The GP employment paradox: why GP trainees are worried about finding jobs in a system short of GPs

Only a small minority of GP trainees in England feel confident they will be able to find a job after training, despite longstanding political commitments to expand the GP workforce.

GP training in the UK is typically a three-year programme during which trainees rotate through a series of jobs in GP practices and hospitals. During the final year of the programme, trainees apply for jobs before receiving their Certificate of Completion of Training (CCT) and qualifying as GPs.

These worries are not just perceptions – many newly qualified GPs are finding it harder to secure work.

Why are newly qualified GPs struggling to find work?

A recent analysis by Dr Becks Fisher of the Nuffield Trust examined the underlying causes of the GP underemployment paradox and the reason that the number of available GP jobs has fallen. One obvious reason is that overall funding for primary care has not kept pace with inflation or the rise in complexity and demand for services in recent years. However, despite a 7.2% increase in core funding for general practice in 2025/26 after 15 years of investment lagging behind inflation, GP underemployment has persisted. The 2026/27 GP contract attempted to address this shortfall by repurposing nearly £300m of funding for primary care networks (PCNs) and ringfencing it for practices to employ GPs. Whether this will make any immediate difference is difficult to tell, as much of this funding may already be committed to other work.

Another important factor is the Additional Roles Reimbursement Scheme (ARRS). Since its introduction in 2019, ARRS has allowed PCNs to recruit non-doctor clinical staff – including physiotherapists, paramedics, pharmacists and physician associates – at no direct cost to individual practices. As a result, around 42,500 additional non-GP full-time equivalent (FTE) staff now work in general practice. Because these roles are funded, some practices may find them more attractive than employing additional GPs. In October 2024, as an ‘emergency’ measure, the government allowed newly qualified GPs to be recruited under ARRS, and over 2,500 GPs were employed through the scheme in the following year. The 2026/27 contract has expanded this to include experienced GPs. However, unlike traditional salaried GP jobs based in a single practice, ARRS GP posts are fixed-term and often involve working across multiple practices within a PCN, with less opportunity to provide continuity of care and build strong relationships. Crucially, ARRS also reduces incentives for GP partnerships to employ salaried GPs directly at practice level, when ARRS-funded GPs can be recruited at no cost.

Local labour markets and regional mismatches

The most deprived areas have fewer qualified GPs per patient than more affluent ones. Historically, these areas also struggled to recruit GP trainees. To address this, the Targeted Enhanced Recruitment Scheme (TERS) was introduced in 2016, offering a taxable lump sum of £20,000 to doctors entering GP training in hard-to-recruit, under-doctored or deprived areas. TERS was withdrawn for the 2025/26 recruitment cycle, with NHS England citing record numbers of applicants, including in areas where take‑up had previously been low. Competition for GP training posts has risen sharply: applications almost doubled in two years, from 10,514 applicants for 3,935 posts in 2023 (2.67 per post) to 20,995 applicants for 4,276 posts in 2025 (4.91 per post). In this sense, high demand for GP training has addressed the recruitment problem TERS was designed to solve at least at the point of entry into training.

However, increasing trainee numbers in under‑doctored areas will only translate into improved GP supply if sufficient jobs are available once training is completed. Despite the increase in trainee numbers, the volume of GP jobs advertised nationally each quarter has fallen by almost half since 2022/23. The decline has been particularly sharp in regions with the largest and most competitive training schemes, notably London and the North West. These areas also accounted for the highest proportions of respondents to our survey (21.1% from London and 14.2% from the North West). As a result, concerns about post‑qualification employment are likely to be most acute in places where large numbers of trainees have chosen to live and train but where relatively few GP jobs are available once they qualify. National workforce statistics can mask these local mismatches between training capacity and employment opportunities.

Exactly half of respondents to our survey indicated that a financial or professional incentive – known as a 'golden handshake' – might persuade them to apply for a job in an area they would not otherwise consider. However, no such incentive currently exists for newly qualified GPs.

Training more GPs is only part of the solution

The most recent NHS Workforce Plan was published under the Conservative government in June 2023, and updated in April 2024. It promised to increase the number of GP training places from around 4,000 in 2022 to 5,000 by 2028, and 6,000 by 2031. Implicit in this commitment is the assumption that training more GPs will automatically translate into more practising qualified GPs. Our survey findings challenge this assumption.

Consequences for GP retention, emigration, and career choices

Fears about post-CCT employment are already reshaping trainees’ career plans. Over a third (37.7%) of our respondents are considering working abroad, and nearly one in ten (9.8%) are considering leaving medicine altogether, specifically because of worries about finding a job after qualifying. While doctor emigration and attrition are often framed in terms of burnout or pay, our findings suggest that job availability itself is now a significant driver.

Relocation is also challenging for doctors, partners or children who would need to change employment or school places too. And if doctors must relocate to find work, it is reasonable to ask why they would move to another part of England, with all the upheaval that would entail, when they could instead move abroad and earn more in better working conditions. Almost half (45.6%) of our respondents attended medical school outside the UK, consistent with data presented in the Medical Training Review. A GP workforce trained internationally, with potentially fewer financial and emotional ties to this country, may be more mobile, and more likely to leave the NHS if domestic employment prospects remain poor.

Uncertainty around jobs is also contributing to the growing popularity of part-time and portfolio careers among current trainees. The vast majority of our respondents intend to work fewer than eight clinical sessions per week. Only 28.9% plan to work full-time one year after qualifying, falling to 11.8% after five years and just 5.9% after ten years. This trend is often framed as a supply-side problem, driven by rising workloads, high rates of burnout and low job satisfaction. However, 32.8% of respondents reported that concerns about post-qualification employment were directly influencing their decision to pursue portfolio or non-clinical roles, suggesting that employment insecurity has become a major factor.

Conclusion

Our findings suggest that the fundamental challenge facing the GP workforce is not only a lack of supply, but a system that cannot reliably absorb newly qualified GPs. Trainees are qualifying into a service that says it needs them, but cannot consistently offer them attractive work.

Addressing this will require additional investment to create stable GP posts – especially if the government delivers on its promise to expand the pool of GP trainees over the next few years. How that funding is distributed also matters. The British Medical Association (BMA) has argued for a return to practice-level funding to replace the current PCN-based ARRS model, citing benefits for GP job stability, continuity of care and patient access.

Another key consideration is how the shift towards a ‘neighbourhood health’ model, central to last year’s 10 Year Health Plan for England, will reshape GP employment. While integrated neighbourhood health teams may create new leadership opportunities for GPs, their structure, funding, and relationship to traditional GP practices remain unclear.

The insecurity surrounding GP employment is already influencing trainees’ career intentions and affecting workforce outcomes. The forthcoming Workforce Plan, expected later this year, is an opportunity for policymakers to take decisive action on some of these issues. Increasing the number of GP trainees without expanding post-CCT employment will simply shift the bottleneck downstream – from entry into training to entry into work.