The BMA’s ‘gold standard’ benchmark for GP-to-patient ratios is no being met by any integrated care board (ICB) in England, with four fifths needing to at least double their GP numbers to meet it, according to analysis by The BMJ.

The BMA set out the benchmark for manageable workloads and patient safety as one full-time equivalent (FTE) GP per 1,000 patients in its 2023 report Patients First.

The report said that the aim should be meeting this standard by 2040.

But new BMJ analysis used NHS general practice workforce data published in January 2026 and found that every ICB is currently above that 1:1,000 standard.

The BMA benchmark is a professional gold standard ambition, rather than an official NHS safety standard.

Nationally, the BMJ reported an average of one FTE GP for every 2,220 patients but some ICB areas are more stretched than others.

The highest reported patient to doctor ratios are in London, Bedfordshire, Luton and Milton Keynes where there are more than 2,700 patients for every GP, the analysis found.  

Prof Victoria Tzortziou Brown, chair of the Royal College of GPs. said that the ‘stark disparities’ between ICBs were worrying.

‘We know that areas facing higher deprivation often have the highest ratios of patients to GPs, as well as the most difficulty recruiting and retaining GPs,’ she said.

 ‘The pressures on general practice are clearly far beyond what is safe or sustainable,’ added Prof Tzortziou Brown.

The BMJ analysis found North West London ICB to have the highest ratio of patients to GPs, at one FTE GP for every 2,746 patients.

A spokesperson for North West London ICB said: ‘While the BMJ analysis uses GP FTE data alone, it does not include the wider primary care workforce funded through the Additional Roles Reimbursement Scheme (ARRS).

‘When these roles are included, North West London has more than 5.1 GPs per 10,000 population, supported by 4.7 ARRS roles per 10,000.

‘Primary care is delivered by a broad multidisciplinary team, and this combined workforce enables practices to deliver the highest number of appointments per head of population across London at 460, compared with a London average of 414, with 17.8 million appointments offered in the past year and an 88.4 percent uptake.’

Bedfordshire, Luton, and Milton Keynes ICB was just below this, at one FTE GP for every 2,706 patients.

A spokesperson for Bedfordshire, Luton and Milton Keynes ICB said, ‘We presently have over 140 GPs in training roles, many of whom we expect to contribute to improving our GP to patient ratio when they qualify.’

But they acknowledged that a low number of GP vacancies could make it difficult for trainees to secure posts once they qualified.

NHS Devon ICB had the smallest ratio with 1871 patients per GP while NHS Herefordshire and Worcestershire ICB was just above with 1880.

The Department for Health and Social Care (DHSC) said that, including PCN-employed GPs, there are 2,143 registered patients per full-time equivalent FTE fully qualified GP.
However, DHSC’s figure is not directly comparable with the BMJ’s ratios. The BMJ has used the NHS general practice workforce dataset and does not specify whether PCN-employed GPs are included in its analysis.

A DHSC spokesperson said that the NHS had ‘the highest number of fully qualified GPs since 2015 – almost 30,000.’

The BMJ analysis noted that patient registrations have risen faster than GP numbers in recent years, widening the gap between demand and GP capacity.

The DHSC spokesperson continued: ‘We’ve recruited over 2,000 of these in the past year alone, given primary care a £1.1 billion funding boost, and rolled out online GP booking requests to ease pressure on services and improve access to appointments.

‘We’re bringing back the family doctor and patient satisfaction is rising as we build an NHS the country can be proud of again.’

The DHSC said it does not set a recommended patient-to-GP ratio because demand varies based on factors such as practice location and patient demographics.

It also said the BMJ’s analysis does not take into account growth in trainee numbers or wider workforce growth among other clinical staff groups working in primary care.