25 June 2025

In Canada, I am rediscovering what being a GP can mean

Wes Streeting could learn a thing or two from British Columbia.

The lady behind the counter at the Canada Post – her name badge informed me she was Sharon – noted my English accent. What brought me to Vernon? I said I was joining one of the clinics in town as a family physician. She did a literal jig and called through to two colleagues, who hurried out of a back office. “He’s a new doctor!” The three of them smiled sunnily at me. “Will you take us on?”

One in five Canadians has no GP – that’s 20,000 in Vernon alone. There’s a provincial waiting list, on which people can languish for years. If someone gets wind of a new family doctor, word spreads rapidly – my clinic had 180 grapevine enquiries before I even arrived. I’ve taken on several GP-less patients with active cancer; numerous others with established heart disease, complex diabetes or prior stroke; families with extremely vulnerable children. Neither I nor Carrie – an ex-London GP who relocated here around the same time – can possibly register everyone who is waiting.

Per capita, Canada has approximately twice as many GPs as the UK, so why the shortfall? Geography accounts for some of it: metropolises like Toronto and Vancouver are well served, other areas less so. But the key difference is control over list size. A UK GP must keep registering all newcomers; only in exceptional circumstances are they permitted to stop taking people on. The average number of patients per full-time equivalent GP in England now stands at a record high of 2,300. In Canada, family physicians stop taking on patients when they’ve got enough to look after. A typical list is around 1,200. This allows excellent continuity of care – people still see “their doctor” whenever they attend – delivered during sustainable working hours. The UK population might nominally be registered with a GP, but it’s increasingly rare for patients to get to see the same doctor twice – that’s if they can see a doctor at all.

With working conditions out here still allowing the proper practice of medicine, you’d think family practice would be more popular. But Canada, like the UK, has failed to train and retain sufficient numbers of GPs to meet growing demand. Under the Tories, England tried to address the problem by a policy of pumping increasing numbers of non-medical personnel into primary care in an attempt to fill the gaps – which has helped turn the NHS into the disjointed, impersonal, inefficient and hospital-centred mess it largely is today.

British Columbia – where I’ve moved – responded completely differently, launching a strategy in 2018 to boost both recruitment and, crucially, retention of GPs and nurse practitioners. A new contract, now taken up by more than 80 per cent of BC family physicians, strongly incentivises continuity of care – the single most effective intervention any healthcare system has, which can reduce morbidity, mortality and hospital activity by 25-30 per cent. BC has attracted more than 1,300 internationally trained doctors over the past two years alone, and now has more GPs per capita than any other Canadian province. The rate at which unattached patients are finally finding a family physician is increasing year-on-year.

Norway, notable for its comprehensive general practice and strong continuity of care, also has list sizes of around 1,200 – Canadian GPs seem intuitively to be finding the “sweet spot” where it’s possible to provide high-quality primary care in the present era. It is no coincidence that the British Medical Association’s GP Committee wants the government to target a comparable average list size for England over the next 20 years. Wes Streeting has committed to negotiating a new GP contract during this parliamentary term. There is no room for tinkering round the edges: the contract requires radical reimagining if he is to achieve his stated aim of bringing back the family doctor – on which the very sustainability of the NHS will depend. If Streeting wants to come to British Columbia to see what he might learn, I would be more than happy to show him around.