Devalued: The financial erosion of the GP role

Nada Khan is an Exeter-based GP and an NIHR Academic Clinical Lecturer in General Practice at the University of Exeter. She is also an Associate Editor at the BJGP.

How much does pay matter? It might matter a lot when the financial realities of working in general practice are shifting, and not for the better. GPs across the UK are facing a decline in income, with the impact felt across all contractual roles.  This stagnation and decline in GP pay is exacerbating already significant pressures of rising workloads and declining morale across the profession. 

Partner pay and the squeeze from rising expenses

For GP partners, a main driving factor impacting take-home salary is the rising cost of running a practice. The British Medical Association (BMA) reports a marked increase in the proportion of practice income being consumed by expenses, leaving less available for partner drawings. According to a BMJ analysis of NHS Digital figures, the ratio of expenses to earnings continues to rise, suggesting that GPs are being asked to deliver more with less each year.¹

Increasing practice expenses are leading to a significant decline in real-terms pay for GP partners. Between 2021 and 2022, the BMA estimates that GP income, when adjusted for inflation, fell by 18% for partners. This erosion of income continues to undermine the sustainability of practice partnerships as a business model. The number of GP partners is steadily falling, with a 25% drop in GP partners over the past 10 years.² Fewer GPs may feel willing to shoulder the financial risks and administrative burdens of partnership when the rewards are dwindling.³

Pay erosion across the workforce

Salaried GPs have not escaped this trend in falling income. NHS Digital figures show that while nominal incomes have increased slightly, pay is not keeping pace with inflation. In 2022/23, salaried GPs saw a 7.5% drop in real-terms income, contributing to an overall 9% real-terms fall since 2021.⁴ This is compounded by the fact that salaried pay is typically structured around sessional work, a model that increasingly fails to reflect the real hours required to complete the clinical and administrative burden of each session.

Locum GPs face a unique set of pressures especially with availability of work, a topic that I covered here in the BJGP last year. The National Association of Sessional GPs (NASGP) has highlighted a drop in hourly locum GP rates across multiple regions, citing both falling demand and increased competition.⁵  GPs working locum shifts are increasingly cutting their rates due to a shortage of available roles and the growing use of Additional Roles Reimbursement Scheme (ARRS) staff to fill clinical gaps.⁶ This trend of lower pay for locum work highlights how in some regions, a career as a locum GP is becoming an unpredictable and financially insecure option that risks becoming unsustainable.

What’s happening in general practice is not isolated. Across the UK workforce, average earnings have fallen by 10% in real terms over the past 15 years.⁷  But doctors and GPs in particular have seen a much steeper decline in their real-terms wages. Doctors’ purchasing power has fallen further and faster than the general workforce, especially for those in training posts, a driving force behind recent industrial action by junior (now resident) doctors.⁷

Working more, getting less

Is the decline in GP income hidden in the way work is counted?  General practice contracts continue to revolve around sessions, a term that increasingly seems to underestimate the true workload involved. The British Medical Association (BMA) current standards for a session of GP work is 4 hours and 10 minutes with no more than 3 hours of patient-facing time. A recent study in the British Journal of General Practice, however, suggests that the average hours per session has increased to 6.2 hours, with partners working more hours, more sessions, and hours per session.⁸ What’s acceptable as full-time working, and what is deemed safe by the BMA, is being redefined in general practice, with GPs increasingly working more hours within their sessions. To compensate for the increase in sessional time, a growing proportion of GPs are working fewer sessions to maintain safety and a semblance of a work-life balance amidst the increasing workload.  At the current duration of sessions, working six clinical sessions a week would align with the NHS definition of full-time hours.⁸ This misalignment between pay for sessional work and time spent actually doing the work leads to a decline in pay per hour, a pay erosion that affects GPs working longer and harder for fewer paid clinical sessions.

Revaluing general practice

The financial decline in general practice pay is signals a change in how GPs are valued. GPs who feel that they are asked to take on more work for less pay feel that they are not valued. This is critical at a time when we are thinking about GP retention. Pay and feeling valued are both important ‘pull’ factors keeping GPs in practice.⁹

Partnership models in general practice can lead to local innovations and are seen as a financially disciplined model within the NHS.  But, despite the benefits, the GP partnership model is also increasingly undervalued and under stress with more work for less reward, which is leading to a decline in the numbers of GP partners.² Without financial recognition that matches the increasing intensity, responsibility, and breadth of working as a GP, we will continue to see attrition from the workforce, reluctance to enter partnerships, and increasing difficulty filling posts.  It is time to revalue the real worth of general practice and its workforce.

As we await the next 10-year plan for the NHS, it’s clear any meaningful recovery must begin with general practice. And that means reversing the long, slow erosion of general practice funding and of the value placed on the GP role itself.

References

1. Iacobucci G. More of GPs’ income is going on expenses and less on pay, data show. BMJ. 2024;386:q1916.
2. RCGP lays out key principles for GP partnership: Royal College of General Practitioners; 2025 [Available from: https://www.rcgp.org.uk/news/key-principles-gp-partnership.
3. Owen K, Hopkins T, Shortland T, Dale J. GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey. BMJ Open. 2019;9(2):e026048.
4. GP Earnings and Expenses Estimates, 2022/23: NHS Digital; 2024 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/2022-23.
5. ARRS has ‘ostracised’ sessional GPs amidst locum rate falls: NASGP data: National Association of Sessional GPs; 2025 [Available from: https://www.nasgp.org.uk/gp-locum-work/gp-locums/arrs-has-ostracised-sessional-gps-amidst-locum-rate-falls-nasgp-data/.
6. Hackett K. Locum GPs forced to cut rates again due to work shortage GP Online2025 [Available from: https://www.gponline.com/locum-gps-forced-cut-rates-again-due-work-shortage/article/1917068.
7. Waters A. Devalued: doctors’ real terms purchasing power has declined substantially over 15 years, independent economic analysis confirms. BMJ. 2024;384:q666.
8. Hutchinson J, Gibson J, Kontopantelis E, Checkland K, Spooner S, Parisi R, et al. Trends in full-time working in general practice: a repeated cross-sectional study. Br J Gen Pract. 2024;74(747):e652-e8.
9. Campbell JL, Fletcher E, Abel G, Anderson R, Chilvers R, Dean SG, et al. Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study. Health Services and Delivery Research. Southampton (UK) 2019.

Featured image by Josh Appel on Unsplash