Why Are More GPs Opting to Work Outside the NHS?

In recent years, a growing number of General Practitioners (GPs) in England have chosen to work outside the National Health Service (NHS), with one in three licensed GPs not engaged in NHS general practice by 2024.[5][6] This trend, accelerating despite overall workforce growth, stems from burnout, poor pay satisfaction, declining partnership roles, and heavy workloads amid rising patient demands.[1][2][3][4]

The Scale of the Shift Away from NHS General Practice

Data reveals a stark picture: the proportion of licensed GPs not working in NHS general practice rose from 27% (13,492 individuals) in 2015 to 34% (19,922) in 2024.[5] By January 2026, fully qualified full-time GPs in general practices had declined by the equivalent of 550 compared to September 2015 levels, even as patient numbers surged 14.2%.[2] A single full-time GP now manages an average of 2,214 patients—276 more than a decade ago.[2]

While the overall fully qualified permanent GP workforce reached 28,703 full-time equivalents (FTEs) by September 2025, surpassing 2015 figures by 0.4%, this masks deeper issues.[1] Salaried GPs have driven growth, up 20.5% (2,219 FTEs) from June 2024 to September 2025, fueled by a 62.6% rise in trainees since 2019, with over half now internationally recruited.[1] However, GP partners—key to the traditional model—fell 29.1% FTE since 2015, with a 61.3% drop among those under 40.[1] Younger GPs in London show particularly high exit rates at 10.2% (versus England’s 6.8% average for under-40s).[1]

Leaver rates remain low at 6.6% in the year to September 2025 (down from a pre-pandemic low of 6.2%), but regional variations persist, with the South West at 8.1%.[1] Alarmingly, one-third of licensed GPs have entirely opted out of NHS primary care, signaling a chronic shortage.[6]

Burnout and Work-Life Balance: The Top Drivers

Work-life balance emerges as the leading reason for GPs leaving NHS roles, with resignations for this purpose tripling since 2013/14.[4] Health issues rank second among voluntary exits, which comprise over half of leavers.[4] Intensifying workloads exacerbate this: despite government pledges, GP numbers lagged until recent salaried gains, leaving remaining staff overburdened.[1][2]

The partnership model’s erosion compounds fatigue. Rapid declines in younger partners threaten sustainability, as fewer replacements emerge amid policies that may deter commitment.[1] High-pressure environments push GPs toward alternatives offering flexibility, such as private practice, locum work, or non-clinical roles.

Pay Dissatisfaction Fuels Attrition Intentions

Pay plays a pivotal role, with 48% of healthcare workers somewhat to very dissatisfied in recent surveys, and 26% considering leaving the NHS.[3] Among those “very dissatisfied” with their latest pay deal, attrition intentions peak for medical staff: 52% for resident doctors/dentists and 45% for senior doctors like GPs.[3] Logistic regression shows a 1.40 odds ratio increase in leaving intentions per point of pay dissatisfaction for residents, and 1.20 for senior doctors.[3]

Lower-paid groups feel this most acutely, though financially secure staff with high satisfaction sometimes exit for better opportunities.[3] The British Medical Association (BMA) warns that failing to value doctors drives early exits, worsening shortages: for every 10 doctors joining, nearly 8 leave in secondary care, with similar pressures in general practice.[2]

Regional and Demographic Disparities

Exit patterns vary: London sees high young GP departures (10.2%) but lower older GP exits, suggesting extended working lives there.[1] The South West has elevated overall rates (8.1%), driven by older GPs (60-64 and 65+).[1] Younger GPs (under 40) and partners bear the brunt nationally, with leaver rates ticking up across ages to 6.6% by late 2025.[1]

International trainees bolster numbers but may not anchor long-term in partnerships, preferring salaried or external paths.[1]

Appeal of Alternatives Outside the NHS

GPs increasingly favor private sector, occupational health, telemedicine, or even non-clinical jobs like medico-legal work or pharma consulting. These offer better hours, higher earnings, and autonomy without NHS bureaucracy. Pulse Today’s study underscores how one in three licensed GPs pursue such options, eroding NHS capacity.[5]

Implications for Patients and the NHS

This exodus strains access: chronic family doctor shortages persist into 2026, with patients facing longer waits.[6] Without reversing partner declines and addressing retention, the model risks collapse.[1] The BMA calls for valuing staff to stem losses.[2]

Pathways Forward

To halt the trend, prioritize partner incentives, competitive pay, workload relief, and flexible models blending NHS and private work. Record joiner rates and low leavers provide a window, but bold action is essential.[1][3]

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Original source: BBC News – Why are more GPs opting to work outside the NHS?