Drop in GPs per person linked to shorter life expectancy, study shows

The number of GPs in a region have a bigger impact on life expectancy than other specialist doctors, according to US research which raises the alarm about the falling amount of family doctors.

Stanford University academics studying population changes between 2005 and 2015 found areas with more GPs added more than a month to life expactancy, over and above an equivalent expansion in cardiologists or other specialists.

This is significant because primary care doctor numbers have fallen behind rising population levels and patient needs, particularly in poorer and rural areas – a trend experts have said also applies to Britain.

The US study, published in JAMA Internal Medicine on Monday, found areas with more family doctors saw average life expectancy increase by 51.5 days for every 10 additional GPs per 100,000 people.

However, states with more hospital specialists only saw average life expectancy rise by 19.2 days with each 10 additional doctors per 100,000 of population.

“Greater primary care physician supply was associated with lower population mortality, suggesting that observed decreases in primary care physician supply may have important consequences for population health,” the authors wrote in JAMA Internal Medicine.

While factors like education, obesity, wealth and access to healthcare play a major role in life expectancy, and vary between communities, this life expectancy trend persisted when controlling for these factors statistically.

“The study reiterates just how important it is that we build the GP workforce in the UK,” said Professor Helen Stokes-Lampard, chair of the UK’s Royal College of GPs (RCGP).

RCGP danalysis has found GP-patient ratios are at their worst levels since 2004, as doctors leave or cut down their hours because of soaring workloads, putting patients at risk.

There were just 61.9 full-time equivalent doctors per 100,000 population in England in 2017. “This is despite workload in general practice escalating both in terms of volume and complexity,” Professor Stokes-Lampard said. “This is not safe for GPs, our teams or our patients.”

While there are more GPs per patient than in the US research, UK family doctors play a bigger role in managing patients and keeping them out of hospital. Having insufficient GPs to manage testing or support complex patients in the community can delay diagnosis and result in a minor case becoming an emergency.

“The NHS long-term plan has some great aspirations that will benefit patients, but if these are to be realised we need an expanded workforce to deliver it,” Professor Stokes-Lampard added.

A report last year by the Health Foundation think tank found the UK has just 2.8 doctors per 1,000 patients – 28 per cent lower than the EU average of 3.9 doctors.

Attempts to increase GP numbers have so far fallen flat, though a scheme offering £20,000 “golden handshakes” to junior doctors willing to train in rural areas for a fixed period has been offered by Health Education England.

The government has accepted it is unlikely to hit former health secretary Jeremy Hunt’s flagship 2015 pledge to increase GP numbers by 5,000 by 2020, after figures last year showed they were 1,000 doctors further away.

The recently published NHS 10-year strategy includes plans for how more care will be delivered away from hospitals and closer to patients’ homes.

However, it sets out plans to raid thousands of doctors and nurses from overseas to deliver these commitments in the short term, with a longer-term workforce plan delayed until later in 2019.