A 2022 report from The Office of National Statistics highlights a gaps in life expectancy across England – 9.7 years for men and 7.9 for women between the most and least deprived areas. While England’s National Health Service (NHS) is often praised for its commitment to universal healthcare with access based on clinical need, the concept of the Inverse Care Law still remains relevant: those with the greatest health needs often receive the least healthcare.
Mismatch between GP supply and demand
This is a particular challenge within general practice, where more socioeconomically deprived areas often have fewer GPs per 1,000 people, higher turnover of GPs, and greater difficulty filling vacancies. At the same time, health needs tend to increase with deprivation, with reports of multimorbidity and mental illness being higher in low socioeconomic areas. Higher numbers of GPs have been linked with improved health outcomes, so this mismatch between supply and demand of GPs in deprived areas may be exacerbating health inequalities.
Job pressures faced in areas of greater deprivation
Although GPs shortages are well recognised, there is surprisingly little insight into how these shortages affect the working experiences of GPs in deprived areas. Our study, published in the Journal of the Royal Society of Medicine, aimed to explore the challenges faced by GPs in these areas by analysing responses from around 8,500 GPs to the GP WorkLife Survey, between 2015 and 2021. We examined differences between GPs working in the most and least deprived areas across multiple dimensions, including job pressures, job satisfaction, intentions to quit direct patient care in the next five years, hours worked per week, and reported annual income.
We found that GPs working in more deprived areas experience significantly higher job pressures related to managing complex patients, insufficient resources, and difficulty in finding locum cover. We also found that GPs in the most deprived areas earn, on average, £5,525 less per year than those in wealthier areas – approximately 5% less than the average GP income. Despite higher job pressures, there were no differences in overall job satisfaction, hours worked per week, or intentions to leave patient care between GPs working in more deprived and less deprived areas.
Improving GP recruitment and retention
These findings provide unique insights into why general practice in areas of greater deprivation may be less viable for GPs. There are several policy interventions which could be considered to address these disparities. First, incorporating deprivation as a factor in resource allocation formulae would be a key step to ensure GP practices in deprived communities receive additional financial support and help address income disparities. Second, financial incentives have been proven effective in certain contexts to promote recruitment and retention of GPs in hard-to-recruit areas, and until recently, were used by the Government as part of the Targeted Enhanced Recruitment Scheme (TERS).
Third, non-financial incentives – such as enhanced career development opportunities that incorporate time for additional training and leadership responsibilities, or peer support networks to share strategies for managing complex patients’ needs – can also play a valuable role. Fourth, expanding the use of other general practice staff, such as social prescribers and mental health nurses, can also be used to alleviate pressure on GPs and offer more support for patients with complex needs. However, the roll-out of these staff across England needs to be guided by workforce planning models designed to optimise staff supply according to local population needs.
It is important to note that we found no differences in hours worked per week, job satisfaction, and intention to quit direct patient care between GPs in more and less deprived areas. There should be greater recognition within the GP community of the potential advantages of working in deprived areas – including the rewarding nature of the work, positive relationships with patients, and the opportunity to develop greater confidence and skills through managing complex clinical cases.
A Call to Action
If policymakers fail to address the GP workforce gap in deprived areas, the quality of primary care across these areas will continue to decline, further worsening health outcomes for already disadvantaged populations. A more equitable approach to GP funding and support is crucial to ensure that all patients – regardless of their postcode – have access to the high-quality care. As the NHS faces an ongoing workforce crisis, it is critical that GPs working in the most deprived areas are recognised and rewarded for the vital role they play in improving recruitment and retention.
To read our recent study, visit: Deprivation and general practitioners’ working lives: Repeated cross-sectional study - Michael Anderson, Jonathan Gibson, Benjamin Walker, Joseph Hutchinson, Katherine Checkland, Matt Sutton, 2025