Location may not replicate the Sub-ICB Location figures as PCN membership is not mandatory and some practices have not taken the opportunity to join a PCN.

In some months the publication includes some analysis of GP joiners and leavers. These tables, which were previously released biannually as part of the March and September publications, are now released quarterly. Time series figures are biannual up to March 2021 and quarterly from June 2021.   The figures presented related to the joiners and leavers to and from two separate cohorts.  Tables 1a and 1b relate to the Qualified Permanent GP workforce (so excluding GPs in training and locums), while Tables 2a and 2b are concerned with the Qualified GP workforce (so including locums and excluding only GPs in training).

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.

We are not currently collecting information on staff absence or practice-level vacancies.

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 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 August with a smaller intake in February.
• 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 was 99.6% in October 2022.
• 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 (now Sub-ICB Location-level). However, these estimates are not available by gender, age or other personal characteristics which should be taken into consideration.

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 (ICB and Sub-ICB Location) 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 July 2022.

Annex A

• England-level data quality, September 2015 onwards
  • Data submission rate
  • Percentage of practices with partially and fully estimated records by staff group
  • Percentage of FTE and headcount estimated, 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, December 2017 onwards

Annexes C1 and C2

• Regional FTE (C1) and headcount (C2) 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 Sub-ICB Location each individual works in, but no practice-level details. The file also contains estimated records, calculated for practices that did not provide any valid data for one or more staff groups, and 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 Sub-ICB Locations – they will be allocated the same UNIQUE_IDENTIFIER for every role. This means that accurate headcounts can be calculated for each group, Sub-ICB Location, ICB 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 estimated for some working hours due to poor quality or missing data (labelled as “Partial estimates”).  We also note where a practice has provided either no data or no valid data for a staff group. Fully estimated records are calculated for these practices but as these estimates are aggregated up to Sub-ICB Location-level, they are not included in the practice-level CSV.
  This CSV includes information about the Primary Care Network (PCN) each practice belongs to, where the practice is a member of PCN. This information is provided for reference only and should not be used to attempt to quantify the PCN workforce, as these figures relate only to the general practice workforce. 

We re-map and revise the historical Individual-level and Practice-level CSVs as soon as we are able following the regional restructures that take place, usually each April. For 2022, NHS geography updates came into being on 1st  July 2022. Consequently, all previous Individual and Practice-level CSVs have were remapped to reflect the new structure, and re-published as part of  the 31 July 2022. 

September 2015 to present high-level figures and charts visualising them are available in the Power BI dashboard.  The dashboard includes a variety of interactive charts displaying different characteristics of staff providing services at traditional general practices in England. 

The dashboard is in Microsoft PowerBI which does not fully support all accessibility needs. If you need further assistance, please contact us for help.

Every six months, for extracts of March and September, 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

Every quarter, for extracts of March, June, September and December data we produce:

• GP joiners and leavers: annual counts of joiners to and leavers from the Qualified Permanent GP workforce (excluding GPs in training and locums) – FTE and headcount
• GP joiners and leavers: annual counts of joiners to and leavers from the Qualified GP workforce (excluding GPs in training) – FTE and headcount
  • These tables were previously only produced for March and September. Quarterly figures are available from June 2021 onwards.
  • These tables were previously labelled as experimental statistics but are now considered to be of sufficient reliability to no longer be considered experimental.

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.

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 [email protected],