NHS England needs to increase spending on primary care in order to achieve the desired shift in patient care out of hospitals, says the policy director of the Nuffield Trust.
In an exclusive interview with Pulse, Dr Judith Smith said that at the moment GPs feel constrained by workload, funding pressures and ‘being stuck’ in the current general practice service model.
Speaking after the think-tank’s joint report with the King’s Fund on the future of general practice, which suggested a new alternative GP contract is developed to incentivise larger-scale working, Dr Smith said that this would require general practice taking a larger chunk of the overall NHS budget – than the current 9% – in the longer term, alongside investment in workforce and premises.
She said: ‘Primary care spending has been flat and even reducing as an overall percentage of NHS funding in the recent past, and I think as we look forward and there is a requirement for primary care to take on more if we look at changes to how our hospitals might run. We have to think seriously about how primary care is funded and supported.
‘I think we would be looking at a phased [shift of resources into primary care] over time, matched to workforce and premises development, and wider changes being made to hospital care and configuration.
But she warned that it was unlikely the NHS would increase spending without GPs delivering more.
She said: ‘It is actually not just putting in money for more of the same, but actually it is going to have to be organised and designed in a different way to offer a wider range of services to patients. So, yes, more investment, but for something different and more up-scaled.’
Dr Smith also warned it will be difficult to achieve the scale required without relieving the pressure on GPs who at the minute feel ‘stuck on a treadmill’ of workload and funding constraints.
Dr Smith said: ‘I think GPs are up for this. They are very conscious about how services could and should be, but feel constrained about the current service model that they find themselves in.
‘For many at the moment they feel I think trapped on a treadmill of workload, of constrained funding, and so what we heard quite clearly in our research for this work was that people need the time and space to get off the treadmill for a little while, think about how they would like to design and deliver primary care differently for their local populations.’
‘What we are saying is that we need, from NHS England primarily, some support in place to make some resources available for groups of practices for where they’ve got some ideas that they’d like to take forward. To perhaps give them some space and time, to buy out some time for those leaders to reflect and plan and so they can actually design their future as they want it to be for their patients and their population.’