One in Three GPs in England Do Not Work in NHS, Raising Concerns Over Access to Care

Published: 18 September ‘2025. The English Chronicle Desk

A startling new study published in the British Medical Journal (BMJ) has revealed that nearly one in three general practitioners (GPs) in England no longer work within the National Health Service (NHS), with many choosing private practice, relocating abroad, or leaving general practice entirely. The findings highlight a growing crisis in primary healthcare, leaving patients struggling to access appointments despite significant government efforts to bolster GP numbers.

According to the study, the proportion of family doctors who, while fully qualified, do not provide care through the NHS has increased steadily from 27% in 2015 to 34% last year. This translates to almost 20,000 GPs effectively “lost” to the NHS, a stark figure at a time when demand for primary care services has reached unprecedented levels. Of the 58,548 GPs on the General Medical Council (GMC) register at the end of 2024, only 38,626 were actively working in general practice, leaving 19,922 doctors qualified but not serving the public in the state healthcare system.

The Patients Association has described the findings as “deeply distressing,” warning that patients already face long waits, fragmented care, and delays in diagnosis, all of which can compromise health outcomes. Rachel Power, chief executive of the Patients Association, said: “While there is a welcome rise in GP numbers on paper, this report that one in three GPs are not working in the NHS is deeply distressing for patients who already experience frustration and anxiety when trying to access a GP appointment. Long waits, fragmented care, and delayed diagnoses are putting people’s health at risk.”

The report, led by Luisa Pettigrew of the London School of Hygiene and Tropical Medicine, points to the intense pressures GPs face as a key factor behind their growing disengagement. Heavy workloads, rising patient expectations, and insufficient time to provide adequate care contribute to burnout, prompting many to leave the NHS shortly after completing their training or to avoid NHS work entirely. Young doctors, in particular, are increasingly opting for private practice or overseas opportunities that offer more flexible schedules and greater financial incentives.

Financial implications of this exodus are significant. Each fully qualified GP represents an estimated £430,540 in training costs across undergraduate and postgraduate education. The BMJ study calculates that the gap between GMC-licensed GPs and those actively practicing in the NHS in 2024 equates to a loss of approximately £8.6 billion in training investment by headcount, or £13.1 billion when measured by full-time equivalents. Although these figures may be adjusted downward to account for international medical graduates, the scale of the financial impact is considerable.

The study also aligns with recent research from the GMC, which found that the number of GPs planning to move abroad, work privately, or leave the profession entirely has risen sharply. Between 2020 and 2024, the proportion of GPs considering relocation overseas more than doubled, from 10% to 21%. Similarly, those intending to move into private practice or increase private working hours rose from 23% in 2019 to 29% last year, outpacing similar trends among doctors overall. Meanwhile, the proportion of GPs taking concrete steps to exit the profession—such as contacting recruiters, applying for non-clinical roles, or initiating retirement—jumped from 4% in 2019 to 15% in 2024.

The BMJ study identified certain groups at higher risk of leaving NHS general practice. Female GPs, particularly those aged 30 to 49, younger doctors early in their careers, and practitioners in London and the South East, are disproportionately likely to quit or reduce their NHS commitments. Experts warn that this trend poses a significant challenge to government plans to shift more care into the community and develop new “neighbourhood health services.” Without an effective retention strategy, these initiatives could be undermined.

Prof. Kamila Hawthorne, chair of the Royal College of GPs, commented on the findings, noting that although record numbers of newly-qualified doctors are entering GP training in England, retention remains a critical issue. “Despite the increase in recruitment, the NHS is effectively pouring doctors into a leaking bucket. The system is unable to hold onto family doctors long enough to make a real difference for patients.” She emphasized that the focus should be on improving retention rather than simply increasing the number of new recruits, urging Health Secretary Wes Streeting to prioritize support measures, workload management, and professional wellbeing for GPs.

The Department of Health and Social Care (DHSC) did not comment directly on the BMJ findings but highlighted ongoing efforts to strengthen primary care. Officials stated that more than 2,000 extra GPs have been recruited over the past year, supported by a £1 billion investment in primary care facilities, upgrades to surgeries, and reductions in administrative burdens. DHSC also emphasized that July 2025 marked the highest-ever headcount of fully qualified GPs in England, with patient satisfaction rising alongside these improvements.

However, researchers and patient advocates argue that recruitment alone cannot solve the problem. Retention and engagement of existing GPs remain central to ensuring accessible, high-quality care. Without meaningful reforms to address burnout, excessive administrative tasks, and workload pressures, the NHS risks losing more family doctors to private practice, overseas work, or complete departure from the profession.

The human cost is already evident. Patients in areas with chronic GP shortages face long waits for appointments, limited continuity of care, and delays in essential treatments. These challenges are particularly acute in urban centers like London, where attrition among younger GPs and female practitioners has been pronounced. In rural and underserved communities, the departure of even a small number of GPs can have a disproportionately disruptive effect, leaving vulnerable populations with limited access to basic healthcare.

The BMJ report underscores that addressing these challenges will require a holistic approach. Recommendations include improved working conditions, mental health and wellbeing support, flexible working arrangements, better remuneration, and targeted retention strategies for groups at highest risk of leaving NHS general practice. The study also stresses the importance of reducing administrative burdens to allow GPs to spend more time on direct patient care, reinforcing the primary aim of the NHS as a patient-centered health service.

As the NHS continues to face growing demand for primary care, the findings raise urgent questions about how the system can balance recruitment, retention, and quality of care. Without decisive action, the gap between the number of qualified GPs and those actively working in the NHS is likely to widen further, exacerbating pressures on patients and healthcare providers alike.

The BMJ study serves as a stark reminder that the challenges facing England’s primary care system are multifaceted. While investments in recruitment and infrastructure are essential, retaining skilled practitioners, ensuring their wellbeing, and enabling them to provide effective care must remain at the heart of any reform effort. For patients, the stakes could not be higher, as timely access to GP services remains critical for both preventive healthcare and the management of ongoing medical conditions.