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GPs plugging public health gaps

Funding cuts - budget cuts - RF

Funding cuts – budget cuts – RF

Source: getty images 687977348

The Government squeeze on the public health budget has been brutal, and it is already hitting GP practices hard.

GPs are having to take on extra prescribing, manage sexually transmitted infections and tell patients they must self-care when they would previously have been referred to specialist services.

Councils have little choice. The public health grant for England has been cut by almost 10% (£531m) from 2015/16 to 2019/20, in addition to reductions in other funding schemes that feed into public health programmes.

The effects are stark: only 11 of the 80 councils who replied to Pulse’s freedom of information request have maintained public health spending at last year’s levels. Since 2015/16, the majority have cut funding for drug and alcohol treatment (87% of councils), sexual health (83%) and smoking cessation (79%).

Some councils have cut funding for weight management altogether, while others have cut sexual health budgets by a third or more.

Local authorities say they are doing their best to commission more effective programmes but are having to make difficult decisions against the backdrop of austerity.

Yet GPs are at the frontline of the cuts and believe their severity will have long-term repercussions for the health of the nation. BMA GP Committee chair Dr Richard Vautrey says: ‘Practices are all too often left picking up the pieces and patients are losing the option of access to important services in their area.

‘Ultimately these short-sighted cuts will cost the NHS in the long run as we don’t properly invest in prevention and health promotion.’

The impact of these cuts is insidious and will be seen down the line -Dr Dominique Thompson

The cuts are hitting services patients rely on. For example, Harrow, in north-west London, has ceased all its smoking cessation services, while an alcohol abstinence programme in neighbouring Ealing was dropped in 2017. A specialist weight management service in Middlesbrough stopped in 2015 after weight management budgets plunged by 64%. At least four areas, including Oldham and Havering, have cut weight management services altogether.

Several councils are cutting services such as GP exercise on referral, maternal obesity and breastfeeding support.

And Essex County Council has closed a falls prevention service to save £2.2m a year – a move described by a CCG as posing a ‘significant risk to patient safety’.

Practices are feeling the effects. Around half of the 620 GPs in England who responded to a survey carried out by Pulse last month say their practices are directly feeling the impact of the cuts.

South London GP Dr Alex Bobak, who has a special interest in smoking cessation, described the cuts as ‘appalling’.

‘Services are being cut wholesale. In general, councils are not providing the services and it’s a scandal.’

councils slashing public health spending graph 580x380px

councils slashing public health spending graph 580x380px

He says services have become so limited that GPs are having to see patients for repeat prescriptions of smoking cessation medication, and in some areas are being told not to refer patients who want to quit.

‘People are being left to stop smoking by themselves and they’re not stopping.’

Lincolnshire LMC medical director Dr Kieran Sharrock says local smoking cessation services have been downgraded to a telephone service, but it cannot prescribe Zyban so GPs are being asked to do it, which is ‘not efficient or safe’.

Dr Sharrock adds: ‘A similar situation occurs with sexual health, when they prescribe oral contraception, they request that the GP prescribes ongoing scripts, which undermines the original reason for having the service.’

But the main impact has been from the loss of obesity services in an area that includes the most overweight town in the country, he adds.

‘This is crazy. It makes conversations between GPs and patients very difficult. They say, “you tell me that I need to lose weight, but the only help you can give me is advice and a diet sheet printed off Google”.

‘In some patches there is exercise on prescription but this is limited.’

Dr Elliot Singer, a medical director at Londonwide LMCs, says the impact on GPs of recent cuts has been noticeable, particularly for weight management.

‘You try to refer someone for bariatric surgery but they can only have it if they’ve undergone 12 months of a weight management programme – but there isn’t one.’

He says patients are becoming much more reliant on their GPs for sexual health services, but that GPs simply do not have the resources for activities such as contact tracing.

Dr Singer says: ‘It is easy for local authorities to cut these sorts of services because the long-term effects will be paid for from the healthcare budget.’

‘You can only refer someone for bariatric surgery if they’ve undergone 12 months of a weight management programme – but there isn’t one.’

Dr Elliot Singer

Dr Dominique Thompson, a former GP and now an independent consultant in student health and wellbeing says her former practice, the Bristol Student Health Service, had its sexual health funding cut by £20,000 by the local authority. She points out that while this is not the sort of thing to provoke a public outcry, it will have long-term effects on the patients and on GPs.

‘The current generation will grow up without the public health advice and information campaigns and when they start to have problems it will be general practice that they will go to first.

‘GPs have started to see the impact already but the real problem with these cuts is the impact is insidious and will be seen down the line.’

Local authorities claim they have little choice. The Local Government Association is limited in its response due to ‘purdah’ rules in the run-up to this month’s local elections, but its community wellbeing board chair Councillor Izzi Seccombe said last year: ‘[Taking] vital money away from the services which can be used to prevent illness and the need for treatment later down the line and ease the pressure on the NHS is extremely counterproductive.’

She added that local authorities had been keen to take on responsibility for public health in 2013 but were now left without the appropriate resources.

A Department of Health and Social Care spokesperson says local authorities are best placed to make decisions for their community and that the Government is investing £16bn in public health over the current spending period.

‘We have a strong track record on public health – smoking levels are at an all-time low, more people than ever are being tested for sexually transmitted infections and the number of people infected continues to fall.’

But with councils under ever- increasing funding pressure, the drastic measures highlighted by Pulse may be irreversible. Dr Richard Ma, a GP in Islington, north London, and a sexual health expert, points out that once a service is lost it is unlikely to be resurrected.

‘It is the patients who suffer and we need to fight for a system where they can access the right care at the right time.

‘It does make you wonder how much the Government cares about the nation’s health compared with their own survival.’