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Gold, incentives and meh

Chancellor, general practice needs more money in the autumn statement

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The upcoming autumn statement on 23 November is a chance to avert the crisis in general practice. General practice is gasping for breath and is on life support machine due to plummeting investment and increasing demands.

The funding for general practice in England has slumped to just 8.5% of the total NHS budget in last six years. To prevent the meltdown of the general practice, the chancellor Philip Hammond needs to take steps to increase funding in the primary care to at least 11% in his autumn statement.

Without this, the very future of the general practice is at risk.

In the current climate, it is unsurprising that many of the next generation of doctors are turning their backs on a career in general practice, with more than 600 trainee vacancies left empty last year: it means there are even fewer staff to deliver the appointments our unhealthy, ageing, expanding population needs. A couple of decades ago, GPs approaching 70 had to be persuaded to retire. Now, the average age of retirement is 59. This is a ticking time bomb.

Cuts in the name of ‘efficiency savings’ have eaten away at the NHS to the point where it is down to its bare bones. Health spending is facing almost unimaginable cuts over the next five years. Every health think-tank has been sounding the alarm in recent months.

If economy nose dives as predicted, Philip Hammond, the chancellor, could even seek to end the service’s already leaking funding ‘ring-fence’. This isn’t shroud-waving – the figures show the NHS in general, and general practice in particular is on its knees. 

There is speculation that Simon Stevens’, the NHC England chief executive who has said he wants to revive general practice by restoring funding levels to 11%, may have a reduced political influence after the departure of David Cameron and George Osborne, who oversaw his appointment and worked closely with him.

This means he may not be able to secure the extra funding promised to primary care in the GP Forward View. My real worry is a more right-wing government would use NHS funding crisis to tell British public that a free universal health care is not affordable, and wash its hands of the NHS.

We need Philip Hammond to increase the percentage of the NHS budget for general practice in his autumn statement. Without this, the reality is that patient care – and the very future of the general practice – is at risk.

Dr Kailash Chand OBE is a retired GP and former deputy chair of BMA council. You can follow him on Twitter @kailashchandobe

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Readers' comments (15)

  • Lets face it, there is no money. We need to start making some hard choices:
    - Block patients from suing the NHS as a condition of treatment. Spend this money on improving care instead.
    - Charge a fee for every prescription item for every patient. Even £1 would reduce the waste (5p carrier bag...)
    - Charge a £1 booking fee for every GP consultation booking, no exceptions
    - Make it £5 for attending A and E or home visit request.
    - Block hip, knee and other surgery on fat people for 12 months unless they lose and maintain 10% in weight loss or hit BMI under 30. (I think people will complain, but later thank us)
    - Block elective surgery for smokers until they are 3m smoke free.
    I think making hard choices would still protect the basic ideal of high quality healthcare available for all.
    Meanwhile the STP plans will force some way overdue changes to local hospitals if my patch is anything to go by.

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  • "My real worry is a more right-wing government would use NHS funding crisis to tell British public that a free universal health care is not affordable, and wash its hands of the NHS."

    Kailash, you fall into the same trap as those in the BMA, GPC, JDC. It is NOT the job of those working in the NHS to save it. For goodness sake, it is already being propped up by the goodwill and dedication of its workers. It only exists now because of that!!

    It is actually up to the government to save the NHS, or to be brutally honest and say, it can't be saved without x amount of money pumped into it, or that it must be used responsibly, or that fees/charges must be introduced.

    At the moment, the 'direction of travel' is towards 'working differently' to save the NHS. And those in power are directly channelling precious resources into this direction of travel rather than invest it directly in General Practice itself. As workers in the NHS, we all know what is needed to save it. Working differently isn't it.

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  • General practice can't be saved because no one wants to do the job. Even if they did there are not enough trainers .
    If this winter is bad ,and there are many indicators that it will be , the NHS will fall over and die in the snow. Keep your head down , do what you can and it will soon be finished . Only then will anything be done to address the the situation .

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  • Ah stop whingeing, Gps brought this on themselves with your own undervaluing of yourselves. Today i am going to see a lawyer about something, his fee is £276/hour. He's a normal, standard, town solicitor, not some city barrister. That equates to £46 for a 10 minute appointment but when I try to get my GP partners to agree a sensible fee for private work they wring their hands and come up with silly reasons why you can't the poor people that much for private work etc etc.

    You GPs cheapened yourselves, now here come the consequences.

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  • Nice write up;
    First of all let us ensure that whatever funding is allocated by the Government reaches its right destination
    for example;
    1. NHS England approved funds to improve the premises but the CCGs are sending that money back due to reasons best known to them
    2. Government allocated funds for the struggling practices, but no one knows where those funds are and who will get the money as surgeries are still closing down due to lack of funds to recruit additional GPs

    I agree with few readers comments 'Tell the British Public' that Free NHS is not affordable due to it's rising cost and unavoidable wastage, which are built up into the system.

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