A stark warning has been issued that Britain faces the prospect of mass GP practice closures within the next five years unless their business models undergo radical reform. The alert comes from Vijay Acharya, a leading medical accountant whose firm represents hundreds of surgeries across the UK.
The Funding Paradox and Recruitment Crisis
Mr Acharya highlighted a critical paradox at the heart of general practice. He stated that while surgeries across the country are struggling to recruit permanent doctors, newly qualified GPs are taking to social media to claim there are no jobs, with some even threatening to leave medicine for other careers.
The core of the issue, according to Acharya, is a mismatch in expectations. Practices desperately need permanent, committed GPs who will take on the full responsibilities of running a practice. However, many newly qualified doctors are opting for highly-paid locum work, which offers greater flexibility but comes without long-term practice commitments.
This reliance on locums is financially crippling for many practices. A locum can cost at least £800 per day. With a practice receiving roughly £150 to £200 per patient per year from the NHS, the sums quickly become unsustainable. If a locum sees four patients an hour at a cost of £120 per hour, that's £30 per patient just for the GP's time, before accounting for premises, staff, equipment, and other overheads.
A System at Breaking Point
The financial strain is unfolding against a backdrop of a shrinking GP estate and growing patient lists. The Royal College of GPs reported that the number of practices in the UK fell by 1,000 to 6,229 between 2017 and 2025. Over the same period, patient numbers increased by a staggering 4.8 million.
This pressure is creating extreme variations in workload. A recent investigation revealed that GPs at hundreds of practices are seeing fewer than 10 patients a day on average. In stark contrast, doctors at the busiest surgeries are dealing with at least 100 appointments daily – four times above the 'safe' limit of 25 recommended by the British Medical Association (BMA).
Campaigners have warned that this 'postcode lottery' in access and the pressure to rush consultations can lead to symptoms of serious illnesses being missed.
Government Reforms and Industrial Tensions
The crisis in primary care is compounded by an ongoing dispute between the government and doctors over pay and conditions. Furthermore, the government's recent mandate for all GP surgeries in England to keep online forms open for appointment requests throughout working hours has sparked controversy.
Health Secretary Wes Streeting has defended the change, stating it brings the NHS into the digital age and ends the '8am scramble' for appointments. However, the BMA has warned that necessary safeguards were not put in place and has dangled the threat of a formal dispute, with some GPs considering capping daily consultations to the 'safe' limit.
Mr Acharya argues that the noise around pay and online appointments is distracting from the fundamental business model failure. He believes urgent action is needed to provide GPs with better business training and financial support to manage increasing workloads and economic challenges. He also urged ministers to find ways to encourage newly-trained medics to commit to practice life rather than choosing locum work.
"We are at a tipping point with GP surgeries," Acharya said. "We need to take drastic action if we want to see them maintain their role in treating the public locally. If we don't, then care will be diminished and the prospects of newly qualified doctors will become even worse."
A Department of Health and Social Care spokesperson pointed to government efforts, citing a £1.1 billion boost for general practice – described as the biggest funding increase in over a decade – the recruitment of an extra 2,900 family doctors, and a halving of GP targets.
