Primary care crisis: fight for a better future
Britain should be proud of the NHS, and nurse it back to health
“If you had the hypothesis that the government was seeking to destroy the National Health Service…all the data that we’re seeing are consistent with that hypothesis.” (Professor Michael Marmot)
Briefing document: Brenda Allan and primary care working group
1. Why is primary care so important?
- Patients rely on a skilled, high quality, reliable, accessible general practice, as this is the main arm of the NHS patients contact (90% of patient contacts are with primary care).
- A year’s worth of GP care per patient, costs less than two trips to A&E, (some estimates are £40 for GP visit and £250 plus for outpatient visit), so increasing General Practice’s share of NHS spend, and therefore capacity to prevent, intervene early and treat illness, makes economic sense.
- Primary care is one of the four features highlighted as crucial in top performing health care systems, but the UK
comes 9th of eleven high income countries for health care outcomes (Commonwealth Fund). It ‘’is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution, by focusing on peoples’ needs, and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment.” (WHO)
2. Primary care crisis
Primary care is described by some as at breaking point, as is the rest of the NHS and social care, resulting in higher levels of mortality, illness, pain, and anxiety, with its attendant impact on people’s daily lives, families, and livelihoods. However, this crisis was not inevitable, nor the consequence of the pandemic, but the result of successive political decisions, a government made crisis. So, different decisions can make primary care, and the rest of the NHS, a service that meets need, and that we can again be proud of. Other comparably wealthy countries, whatever their model of fundraising, tax and/or social insurance, just spend much more.
Patient satisfaction has plummeted as thirteen years of underfunding mean patients face potentially life-threatening waits at each stage, from delays and difficulties contacting GP practices, long waits for an appointment, talking to different clinicians for every contact, who know little about them, repeated telephone triage, frustration with e- consult and Patient Access, long waits for referrals to secondary care for diagnosis and treatment (Healthwatch and others).
- Funding for primary care has shrunk as a percentage of healthcare spend, 9%, and is well below the OECD average, 14%. Twelve years of underinvestment have eroded capacity, (staffing, equipment and premises), job satisfaction and morale, with demand now massively outstripping supply.
- Austerity’s cuts to partner services e.g. social care, community nursing, hospital capacity, public health, dentistry and end of life care, has led to an increase in poverty, and more very ill patients living in the community, dependent on primary care, with fewer if any services for earlier intervention, additional support, or timely onward referral.
- These barriers to timely care, have undermined clinical standards, with lethal consequences. (Goyal)
- Creeping privatisation and hostile political and media comment has added to demoralisation, anxiety and despair for patients and staff.
- The combination of these factors has left staff feeling deskilled and anxious about being forced to offer a residual, ‘firefighting’ service, not the safe, high quality and personalised care, that led them to choose their professions, and for which they were trained.
This situation is set to accelerate thanks to the government’s recent budget, the scrapping of manifesto targets to recruit 6000 extra GPs, the reintroduction of the cap in medical school places to near pre pandemic levels, even for students who deferred taking their place during the pandemic, continuing recruitment and retention issues for other primary care staff, Integrated Care Systems’ (ICS) capped budgets, and the reduction in GP representation on ICS boards.
Crisis in detail
◼︎Impact on patients
KONP is calling for urgent action to:
▪︎ Fix the crisis AND re-build primary care fit for the 21st century, patient designed and focused, prioritising continuity of care (it saves lives), well resourced, central to the NHS, and embedded in communities. It will operate as local, one -stop health and wellbeing hubs, providing health promotion, preventive, medical and some outpatient services, in partnership with others, e.g. social care, hospitals, public health, community nursing, palliative care and the voluntary sector. Support, evaluate and extend promising existing initiatives.
▪︎ Raise primary care funding to at least the OECD average (14%), and raise NHS spend as a percentage of GDP, to the level of comparable countries, to redress staff, equipment and premises shortages. Healthy countries are economically healthy also. However, PFI and similar models must not be repeated as a means to achieve this.
▪︎ Target new funds and workforce incentives to disadvantaged/underserved areas, to reduce mortality and morbidity, reweight the Carr Hill funding formula and ARRS allocations more heavily for deprivation to align more closely with need.
▪︎ Increase the workforce: fund enough doctors and nurses to keep the NHS safe with rapidrecruitment, training, returnees, and retention programme, e.g., attract and facilitate returnees/retirees on flexible terms, fund additional university and practice-based training places, reinstate adequate nurse bursaries. fix visa issues for overseas graduates and barriers to refugee health professionals, and introduce NHS terms for administrative staff. Review workforce strategy annually.
▪︎ Reduce the workload: cutunnecessary work – fund Primary Care Networks and larger practices to expand support to others for back-office functions, e.g., HR, premises, improved IT for administrative tasks, end unfunded task shifting by hospitals and others to primary care, and scrap current inspection arrangements (CQC and QoF).
▪︎ Cap patient list sizes, reintroduce personal lists, and prioritise continuity of care alongside improved access.
▪︎ End waste and privatisation: stopaward of new privateAny Provider of Medical Services (APMS) contracts, paid 14% more per patient than NHS General Medical Service (GMS) contracts, and phase out existing APMSs. Explore and support new NHS salaried practice models with PCN/ Federation/ICS held contracts, Employee Ownership Trusts (Somerset) and others.▪︎
▪︎ Increase GP and patient representation in Integrated Care Systems to ensure more patient centred primary care.
Previous Document uploads
- Adding non-medical roles in general practice reduces patient satisfaction, study finds – Pulse Today
- Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey
- DOCTORS IN UNITE PRIMARY CARE AND PUBLIC HEALTH VISION FOR REVITALISING PRIMARY CARE A CHARTER FOR GENERAL PRACTICE
- Next Steps for integrating primary care, Fuller Stocktake report, NHSE
- Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20:an observational study of NHS privatisation, Benjamin Goodair, Aaron Reeves, Lancet Public Health
- House of Commons Health and Social Care Committee, The future of general practice Fourth Report of Session 2022–23