Primary care and GPs

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)

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.

Read our full initial primary care briefing here

➤ Read our update briefing on Physician Associates 5 March here

3. Urgent Primary care update: events are moving fast, and in the wrong direction

What’s good for patients Is good for the economy
Primary care investment is crucial for economic growth and pays for itself. Investment in healthcare generally drives a fourfold economic return, but investment in primary and community healthcare, some estimates put much higher.

What’s bad for patients is less skilled, fragmented, over digitalised, secretive and privatised care.
In addition to 14 years woeful underfunding and understaffing of primary care, with all the rationing and delayed care that has meant for patients, a recent clutch of government policies will add to the misery and dilute the service  beyond recognition.

These include:

  1. increasing the under-supervised employment  of less qualified practitioners e.g. physician associates from 2000-10,000,  instead of core staff, e.g. GP, nurses, pharmacists, physiotherapists
  2. allowing  private and private equity companies to buy and sell  primary  care practices like chips, even when they flout the terms of their  contracts
  3. plans to break up primary care into same-day access hubs for ‘simple’ cases with non-GP’s  (a sort of 111 service for 24/7).  This does not recognise the frequent complexity of people with urgent needs, who often get the best care from a team who knows them. It risks duplicating consultations as people will have to rebook with their own surgery and threatens to further reduce patient choice of who they see.

4. KONP calls 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.

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