Document resource
Background Inequalities in the distribution of general practitioners (GPs) are worsening. Between 2015–2022, the gap in the number of GPs per patient between the most and least deprived areas has widened. Factors driving this inequality are unknown. Here we examine the changing trends in the age, sex and region of qualification of GPs to understand drivers of the workforce inequalities.Methods We undertook a longitudinal analysis using GP workforce data in England from 2015 to 2024. GP workforce data published by NHS England was linked with Index of Multiple Deprivation (IMD) values. GP density per 10,000 patients was calculated for demographics: age range, sex, and region of qualification, by IMD quintile (Q1 least deprived to Q5 most deprived). Trends and ratios with 95% confidence intervals (95%CI) across deprivation quintiles were analysed.Results In 2024, UK-qualified GPs were 1.14 times more concentrated in least deprived areas than the most deprived (95%CI: 1.06–1.22). This pattern has remained constant over time.GPs qualifying in south Asia – the largest proportion of internationally-qualified GPs – were more likely to work in the most deprived quintile compared to the most affluent quintile. This difference has narrowed: the ratio was 4.61 (95%CI: 3.69–5.53) in 2015 and 2.03 (95%CI: 1.78–2.28) in 2024, driven by an increase in density of south Asian GPs in less deprived areas.Female GPs have a widening GP density distribution gap favouring the most affluent quintile over the least: Q5:Q1 the ratio was 0.852 in 2015 (95%CI 0.804–0.899) and 0.744 in 2024 (95%CI 0.699–0.790)). This likely reflects diverging trends: increasing GP density in the most affluent areas (+5%) alongside decreasing density in the most deprived areas (-8%).Male GPs were more evenly distributed; the 2024 ratio between most and least deprived was 1.05 (95% CI: 0.99–1.11) driven by higher numbers of international male GPs working in deprived areas.Conclusion Inequalities in the GP workforce have been increasing. Male GPs and internationally qualified GPs work more in the most deprived areas compared to the least deprived areas. UK-qualified female GPs tend to work in less deprived areas. The number of UK-qualified female GPs is increasing and if the current trend continues GP workforce inequalities may worsen. Targeted approaches to recruiting and retaining GPs in more deprived areas should be sought to address the inequality in GP distribution across the socioeconomic gradient.