Four out of five NHS regions in England are operating below the recommended GP-to-patient ratios, according to a new analysis published by the BMJ. The study highlights ongoing regional disparities and raises concerns about whether current workforce strategies can meet rising demand for primary care.
The British Medical Association (BMA) recommends one full-time equivalent (FTE) general practitioner per 1,000 patients to ensure manageable workloads and patient safety. However, the national average is currently one FTE GP per 2,200 patients. This figure reflects only fully qualified GPs working full time, not headcount, which can be misleading due to part-time work patterns.
Katie Bramall, chair of the BMA’s General Practitioners Committee, commented on the findings: “Patient demand far outstripping GP capacity.” Victoria Tzortziou Brown, chair of the Royal College of General Practitioners, added: “The pressures on general practice are clearly far beyond what is safe or sustainable.”
A spokesperson from the Department of Health and Social Care (DHSC) responded that government actions have resulted in the highest number of fully qualified GPs since at least 2015. Over the past six years, there has been a 2.3% increase in FTE GPs—an addition of 648.1 doctors—while patient numbers grew by 3.69 million (6.1%) during the same period. This means that patient growth continues to outpace increases in GP staffing.
The government has prioritized primary health care as part of its plan to reform the NHS over ten years by shifting more care into communities rather than hospitals. However, current data indicate this goal remains unmet in many areas.
Regional differences are pronounced at the level of integrated care boards (ICBs). Areas such as London, Bedfordshire, Luton, and Milton Keynes have some of the lowest staffing levels—with ratios exceeding one GP per 2,700 patients—and North West London records the highest shortfall.
Disparities between regions have persisted over time; in December 2019, ICBs with higher GP-patient ratios had an average difference of 862 patients per doctor compared to those with lower ratios. By December 2025, this gap remained nearly unchanged at 875.
Tzortziou Brown noted that regions most affected by shortages tend also to be among England’s most deprived and face greater challenges recruiting and retaining GPs. These areas often see higher rates of chronic illness, further deepening health inequalities.
Infrastructure issues contribute to these challenges as well. According to a North West London ICB spokesperson, some practices cannot expand due to space limitations. Between 2023 and 2024 alone, their population increased by 3.5%, while FTE fully qualified GPs rose by just 3.2%.
Efforts are underway within ICBs to train more GPs locally; however, limited vacancies may make it difficult for newly qualified doctors to find positions once training is complete. Practices cite insufficient funding as a barrier to hiring more staff—a situation compounded by government investment not keeping pace with inflation.
The DHSC stated it is working “to reverse more than a decade of neglect of primary care,” noting recruitment of over 2,000 GPs in the past year and improvements in patient satisfaction with services. Health and Social Care Secretary Wes Streeting promised further expansion through increased training places supported by a long-term workforce plan.
Demand for GP specialty training has risen sharply: In 2025 there were five applicants for each available post compared with just over one applicant per post in 2019.
To address competition for training posts among international graduates versus UK medical graduates, legislation was introduced in January aiming to regulate entry proportions into specialty training programs.
Meanwhile, overall appointment numbers have reached record highs over recent years—averaging about 1.7 million appointments daily across England—and even understaffed areas like Bedfordshire saw significant increases last summer compared with previous years.
Despite these gains in appointment volume (with much being delivered by nurses or allied health professionals), only around 45% now result in direct contact with a GP—down from more than half six years ago—as multidisciplinary teams increasingly share workload under schemes like the Additional Roles Reimbursement Scheme (ARRS).
High GP-to-patient ratios affect other parts of NHS operations too; difficulty accessing primary care can lead people toward emergency departments instead—adding cost and pressure elsewhere within hospitals’ systems.
Bramall emphasized that long-term investment will be needed both for infrastructure upgrades and expanded recruitment if safe staffing levels are ever to be achieved nationwide.
The government maintains that GPs remain central to its transformation plans for healthcare delivery but has yet to publish detailed proposals addressing workforce shortages or funding allocations.
