More than a quarter of GP practices in England have experienced a high turnover of doctors, according to major new analysis published today.

This is a “wake-up call” about primary care, researchers said. Analysis by researchers at the University of Manchester found persistent high turnover – defined by more than 10% of GPs changed in a practice in at least three consecutive years – affected 2,309 of English practices (more than 28%) at least once between 2009 and 2019.

Writing in today’s BMJ Quality and Safety, the team says the affected practices tended to be larger and located in more deprived areas and had a higher health burden from serious chronic conditions. The highest levels of persistent high turnover were in Cumbria and the North East, South Central and the West Midlands. The researchers studied an average of 7,526 practices each year from 2007 to 2019 and found high turnover increasing from 2.7% in 2009 to 6.3% in 2019.

Co-author Rosa Parisi said: “This study is a wake-up call for primary care and for the first time gives us clarity on one of the major problems affecting it. Thanks to this work, it is now possible to identify an association between high turnover and both patients’ health outcomes and the service they receive.

“We think high GP turnover is likely to affect continuity of care, and that might explain why avoidable emergency attendances are more likely to happen. Indeed, we know from previous studies that continuity of care is deeply important to patients. And the link between high turnover and deprivation may be explained by the challenges GPs face in those areas in managing patients with more complex health needs with no additional resources.”

The study also involved two discussion groups with four GPs, who highlighted workload pressure, limited opportunities and contribution to decision making and the management of their practice, particularly salaried GPs, with lack of funding and investment from the government.

Co-author Professor Evan Kontopantelis said: “This study shows practices with persistent high GP turnover need more support from local and national authorities. There is a desperate need for policies to maximise retention of GPs and personal and professional support, targeting areas which influence job satisfaction and work-life balance. In addition, the current funding formulae do not fully take account of the demands associated with practising in deprived areas – and this too needs to be addressed. We already know that socioeconomic deprivation impacts GP work and found that in highly deprived areas, GP work typically extends beyond the management of the illness but that they are not resourced to perform those additional tasks.”

Practices with persistent high turnover were associated with: 1.8 more emergency hospital attendances per 100 patients; 5.2% fewer people seeing their preferred doctor; 10.6% fewer people reporting obtaining an appointment on the same day; and 1.3% more people having lower overall satisfaction with their practice.