This site is intended for health professionals only

Efficiency drive forces cuts to frontline care

By Gareth Iacobucci

Exclusive: The Government’s programme of NHS ‘efficiency savings’ is already translating into biting cuts to frontline services across the country.

More than half of GPs responding to a Pulse survey say cutbacks to local services have now begun, with many others warning reductions in services are planned.

Health visiting, phlebotomy services and palliative care are among the areas being squeezed, making a mockery of pledges from politicians to ensure efficiency savings do not affect the front line.

Our survey of 370 GPs also found widespread alarm at the prospect of a large-scale shift of services from hospitals into the community, with GPs supporting the move in principle, but overwhelmingly concerned that primary care does not have the capacity to cope.

The Department of Health has demanded PCTs save £15-20bn in health service efficiencies over the next three years.

A recent Pulse investigation found 86% of trusts planned to achieve their savings partly by closing hospital services, and through a wholesale shift of some workload into the community.

As many as 55% of GPs responding to our survey said cuts to frontline services had already begun in their area, and a further 31% that cuts were being planned. Just 13% said their local PCT had no plans to reduce services.

Dr Krishna Chaturvedi, a GP in Southend-on-Sea, Essex, said large-scale cuts were being made across the board in his area, including removal of a weekly practice-based health visitor and scaling back of phlebotomy services for the elderly and infirm, which were being moved ‘away from practices to various satellite clinics’.

He said cuts were also being made to community nursing, palliative care nursing and dietetic and nutrition services.

‘The list is endless,’ he said. ‘Any transfer of services from secondary care to the community when there are so many problems of nurse employment as well as a reduction in services is going to be impossible.’

Dr Gill Beck, a GP in Aylesbury, Buckinghamshire, said her PCT was ‘ahead of the game’ in cuts because of its low capitation funding, which has led to reductions in treatment for conditions such as varicose veins and hernia, tighter referral management, and cuts to mental health. ‘It’s increasingly difficult to access a psychiatrist,’ she said.

Dr Richard Deacon, a GP in Haslingden, East Lancashire, said health visitors had been removed from practices, and a successful local drugs and alcohol service had been ‘outsourced to the private sector’ to save money without any consultation with local clinicians.

A GP in Hull, who did not wish to be named, described a host of cuts being made across the board in his locality.

He said: ‘We’ve had a community psychiatric nurse taken off us, and hospital consultants who used to do in-house clinics taken away, in areas such as general surgery, ENT, gynaecology and dermatology. They’ve also closed many departments at local hospitals, such as maternity and cardiology.’

Our survey found 54% of GPs backed the idea of shifting services into the community in principle, but most were desperately worried primary care would not be able to cope.

Just 12% felt primary care had the capacity to take on the extra work, with 56% backing Conservative plans to hold local consultations before any of the plans were implemented.

Dr John Grenville, secretary of Derbyshire LMC and a GP in Derby, said a similar picture was emerging in his area. ‘Our PCTs are very strapped for cash – the general message is there will have to be cuts,’ he said.

Efficiency drive forces cuts to frontline care