Rising life expectancy, accompanied by increasingly complex long-term health conditions, a stretched general practice workforce and unprecedented financial and healthcare reform are among the greatest challenges facing primary care, says a new report.

The increasing age profile of GPs and practice nurses is creating a major primary care supply challenge, with 22% of GPs now aged over 55 - compared to 17% in 2000 - and almost 20% of practice nurses now aged 55 or over, says the study, which is published by the Deloitte UK Centre for Health Solutions.

Moreover, the study notes, 10,000 GPs say they intend to retire within five years, while increasing numbers of GPs are salaried or work part-time and there has been a growing reliance on practice nurses, many of whom are also approaching retirement. 

Against expectations that an ageing UK population will have the greatest impact on demands on general practice, new entrants and returners to work in the primary care sector have fallen, says the report. Given the many years it takes to train GPs and general practice nurses, any immediate recruitment shortfalls can only be met by qualified practitioners from abroad. However, changes to employment regulations and agreements to limit recruitment from countries facing similar challenges means overseas hiring will not be a viable solution, and will only compound the strains on the GP workforce, it warns.

"Primary care, and in particular care provided by GPs and practice nurses, has been the cornerstone of the NHS since its inception in 1948," says Karen Taylor, research director at the Deloitte Centre. 

"With responsibility for 90% of all patient contact in the NHS, GPs not only provide care, they also act as gatekeepers to the rest of the NHS. In future, GPs will also have a new role as commissioners of all the healthcare services needed by their patients. They will need to maintain their role as providers of safe, good-quality care in the face of this new commissioning challenge, new regulatory and performance management systems and a requirement to provide more care with less money,” she adds.

However, the report also forecasts that, if the pattern of GP consultations remains unchanged, there could be 433 million consultations a year in the UK by 2035. Of this number, 180 million would be for people aged 65 and over, or nearly double the current figure, it says.

The traditional ways of working, which rely on face-to-face consultations between the patient and the GP - and, increasingly, the practice nurse - are important but no longer sustainable, says Ms Taylor. In addition, rising life expectancy is bringing about increasingly complex long-term health issues requiring frequent GP visits.

"GPs need to adopt new models of care, using new technology and other practice staff more effectively, working closely with patients to provide more care in the community, with an emphasis on shared decision-making and self-management. GPs will still need to act as gatekeepers, but also, increasingly, as care navigators," she says.

"The Health and Social Care Act has provided more clarity as to what the reforms mean for general practice in England. New ways of working offer solutions that can help bridge the gap between increased demand for primary care and growing capacity and capability constraints. However, what they all have in common is the need for primary care staff to work differently," Ms Taylor concludes.