General Practice in England

Health policy is devolved. The information in this briefing applies to England unless otherwise stated.

What do GPs do?

General practitioners (GPs) are expert medical generalists. They are often the first point of contact for medical advice and treatment for their registered NHS patients. Almost all general practices in England are part of a primary care network (PCN), working together with other local health and social care providers to provide coordinated care and an extended range of services.

How many GPs are there in England?

At the end of September 2024 there were 38,421 NHS GPs in England, according to data from NHS Digital. This is measured on a full-time-equivalent basis (FTE) which takes into account whether GPs work full-time or part-time.

In September 2024, there was an average of 1,655 registered patients per full time equivalent (FTE) GP, including training grades.

GPs make up only a quarter of staff in general practice. Healthcare and support services are also provided by a range of other staff groups.

How are GPs funded?

GPs provide services to the NHS independently through a contract. This means general practices operate like businesses, and many GPs are responsible for running their own practices either alone or in partnership with other GPs.

General practices are funded by the NHS and have various income streams from the NHS. The government has said between 50% to 60% of a practice’s income comes from funding to deliver its core contractual arrangements. Other NHS funding sources include incentive schemes, practices offering extra services, or funding from primary care networks.

GP partners are self-employed independent contractors, rather than NHS employees. Salaried GPs are mostly employed directly by GP practices. As businesses, general practices have the freedom to set the pay and terms and conditions of their workforce.

In the 2024 Autumn Budget, the government announced changes to employer National Insurance contributions (NICs). The Treasury is compensating public sector employers for employer NICs bills through increases to their budgets. Since workers in general practices aren’t technically public sector employees, general practices might not be compensated for the NICs increases. Various stakeholders have highlighted concerns about how the NIC changes may affect general practices (see section 2 of this briefing).

In December 2024, the government announced that general practice will receive a funding uplift of £889 million in 2025 to 2026 on top of its existing budget, which it said represents an estimated real-terms growth of 4.8%.

The government said it is consulting with the British Medical Association’s general practitioners’ committee (GPCE), the professional body representing GPs in England, on its proposals for the GP contract for 2025 to 2026. It has said that it will publish the contract in spring 2025.

What are the concerns about the GP workforce?

There have been longstanding concerns about the recruitment and retention of GPs, and about overwork and low morale within the GP profession. The pandemic increased pressures and patient dissatisfaction about the difficulty of accessing services.

In 2019, the government introduced the Additional Roles Reimbursement Scheme (ARRS) to increase capacity, alleviate GP workload and help solve the workforce shortage in primary care in England. In August 2024, the government announced it was adding recently qualified GPs to the ARRS from October 2024 to aid with workforce numbers for 2024/2025. The government announced £82 million from the existing Department of Health and Social Care budget to support the inclusion of over 1,000 newly qualified GPs in the ARRS. In January 2025, the government said recently qualified GPs who are employed via the ARRS will continue to be supported through the scheme in 2025/26.

The government said it will publish a 10-year health plan for England in spring 2025 to “reform” healthcare by shifting from “hospital to community” care, rolling out new technologies and focusing on preventing illnesses by identifying and managing issues earlier. Regarding general practices, the government has said it will, through the 10-year plan:

• “bring back the family doctor”
• reduce bureaucracy
• focus on preventing diseases
• “end the 8am scramble” for GP appointments

Who are GPs accountable to?

Responsibility for commissioning primary medical services has been delegated from NHS England to integrated care boards (ICBs) since they replaced clinical commissioning groups (CCGs) on 1 July 2022.

GP practices are accountable via their contractual arrangements to ICBs and to NHS England, which is in turn accountable to the government and to Parliament.

Who is responsible for GP infrastructure?

As independent businesses, GP partners are responsible for making decisions about what infrastructure their practices need. General practices can receive funding from NHS England and ICBs towards improving their infrastructure and estates.

The 2024 Autumn Budget announced £100 million to support 200 GP estate upgrades across England and to improve the use of existing buildings.

What challenges are there for the future of general practice?

With a growing and ageing population and increase in long-term chronic conditions, demands are increasing and the work of general practice is becoming more complex.

Combined with these pressures, there are serious recruitment and retention challenges, questions about the sustainability of the GP partnership model, calls to reform GP funding and questions about what the future of general practice might look like.