Increasing demands on general practice over the past five years – not just a heavier workload but the increasing complexity and intensity of work – have led to a feeling of crisis, according to a report published today by The King's Fund (May 5).

The NHS is finding it difficult to recruit and retain sufficient GPs who want to do full-time, patient-facing work, the report's authors say.

Moving care closer to home means that many activities previously undertaken in secondary care are now done in primary care, but funding has not followed the patients. At the same time, more people report difficulty in accessing care and are less satisfied with their experience of using GP services.

This report looks at patient factors, system factors and supply-side issues to see what lies behind this increasing pressure on general practice. It finds that despite GPs being at the heart of the healthcare system, a lack of nationally available, real-time data has made their changing workload largely invisible to commissioners and policy-makers.

Some of the key findings include:

• There has been a 15 per cent overall increase in contacts, a 13 per cent increase in face-to-face contacts and a 63 per cent increase in telephone contacts
• Population changes account for some of this increase, but changes in medical technology and new ways of treating patients also play a role
• Wider system factors have compounded the situation. For example, changes in other services such as community nursing, mental health and care homes are putting additional pressure on general practice. Communication issues with secondary care colleagues have exacerbated GP workload
• Increase in workload has not been matched by a transfer in the proportion of funding or staff
• The number of GPs has grown more quickly than the population but has not kept pace with groups most likely to use primary care (over-65s and over-85s).
• GPs are increasingly opting for ‘portfolio careers’ or part-time work. Only 11 per cent of GP trainees surveyed intend to do full-time clinical work five years after qualification.