General Practice Workforce, 30 November 2021

For 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, 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. 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 collect and publish 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. 

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.

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.

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 Annex B of the Excel Bulletin. 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 monthly figures presented in Annex B 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.

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.

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.

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

England-level figures, November 2021:

• 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, November 2021:

• 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, July to November 2021
• Headcount of ad-hoc locums in other roles within general practice, July to November 2021

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.

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

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.