General practice workforce: as at 31 December 2021

The purpose of this release is to provide timely statistics on the number and the characteristics of staff working in general practices across Wales.

Statistics are presented for different job types and all headcount data are for unique counts of people. This means that if a person works across multiple practices, they are only counted once. In addition, statistics on full-time equivalent (FTE) staff are presented for the first time.

This release also includes analysis of GPs and wider practice staff by age, sex, ethnicity and Welsh language skills. Additional data tables are published on StatsWales.

The main source of data is the Wales National Workforce Reporting System (WNWRS). Additional information is available in the quality and methodology information section.

There has been a slight upward trend in the number of GPs working in general practices across Wales in recent years. New and robust estimates show that the number of FTE of fully qualified GPs was around 68% of the headcount.

The majority of GPs had permanent contracts with part-time hours. Most GPs were partners or providers, though the number of salaried GPs has increased by 19% since March 2020.

In the quarter to 31 December 2021, locum sessions recorded through Locum Hub Wales accounted for 7.4% of the total full-time equivalent for fully qualified GPs.

There was close to one fully qualified GP (headcount) for every 1,350 people in Wales, or using full time equivalents, close to one GP for every 2,000 people in Wales.

The number of trainee doctors continues to increase with more registrars than ever before.

The number of wider practice staff (non-GP) also continues to grow, driven primarily by increases in direct patient care and admin staff. The number of nurses remains stable.

More than half of GPs were female and nearly 95% of wider practice staff were female. A little over 80% of GPs were from a white ethnic background and 13% were from an Asian or Asian British ethnicity. Around one in ten of all staff employed in general practice speak Welsh to a high or proficient standard.

In Wales, at 31 December 2021, there were:

• 390 active GP practices
• 2,353 fully qualified GPs with an FTE of 1,611 (or 68.5%) of the headcount; this includes partners, providers, salaried, retainers and active locums only
• 427 GP registrars (trainee GPs) with an FTE of 385 (or 90.0%) of the headcount
• 7,955 wider practice staff (non-GPs) with an FTE of 5,728 (or 72.0%) of the headcount

When broken down by specific GP types and staff groups, there were:

• 2,033 GP practitioners with an FTE of 1,480 (or 72.8%) of the headcount; this includes partners, providers and salaried GPs only
• 28 GP retainers with an FTE of 11 (or 39.7%) of the headcount
• 410 GP locums with an FTE of 119 (or 29.1%) of the headcount (locums are only counted if they were active and had contracts recorded in the Locum Hub Wales system between 1 October and 31 December 2021)
• 1,410 registered nurses with an FTE of 1,015 (or 72.0%) of the headcount
• 1,264 direct patient care staff with an FTE of 876 (or 69.3%) of the headcount)
• 5,349 administrative or other non-clinical practice staff with an FTE of 3,837 (or 71.7%) of the headcount)

Full definitions of GP types are included in the quality and methodology information section. This section only includes data for GPs with contracts as a partner, provider, salaried, retainer or locum. Locums are only counted where they were active in the quarter and had contracts recorded through Locum Hub Wales.

If a GP has more than one contract type, they are only counted once in the headcount of a ‘fully qualified GP’ but all hours are counted towards the FTE number.

One FTE is the equivalent of a 37.5 hours, or 9 sessions of 4.167 hours, per week for fully qualified GPs. If a single fully qualified GP is contracted to more than 37.5 hours, their FTE will be greater than 1.

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The increase in the number of fully qualified GPs in June 2021 is explained by locum data being available from this point. The headcount of fully qualified GPs has been on a slight upward trend since 31 March 2020, even when the effect of including locums is discounted. There have been more than 2,000 fully qualified GPs in every quarter since 31 December 2020.

The latest data shows that there were 2,353 fully qualified GPs working in Wales as at 31 December 2021. This is a marginal decrease (1.0%) from the previous quarter, but an increase of 2.3% from the same quarter last year (with locums removed for fair comparison).

There were 1,611 FTE fully qualified GPs at 31 December 2021. This is equivalent to 68.5% of the headcount performing full-time hours.

Considering only fully qualified, permanent GPs, there was a headcount of 2,061 contracted to work a full-time equivalent of 1,492 GPs, or 72.4% of the headcount. This measure includes partners, providers, salaried and retainers, but excludes locums.

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At 31 December 2021, there were 5.1 FTE fully qualified GPs per 10,000 population in Wales. The FTE number of fully qualified GPs per 10,000 population was relatively similar across all health boards other than Powys Teaching which had the highest FTE per 10,000 population at 5.9. Betsi Cadwaladr had the lowest at 4.8.

GPs can be categorised by the types of contract they hold. Definitions for each GP type are included in the quality and methodology information section.

If a GP has multiple contracts within the same type, they will be counted once in the headcount for that type but all hours will be counted in the FTE number.

If a GP has multiple contracts with different GP types, they will be counted once in the headcount for each type and the hours for each contract type will be included in the FTE number for the associated contract type only.

For these reasons, the FTE of ‘fully qualified GPs’ is equal to the sum of the FTE for partner/provider, salaried, retainer and locum. However the headcount is not equal to the sum of the component GP types.

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The majority of GPs at 31 December 2021 were partner/providers, with a headcount of 1,463. There were 1,127 FTE partner/providers, which is equivalent to 77.0% of the headcount performing full-time hours.

Salaried GPs typically performed fewer hours than partners/providers, with their FTE being equivalent to 61.7% of the headcount. While, the FTE for retainers was equivalent to 39.7% their headcount.

There were 410 locums, who had contracts recorded on Locum Hub Wales, who worked an equivalent of 119 full-time jobs (or 29.1% of their headcount). Any locum work which was not recorded on Locum Hub Wales will not be accounted for in this data. This may include locum work in health board managed practices.

There were 427 registrars with an FTE of 385 (or 90.0% of the headcount) and 38 F2 trainees with an FTE of 38 (or 100.0% of their headcount).

This section only includes data on GPs with contracts as a partner, provider, salaried, retainer or locum.

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Over half (58.2%) of the headcount of fully qualified GPs were female and 41.8% were male.

The FTE of fully qualified female GPs was 53.7%, 4.5 percentage points lower than the headcount; for males, the FTE was 46.3%, 4.5 percentage points higher than the headcount. This means that typically male GPs had longer contracted hours than females.  When all contracted hours were summed for each GP, 90.8% of female GPs were part-time (less than 37.5 hours per week), compared to 74.9% of male GPs.

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There was a higher concentration of younger, female GPs than male; and a higher concentration of older, male GPs than female.

Of the 1,437 fully qualified GPs aged up to 49, nearly two thirds (64.7%) were female. Of the 768 GPs aged 50 and over, a little over half (53.8%) were male.

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Eight out of ten (or 82.8% of) fully qualified GPs were from a white ethnic background. Asian or Asian British was the largest ethnic group within GPs of minority ethnic background (13.0% of all GPs).

There is greater ethnic diversity among GPs than the general population in Wales, where 4.8% of people are estimated to be from Black, Asian or minority ethnic backgrounds (year ending Sept 2021, Annual Population Survey (StatsWales)).

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One in ten (9.5%) fully qualified GPs reported that they had higher or proficient Welsh speaking skills. Around one in twenty (5.1%) reported entry to intermediate level Welsh speaking skills, while 85.4% reported that they had no Welsh speaking skills.

The percentage of GPs who had any Welsh speaking skills is lower than the Welsh population. The 2011 Census (StatsWales) estimates 27% of people in Wales had some Welsh speaking skills, and the Annual Population Survey (StatsWales) as at December 2021 estimates 30% of people in Wales had some Welsh speaking skills.

To deliver primary care services, GPs work closely with wider practice staff including nurses, pharmacists, managers, administrators and others involved in direct patient care. This section provides data on the number of staff employed in other job types within GP practices.

As with fully qualified GPs, one FTE is the equivalent to a contract of a 37.5 hours per week. If a member of staff is contracted to more than 37.5 hours, their FTE will be greater than 1.

If a person held multiple contracts at the same or different practices, they would be counted once in the headcount but all contracted hours would be counted in the FTE number.

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The wider practice staff headcount has been on a broadly upward trend since 30 September 2020, reaching a peak of 7,955 in the latest available period (at 31 December 2021).

The latest data showed a small increase of 0.4% since the previous quarter (30 September 2021), and an increase of 5.2% since the same date last year (31 December 2020).

There were 5,728 FTE wider practice staff at 31 December 2021. This is equivalent to 72.0% of the headcount doing full-time work and similar to fully qualified permanent GPs.

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At 31 December 2021, there were 18.1 FTE wider practice staff per 10,000 population in Wales. This ranged by health board from 27.9 in Powys Teaching to 15.2 in Cardiff and Vale.

Wider practice staff can be categorised by their staff group. Data on individual job types within each staff group are published on StatsWales.

When an individual has more than one contract within the same staff group, they are counted once in the headcount but all contracted hours are counted in the FTE number.

When an individual has multiple contracts under different staff groups, they will be counted in the headcount for each staff group and their contracted hours will be counted in the FTE numbers for the associated staff group only.

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The three groups of wider practice staff worked a broadly similar proportion of full-time hours, relative to their headcounts.

There were 1,410 nurses who worked the equivalent of 1,015 full-time equivalent (FTE) hours. This is 72.0% of their headcount.

There were fewer direct patient care staff to nurses (1,264). These staff also worked fewer full-time equivalent hours to nurses (876). This is equivalent to 69.3% of their headcount.

The largest staff group were admin/non-clinical staff, with a headcount of over 5,000 (5,349) at 31 December 2021. These staff worked 3,837 full-time equivalent hours, or 71.7% of the headcount.

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The large majority (96.9%) of nurses in general practice are female. The percentage of FTE female staff is slightly smaller than the headcount, as male nurses typically had longer contracted hours.

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The number of female nurses generally increases with age until around 60 years old. Less than one in twenty (4.0%) female nurses were 29 or younger; 41.8% were aged between 30 and 49; while over a half (54.2%) were aged over 50.

The majority (53.5%) of male nurses were aged between 40 and 55.

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Nine out of ten (89.9%) direct patient care staff were female. The proportion of female FTE is only marginally lower than the headcount (0.5 percentage points). Broadly, male and female direct patient care staff had a similar number of contracted hours.

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The relationship between age and headcount is not as strong with direct patient care staff as it is with nurses, with a more evenly spread headcount by age group.

For female direct patient care staff, nearly one in ten (9.0%) were aged 29 or younger; 43.5% were aged between 30 and 49; while a little less than half (47.6%) were 50 or older.

Male direct patient care staff were spread more evenly than females, with a concentration of staff aged between 30 and 40 (40.5%).

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Around nineteen out of twenty (94.8%) administrative or non-clinical staff in general practice were female. The proportion of female FTE was almost the same as the headcount, therefore there was little difference between the average contracted hours between male and female administrative/non-clinical staff.

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Administrative/non-clinical staff were spread over all age groups but had a high concentration of staff aged 50 or over. For females, more than half (54.1%) of staff were aged 50 or over. The relatively few male staff were spread more evenly, with just over a third (36.1%) aged 30 or younger.

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Nearly 99% of nurses were from a white ethnic group. Of those from minority ethnic background, most were from an Asian or Asian British ethnicity (0.7%).

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Nearly 98% of direct patient care staff were from a white ethnic background. Of those from a minority ethnic background, most were from an Asian or Asian British background (1.0%).

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Nearly 98% of admin/non-clinical staff were from a white ethnic group. Of those from a minority ethnic background, most were from an Asian or Asian British background (1.1%).

All wider staff groups had a lower percentage of people from Black, Asian or minority ethnic backgrounds than the general population of Wales (4.8% year ending Sept 2021, Annual Population Survey (StatsWales)).

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One in ten (or 10.1% of) nurses were either recorded as having a high or proficient Welsh speaking skills. A further 6.2% reported skills between entry and intermediate level, while 83.6% had no Welsh speaking skills.

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A greater proportion of direct patient care staff were recorded as having any Welsh speaking skills than any other staff group. 12.0% of staff had higher or proficient skills, and 6.8% had entry to intermediate level skills. 81.2% of staff reported that they had no Welsh speaking skills.

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Fewer than one in ten (7.4%) administrative or non-clinical staff were recorded as having a high or proficient Welsh speaking skills. A further 6.2% reported skills between entry and intermediate level, while 86.4% had no Welsh speaking skills.

The percentage of wider practice staff who had any Welsh speaking skills is lower than the Welsh population. The 2011 Census (StatsWales) estimates 27% of people in Wales had some Welsh speaking skills, and the Annual Population Survey (StatsWales) as at December 2021 estimates 30% of people in Wales had some Welsh speaking skills.

Detailed information about the statistics in this release will be published in a quality report in spring 2022.

Glossary of terms

General practice

General practices provide primary care medical services on behalf of the local health board, with at least one qualified general medical practitioner who is able to prescribe medicine and where patients can be registered and held on a list. For the purpose of this release the term general practice refers to main surgeries only and excludes prisons, army bases, education establishments, specialist care centres and walk in centres.

Fully qualified GPs

Includes partners, providers, salaried, retainers and locums GPs only. These are fully qualified GPs registered on the Wales Medical Performers List, but some (retainers in particular) will have contracts with reduced hours and some (locums) will be temporarily contracted to work. Locums are only counted where they were active in the quarter and had sessions recorded through Locum Hub Wales. Therefore any locum who is registered on the All Wales Locum Register, but did not have any sessions recorded in the quarter, will not be counted in the headcounts or FTE.

Fully qualified permanent GPs

Includes partners, providers, salaried and retainers only. These are fully qualified GPs with permanent contracts.

GP practitioner

Includes partners, providers and salaried GPs only (i.e. excludes GP locums, GP registrars, and GP retainers). These make up the large majority of the workforce and has historically been the most stable measure of the GP workforce. Retainers are excluded because they are a small number of GPs who work on specific contracts with reduced hours.

GP partner or provider

Are practitioners who have entered into a contract with a local health board to provide services to patients. These are typically the most senior GPs at a practice. Specifically, GP provider is either a sole practitioner; a partner in a partnership and that partnership is the contractor; or a shareholder in a company limited by shares and that company is the contractor.

Salaried GPs

Are GPs who are generally employed and remunerated by salary through the general practice. Salaried GPs can also be employed by health boards directly to work in health board managed practices.  

GP retainer

Is a registered GP practitioner who has entered the GP Retainer Scheme. This is designed to help keep doctors working in general practice, and usually applies to GPs who are either approaching retirement or who require greater flexibility in their work in general practice. A retainer may only work up to 4 clinical sessions per week in practice.

Locum GP

Is a GP who deputises temporarily at a practice, usually to cover for an absent GP practitioner. In this stats release, locums are only counted if they have actively worked in the quarter and the sessions were recorded through Locum Hub Wales. Any locum who is registered to work in Wales but did not provide any sessions in the quarter is not counted in the headcount or FTE.

Locum Hub Wales

Is a service that enables GP Practices across Wales to advertise their short-term vacancies, and choose and book a GP locum, whose preferences match those of the practice, quickly and efficiently. Locums are not required to book shifts through Locum Hub Wales if they do not wish to do so. However, GP locums must join the All Wales Locum Register (hosted on Locum Hub Wales) and must record details of their shifts worked on in order to be captured by The Scheme for General Medical Practice Indemnity (GMPI) from 1 February 2021.

The Scheme for General Medical Practice Indemnity (GMPI), is managed by NHS Wales Shared Services Partnership Legal and Risk Services as part of the Clinical Negligence Scheme for NHS Trusts and Local Health Boards (Administration) (Wales) Directions 2019 and The National Health Service (Clinical Negligence Scheme) (Wales) Regulations 2019.

GP registrar

Sometimes called a GP trainee, are qualified doctors who are training to become a GP through a period of training in general practice and hospitals. Historically, in Wales the training programme consisted of 18 months in approved hospital posts and 18 months in general practice; however from 2019 the training programme changed to 12 months in hospital posts and 24 months in general practice. This explains some of the increase in registrar numbers since 2019. A standard contract for a registrar is for 40 hours per week (rather than 37.5 hours), therefore their FTE is based on a 40 hour week.

F2 doctors

Are doctors with a full GMC registration in their second year of postgraduate medical training. They have completed their first foundation year and will be rotating through three specialties. They would typically undertake clinical work under supervision but they are not training to be a GP. A standard contract for an F2 doctor is for 40 hours per week (rather than 37.5 hours), therefore their FTE is based on a 40 hour week.

A partnership

Is a financial arrangement between two or more bodies of which one must be a general practitioner.

General Medical Services (GMS)

Is the contract by which all general practices in Wales provide services on behalf of the local health board.

Wider practice staff

Include all non-GP staff employed through a contract with a general practice. There are 3 wider practice staff categories: nurses, direct patient care and administrative/non-clinical staff.

Nurses

Includes practice nurse, advanced nurse practitioner, nurse specialist, extended role practice nurse, nursing partner, trainee nurse and nurse dispenser.

Direct patient care

Typically includes anyone who is directly involved in delivering patient care but who is not a nurse or GP. This includes: health care assistant, dispenser, pharmacy technician, paramedic, occupational therapist, pharmacist, phlebotomist, counsellor, physiotherapist, physician associate, apprentice health care assistant, other therapist, counsellor therapist, apprentice phlebotomist, dietician, health support worker, psychological wellbeing practitioner, social prescribing link worker and other direct patient care.

Administrative/non-clinical

Anyone who is involved in the administration or organisation of the practice. This includes: management partner, receptionist, apprentice, manager, medical secretary, telephonist, estates and ancillary, senior manager, finance director and other admin.

Ethnicity groupings

The table below shows the individual ethnicities that are included in the ethnic groups presented in this release.

Keeping Wales National Workforce Reporting System data up-to-date

The main source of data is the Wales National Workforce Reporting System (WNWRS). Data is also sourced from the Locum Hub Wales system (for locums), the NHS Electronic Staff Record (for registrars and F2 trainees) and Digital Health and Care Wales (for active GP practices).

Data was first sourced from the WNWRS at 31 March 2020 and is subsequently extracted quarterly at the last day of the month. Data for all staff, aside from locums, provides a ‘snapshot’ of the general practice workforce on that specific date. As locum work is temporary, the locum data in this release reflects the contracts record on Locum Hub Wales for the quarter ending in the snapshot date.

For every snapshot date, practices are expected to confirm their WNWRS data as being up-to-date during the quarter leading up to the snapshot. This should provide an accurate reflection of the workforce at the snapshot date. If a practice neither logs in to the WNWRS to view their data nor modifies data during the latest quarter, then they are counted as not confirming their data as being up to date.

• 31 Dec 2021 data: 30 practices out of the 390 active practices did not confirm their data was up-to-date in the quarter up to 31 Dec 2021.
• 30 Sep 2021 data: 11 practices out of the 391 active practices did not confirm their data was up-to-date in the quarter up to 30 Sep 2021.
• 30 Jun 2021 data: All active practices confirmed their data as being up-to-date in the quarter up to 30 Jun 2021.
• 31 Mar 2021 data: 9 practices out of the 396 active practices did not confirm their data was up-to-date in the quarter up to 31 Mar 2021.
• 31 Dec 2020 data: 36 practices out of the 396 active practices with staff did not confirm their data was up-to-date in the quarter up to 31 Dec 2020.
• 30 Sep 2020 data: 6 practices out of the 399 active practices did not confirm their data was up-to-date in the quarter up to 30 Sep 2020 (they last confirmed between April and June 2020).
• 30 Jun 2020 data: 46 practices out of the 402 active practices with staff did not confirm their data was up-to-date in the quarter up to 30 Jun 2020 (they last confirmed between January and March 2020). An additional 50 practices did not modify data in the quarter up to 30 Jun 2020 (although they did view data in that quarter). 3 practices updated their data shortly after the snapshot date (on 2 July).
• 31 Mar 2020 data: 2 out of the 404 active practices did not supply data or did not confirm their data was up-to-date in the WNWRS. These practices did supply initial data through an Excel spreadsheet in late 2019, which was used to pre-populate the WNWRS before the system went live for practices. Therefore the data provided in the initial spreadsheet has been used for these two practices.

Calculation and limitations of FTE data

The full-time equivalent (FTE) measure is a measure of the workload of each staff member which is expressed as a full-time equivalent number and is aggregated for the total workforce. For all staff other than registrars and F2 doctors, 1.0 FTE is equal to full-time work of 37.5 hours per week, 0.5 FTE is equal to 18.75 hours per week. Registrars and F2 doctors have 40 hour per week contracts as standard, so 1.0 FTE is equal to 40 hours for these job types.

The FTE is calculated using the ‘contracted hours’ data item in the WNWRS. If this data item is blank, the ‘hours worked’ data item is used instead. Coverage of these two data items is very good across all job types, however there are some missing data and this is likely to mean that the FTE numbers in this statistical release are a slight underestimate of the true FTE.

Following extensive work by NHS Shared Services Partnership, only 12 GPs and 30 wider practice staff had no hours recorded in the 31 December 2021 data extract. Some of these staff may genuinely have zero contracted hours, but some are likely to be incomplete records.

As the proportion of missing data was low in the 31 December 2021 extract, the contracted and working hours data items have been thoroughly quality assured and are of sufficient quality to publish in this statistical release.

Limitations of staff characteristic data

The age, sex, ethnicity and Welsh language skills has not been recorded for every person working in general practice. The analysis presented is therefore based on partial coverage of staff whose information is available. The percentage of missing data is published on each chart.

Note that locums are not required to enter this information when recording work through Locum Hub Wales, and therefore account for a large proportion of fully qualified GPs with unknown information.

For the sex characteristics, data where staff were recorded as ‘male’ or ‘female’ only has been included in the charts. At present the data collection system has options to report ‘other/unknown’ in the same category. This means that we are not able to robustly distinguish where the person chose not to disclose their sex and where the sex was reported other. Data for these categories are shown in StatsWales tables; however we aim to work with data providers to improve this in future editions.

Similarly there are some issues differentiating between unknown ethnic group and a not stated ethnic group. We also aim to improve this in future editions.

There are a small number of cases where characteristics are not consistent from quarter-to-quarter. For example, there are a small number of cases where a person’s age has changed by more than 1 from one quarter to the next. This affects both GP practitioners and wider practice staff and should be borne in mind when using staff characteristics statistics.

Future plans

It is planned that this annual release will be updated using data for September 2022, which will likely be published in January 2023. This would then become an annual release on this cycle. Each quarter there will continue to be an update of the StatsWales tables which include the high level headcounts and FTE of GPs and wider practice staff.

Well-being of Future Generations Act

The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the wellbeing goals, and (b) lay a copy of the national indicators before Senedd Cymru. Under section 10(8) of the Well-being of Future Generations Act, where the Welsh Ministers revise the national indicators, they must as soon as reasonably practicable (a) publish the indicators as revised and (b) lay a copy of them before the Senedd. These national indicators were laid before the Senedd in 2021. The indicators laid on 14 December 2021 replace the set laid on 16 March 2016.

Information on the indicators, along with narratives for each of the wellbeing goals and associated technical information is available in the Well-being of Wales report.

Further information on the Well-being of Future Generations (Wales) Act 2015.

The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local wellbeing assessments and local wellbeing plans.

Statistician: Craig Thomas
Tel: 0300 025 1646
Email: stats.healthinfo@gov.wales

Media: 0300 025 8099

SFR: 117/2022