Why Are More GPs Opting to Work Outside the NHS?
Across England, a growing number of general practitioners (GPs) are choosing to work outside the NHS, either fully or by splitting their time between NHS and private practice. Rising workload pressures, limited consultation time and increasing patient demand are among the key factors driving this shift. At the same time, many patients are showing a willingness to pay for private appointments in order to receive faster access and longer consultations.
Recent analysis of Care Quality Commission (CQC) data highlights the scale of the change. Between 2021 and the end of 2025, 1,238 doctors registered as “independent consulting doctors”, compared with just 396 in the previous five-year period, a rise of more than 200%. A 2024 report by healthcare intelligence company LaingBuisson also estimated that around 13% of GP consultations are now private, compared with only 3% two decades ago.
For many GPs, the decision to work privately is closely linked to the intensity of NHS workloads. Dr Yvonne Girgis-Hanna, who divides her time between NHS work and private practice in Essex, says the pace of NHS general practice can be exhausting. On a typical day, doctors may conduct around 30 face-to-face appointments, alongside phone consultations and administrative tasks. She says the pressure can leave doctors feeling completely drained.
Private practice, by contrast, often allows more time with patients. Dr Girgis-Hanna offers appointments starting at around £129 for 20 minutes, with longer sessions available. She believes this approach enables a more traditional model of general practice, where doctors can provide continuity of care and spend more time understanding their patients’ needs.
Another factor contributing to the shift is funding pressure within NHS primary care. GP practices receive an average annual budget of around £120 per patient. For patients who visit their GP frequently, sometimes 20 or 30 times a year, this funding can be stretched extremely thin, making it difficult for practices to meet demand.
Patients themselves are also driving the growth in private consultations. Some report difficulties getting NHS appointments quickly or frustration with short consultation times. For individuals who can afford it, private care offers quicker access and the ability to see the same doctor consistently.
Patients such as Vanessa Ravazzotti say the experience can also reduce anxiety, as waiting times are shorter and doctors have more time to listen. Others, like 85-year-old Ian Miller, value the familiarity of seeing the same clinician rather than a different practitioner at each appointment.
Some GPs say private work also allows them greater freedom in how they practise medicine. Dr Karen Benson, who runs private consultations from a pharmacy in Hertfordshire, says she experiences fewer interruptions and can spend more time exploring lifestyle factors and underlying causes of illness. Longer appointments also allow her to review medications more carefully and sometimes reduce unnecessary prescriptions.
However, many doctors continue to work partly within the NHS. According to the British Medical Association (BMA), some GPs split their time between sectors to maintain a better work-life balance while still contributing to public healthcare.
The rise in private GP services has sparked debate about the state of NHS general practice. Some doctors believe the increasing number of patients seeking private care reflects broader problems within the system, including funding constraints and rising demand.
The government has announced measures aimed at improving access to NHS GP services, including additional funding, upgraded phone systems and expanded online consultation options. Ministers say these reforms are intended to make it easier for patients to secure appointments quickly.
Despite these efforts, the trend towards private general practice suggests that both doctors and patients are seeking alternatives to cope with the growing pressures facing primary care in England.
Why Many GPs Still Choose to Stay with the NHS
Although more GPs are exploring private work, a large proportion remain committed to NHS general practice because of the unique professional, ethical and system-wide benefits it offers.
1. Working in line with core professional values
Research on GP retention shows that doctors are more likely to stay when their work feels meaningful and aligned with their core values, such as providing universal care based on need rather than ability to pay. Many GPs value the NHS principle of equitable access and the opportunity to advocate for patients and communities who might otherwise struggle to access healthcare.
2. Continuity of care and stronger relationships
Continuity of care in NHS general practice supports long-term relationships with patients, which improves safety, personalisation and job satisfaction. Seeing the same patients over time enables GPs to build cumulative knowledge of their medical, psychological and social context, which can reduce emergency and secondary care use and provide a sense of professional fulfilment.
3. Being part of a wider multidisciplinary system
Within the NHS, GPs work closely with nurses, pharmacists, allied health professionals, social care and hospital teams. This integrated environment allows them to coordinate complex care, participate in quality improvement and contribute to population health planning in a way that is harder to replicate in isolated private settings. Many GPs value being part of a larger public service with shared standards, governance and training structures.
4. Structured support, education and career development
NHS England and national bodies have developed a range of schemes aimed at helping GPs remain in practice, particularly those at risk of leaving. These include the National GP Retention Scheme, which provides financial and educational support, protected CPD time and greater flexibility for GPs who might otherwise leave the profession. There are also toolkits and local initiatives focused on making general practice “a great place to work,” with investment to support retention at system level.
5. Flexibility and portfolio careers within the NHS
Rather than leave entirely, many GPs choose portfolio careers that combine clinical sessions with teaching, leadership, specialist clinics or some private work, allowing them to manage workload while staying in NHS practice. National retention reports emphasise the importance of flexible roles, protected learning time and tailored local support so that GPs can sustain NHS work over the long term.