In May 2012, our report Primary care today and tomorrow: Improving general practice by working differently highlighted the fact that the capacity and capability of the primary care workforce was coming under increasing pressure and that the expectations under the NHS reforms would add to this pressure. We identified the need for general practice to move to a more strategic approach to improve the health of their practice population, based on more collaborative working and the development of a more multi-professional practice team. We suggested that increasing the actual numbers of GPs and practice nurses was only part of the solution and suggested GPs needed to work differently, including adopting new business models and incentives and embracing technology to improve access, information and support for patients.
Reading last week's newspaper coverage, you could be forgiven for thinking that the threat to general practice is such that we are watching the death throes of a much beloved institution. We are told GP morale is at an all-time low and that many of our more experienced GPs are planning to retire. We know that recruiting full time GPs is becoming increasingly difficult and that most practices are relying increasingly on locums or part time female GPs. Indeed, female family doctors now outnumber their male counterparts for first time.
Paradoxically, we also know that the proportion of NHS funding spent on general practice has actually slumped across the UK. In 2004-2005, 10.33 per cent of the British NHS budget was spent on general practice but by 2011-2012 this figure had declined to only 8.39 per cent. This decline comes despite the fact that that demands for primary care are at an all-time high and the political mantra is for more care closer to home. Importantly, GP feedback suggests that the slump in funding is compromising the standard of care they can offer patients, leading to longer waiting times, and increasing pressure on hospitals.
These concerns have substance as shown by the new report from the over-50s group Saga. This found that 500,000 people had experienced delays of up to four weeks the last time they attempted to book a GP appointment with only one in three managing to secure a same-day appointment. Perhaps if the patient population was getting healthier and needing less intervention then funding reductions might be justified. However, as our recent report on Better services for frail older people shows, demand for primary care is increasing substantially as growing numbers of older people present with more complex health conditions and more people develop life limiting conditions.
Most independent research continues to point to general practice as the core reason why the UK is still able to provide a comprehensive health service that is "free" at the point of delivery. Yet for the most part, the model of care has evolved exceedingly slowly and remains a patchwork of small, independently minded units and, as a result, is unable to operate at the scale needed to meet the changing and challenging population needs. While one size certainly won't fit all its hard to see how small practices can continue to meet the needs of an increasingly medically complex population.
But just how big is the financial challenge? A Deloitte Economic Consulting report, prepared for and published today by the Royal College of General Practitioners, estimates that between 2008-09 and 2012-13 a 12 per cent funding gap has opened up in general practice funding across the UK. The biggest contributor to this gap is the continued growth of consultations in general practice which are estimated to have increased from 303,900 in 2008-09 to 360,838 in 2013-14. The report also estimates that by 2017-18, the funding gap will widen to 24 per cent if the share of the NHS budget spent on general practice remains at 8.39 per cent. However, should the share of NHS funding decline at the same rate as in the last few years, the share of the NHS budget could fall to 7.29 per cent by 2017-18 (creating a funding gap of 36 per cent).
The argument for increasing investment in general practice is compelling but, in return, general practice can no longer continue to rely on face to face, one to one consultations, nor can it remain such a data free zone. For example there is no robust data on the exact scale and complexity of consultations and limited information on the comparative effectiveness of interventions. Now, more than ever, we need general practice to scale up the adoption of new models of care, we also need general practice to collect robust performance data and information on activity and outcomes to justify investing more of the constrained NHS resources in what can and should be a truly cost-effective NHS services. In this way we can ensure more people can receive good quality, continuity of care where they say they want it - in the community.
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