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Determinants and consequences of geographic inequalities in the UK GP workforce

Thomas HALLandT, Olumayokun OLAJIDE, Panders PHILLIPA, Victoria IWUANYANWU and Emmanuel MFOTIE NJOYA

Access to General Practitioners (GPs) is essential for delivering timely, high-quality primary care, yet GP availability varies widely across the UK. Underserved regions experience poorer clinical outcomes, lower patient satisfaction, and greater pressure on hospital services.This study aims to examine the determinants of GP career and location choices, quantify how GP distribution affects primary care quality, and evaluate the effectiveness of recruitment and incentive policies designed to address workforce shortages. Specifically, the study investigates: (1) how educational, demographic, and geographic factors shape newly qualified GPs’ location decisions; (2) how variation in GP-to-patient ratios influences clinical quality indicators such as QOF scores, prescribing behaviour, and patient experience; and (3) which financial and non-financial incentives effectively attract GPs to shortage areas.The study uses a linked longitudinal dataset combining UK Medical Education Database (UKMED) records with NHS Digital workforce, GP Patient Survey, Quality and Outcomes Framework (QOF), and prescribing data. A mixed logit discrete choice model will analyse practice location choices. Causal impacts of GP distribution on quality will be estimated using an instrumental-variable strategy based on registrar density. A structural random-coefficient discrete choice model will assess the effectiveness of policies such as the Targeted Enhanced Recruitment Scheme and widening-participation scholarships. Counterfactual simulations will estimate distributional and equity effects.We anticipate identifying key educational, demographic, and training-related predictors of GP practice location. Preliminary analysis is expected to show that lower GP-to-patient ratios are associated with reduced QOF performance, higher prescribing intensity, and poorer patient satisfaction. Policy simulations are anticipated to demonstrate that targeted financial incentives and widening-participation pathways can increase GP uptake in underserved regions, with heterogeneous effects across subgroups.Understanding GP labour-market behaviours and the causal impacts of GP availability will support evidence-based workforce planning. The findings will contribute to health economics and policy research on healthcare supply, spatial inequality, and labour-market incentives.This study will generate robust evidence on the drivers and consequences of GP distribution, informing equitable and cost-effective policies to reduce regional inequalities in primary care access.