Retention in London general practice

  • Latest news

Our new report looks at pressures affecting GPs' job satisfaction and potential ways to relieve them.

Dr Lisa Harrod-Rothwell, our Deputy CEO, introduces her report:

Strong and sustainable general practice is essential to the delivery of high quality, cost effective healthcare.

General practice offers a very wide range of services to people of all ages, provides a gate keeper role for other providers such as hospitals, and navigates uncertainty and risk on behalf of patients and the NHS. From “cradle to grave”, general practice services are underpinned by:

  • person-centredness with a family and community focus,
  • holistic care with patient autonomy,
  • ongoing care of a defined local population with GP: patient relationship continuity, and
  • multi-disciplinary team working and care co-ordination.

A thriving general practice workforce underpins the success of all key health care deliverables, and yet practices are increasingly under pressure to do more and more with fewer GPs.

People are too complex for their care to be reduced to transactional hurried encounters. Hurried encounters can be unsafe, and transactional care does not enable us to elicit and address our patients’ true agendas. But we can no longer provide the type and standard of care that we want to deliver; that took years of study and training to develop; that provides patient satisfaction and professional fulfilment.

  • GPs want time to listen to and care for their patients, whilst patients want time with expert GPs in their communities.
  • GPs want to support ongoing therapeutic relationships with their patients, understanding how their health and wellbeing needs change over time, treating patients as a whole person rather than a symptom or condition or a set of tick boxes.
  • GPs want to advocate for their patients and their families, working collaboratively with other healthcare professionals to co-ordinate care across organisational boundaries.
  • GPs want to be a part of the community, understanding the particular needs of, and challenges faced by, people whom they live and work alongside.

The recent Health and Social Care Select Committee report into the Future of General Practice states clearly that: “GP retention needs to be improved” adding “…GPs are facing unsustainable workloads, which increase burnout and make GPs more likely to leave the profession. This creates a vicious circle of workforce and workload pressures for the GPs who remain…”.


  • We need more doctors and nurses in general practice.
  • Each full-time-equivalent GP providing care to fewer patients.
  • To be able to provide safe and effective patient care.
  • In a sustainable way that retains this valuable workforce.

The untenable workload suffocating the profession, and causing staff to leave in greater numbers every year, leads to even greater work and pressure falling on those who remain. This spiralling attrition in turn reduces morale, increases burnout and leads to even more vacancies. General practice capacity is inextricably linked to Integrated Care Board (ICB) deliverables for primary care and the wider system, and protecting and nurturing this essential part of the health landscape should be a priority. We believe that ICBs can play a vital role in stemming the spiralling attrition if they are able to work and collaborate with general practice.

This report sets out the challenges, and identifies a series of key lines of enquiry for ICB leaders to consider if we are to save general practice and retain its invaluable resource – its highly trained and skilled workforce.

Download: Retention in London general practice

The report was also covered in an interview with GPOnline.