Rammya Mathew: Trained, qualified, and unemployed—the GP workforce paradox

I can’t stop thinking about the BMA’s recent warning that as many as 1000 newly qualified GPs may struggle to find jobs this year.1 It’s not just a number: it’s a stark symbol of a system that has lost its way. We’re training highly skilled generalists, encouraging them into a specialty we claim to value, only to tell them that there’s no work for them once they arrive.

But this hasn’t come out of nowhere. The seeds were sown with the launch of the additional roles reimbursement scheme. On paper, it seemed a pragmatic response to the rising workload and workforce shortages in general practice: allow networks of practices to employ other healthcare professionals—pharmacists, paramedics, physiotherapists—with full reimbursement. For practices under pressure, it was a lifeline that was hard to refuse.

Over time, however, the scheme has quietly shifted the balance of care. Patients are increasingly being booked in with non-GP clinicians. At first we tried to reassure them: you’ll still get the care you need. But many didn’t feel reassured.

The promise of general practice is comprehensiveness. It’s about managing the undifferentiated—chest pain, fatigue, a rash, a mood problem—all in the same 10 minute slot. Most of my consultations involve two or three distinct problems, often spanning multiple systems. It’s hard to replicate that breadth with narrower scope practitioners, no matter how skilled they are in their own fields.

The economics, of course, are hard to ignore. While GPs may be comparatively expensive, they’re also extremely high value. But when policy nudges us towards cheaper alternatives—often framed as clinically equivalent, sometimes even superior—the difference between cost and value is quietly forgotten.

More recently, the government has also allowed GPs to be employed under the additional roles reimbursement scheme. But networks have already invested heavily in the existing model, and pivoting back feels financially and structurally unviable for general practices. These are small businesses that have seen their real terms funding eroded in recent years. So, we’re left with a painful contradiction: we continue to promote general practice—to champion holistic, generalist care—while simultaneously disinvesting from the workforce that delivers it.

I worry about what we’re asking newly qualified GPs to do: to compete for a shrinking number of salaried roles, often with poor terms and conditions, all while watching their specialty being redefined around them. And I worry that no one in power sees this as their problem to solve. All that seems to matter is throughput—numbers through doors.

In today’s version of general practice, patients no longer see an expert generalist simply because they want to—they see whoever the system can afford to offer. For newly qualified GPs, viable roles may increasingly lie outside the NHS, while patients seeking truly comprehensive care may have to pay for it. I fear that, without realising it, we’ve sacrificed the founding principles of the NHS and laid the foundations for a two tier system, where high quality primary care is reserved only for those who can afford it.