In the year April 2023 to March 2024, English general practices provided 352.6 million appointments, of which 159.6 million (45.3%) were with GPs,1 equating to an average of 5.6 appointments per person (2.5 with GPs). The care provided was for the whole population, lifelong from pre-conception to the end of life, and comprehensive, including illness prevention, the initial diagnosis of new conditions, management of many acute conditions and referral for others, and the long-term management of most common chronic conditions. Of the many outcomes of general practice, we have chosen to focus here on longevity, concentrating specifically on the two measures mortality and life expectancy, about which there is a reasonable amount of general practice evidence.

Social determinants powerfully affect mortality rates but can be improved by national policies to reduce inequalities and enable healthier lifestyles. Cross-government action involving education, transport, welfare, environment, housing, and public health sectors at local and national levels is essential to improving life expectancy. Within the healthcare system, general practice also has a worthwhile role to play. We aim to explore the mechanisms through which general practice contributes to improving longevity, and to discuss some of the implications.

General practices led by GPs are the core providers of primary care in the UK. The development of primary care in low- and middle-income countries has improved population health and mortality rates.2 Primary care has long been part of better funded health systems, though its health impacts can be difficult to separate from those of social progress and improvements in medical practice. Starfield and her colleagues first summarised evidence on primary care’s effect in high-income countries in 2005,3 and more recent research has confirmed the benefits of medically led primary care in these countries. In a 2013 study involving 31 European countries, those …