Not investing in primary care ‘most significant policy failure’ of the ‘past 30 years’

The lack of primary care investment is ‘one of the most significant policy failures of the past 30 years’, one of the country’s most influential health think-tanks has said.

The NHS in England ‘must be radically refocused’ to put primary care at its core, according to a new report by the King’s Fund.

NHS England and the Department of Health and Social Care should consider changes to the current national contract approaches for primary care, ‘creating more flexibility for local commissioners to drive change based on local need’, the report said.

The financing model for primary care – general practice and community pharmacy through mainly national contracts – ‘does not allow easy flexibility or change’, or larger-scale local investment, the authors said.

They also pointed out that on average there are more than 876,164 GP appointments in the NHS every day – an increase of 34,219 appointments a day since 2018/19 – but that despite this rise in demand, the proportion of DHSC spending on primary care has fallen – from 8.9% in 2015/16 to 8.1% in 2021/22.

The report said: ‘The failure to grow and invest in primary and community health and care services
despite the often-avowed intention to do so must rank as one of the most significant and long-running failures of policy and implementation in the NHS and social care over the past 30 years.

‘Future growth in funding and staffing needs to be directed proportionately more to primary and community health and care services rather than to acute hospitals.

‘The Department of Health and Social Care and NHS England need to prioritise capital and revenue investment in technology and estates for primary and community health and care services.’

King’s Fund chief executive Sarah Woolnough said: ‘Many people across the country will have personal experience of struggling to get a GP appointment, trying to contact other services, and when all avenues have been exhausted, reluctantly going to A&E. It feels like all roads lead to the hospital, but our hospitals are already full. 

‘To achieve an effective and sustainable health and care system, politicians and national leaders need to embark on a radical and wholesale refocusing of the health and care system towards primary and community services.

‘Doing so will free up hospitals to treat the patients they are best placed to treat, thanks to many more people being diagnosed and cared for in the community.’ 

Dr Katie Bramall-Stainer, chair of GPC England at BMA, said: ‘These damning findings paint a sad picture of how underfunding and neglect is crippling every corner of our NHS. As stated, demand for general practice has ballooned in recent years, but we’ve not seen adequate support or focus from the Government on addressing these new challenges.

‘This should act as a wake-up call for the Government. As the King’s Fund has outlined, there has to be a rethink on plans for general practice, otherwise services will simply continue to drop in quality. Staff do the very best for their patients, but if there aren’t enough of the right sort of staff then patient satisfaction will continue to decline.’

‘With discussions still ongoing regarding the GP contract for 2024/25, and too many NHS practices struggling due to insufficient investment and high levels of inflation, this is an opportunity for the Government to get serious about its vision for general practice, make significant improvements on its paltry 1.9% contractual offer and invest in the GP workforce of the present and future.’

NHS Providers’ deputy chief executive Saffron Cordery said: ‘As this report highlights, care provided in the community is too often overlooked when headlines and political priorities focus on a narrow set of acute-focused targets. But prevention is better than cure and with the right funding and workforce then community, primary and social care can play an essential role.

‘Community and primary care services help people to stay well, manage their conditions and live independently, which is better for patients and can help to ease pressure on the rest of the NHS.’

RCGP chair Professor Kamila Hawthorne welcomed the report’s recommendations for more focus and funding for primary care.

She said: ‘GP teams are stretched to our limits as demand for our services rises but we have fewer fully-qualified, full-time equivalent GPs than we did five years ago.

‘There is a widespread ambition to move more care into the community where it is more cost-effective, and it’s pivotal that funding follows patients, and but that’s not what we are seeing. We need to turn this around.

‘With an election on the horizon, all parties need to heed this report and invest in general practice.’

A DHSC spokesperson said: ‘This Government wants to end short-term thinking and we are taking the long-term decisions that will mean everyone can access high-quality care that enables choice, control and independence.

‘We commissioned the first ever NHS Long Term Workforce Plan to train, retain and reform the workforce, and put primary and community care on a sustainable footing.

‘Backed by more than £2.4 billion, the plan will increase the number of GP training places by 50 per cent by 2031.

‘We have also delivered our commitment to provide 50 million more GP appointments per year, rolled out the Pharmacy First service to reduce pressure on GPs, and made up to £8.6 billion available over this financial year and next to support the adult social care workforce and help people leave hospital on time.’

In a report for the King’s Fund last year, Professor Sir Chris Ham said that priority ‘must be given’ to investing in primary care and community services to stem the decline of the NHS.

Last week, the Times Health Commission report suggested 10 reforms to the NHS and social care in order to create a ‘healthier Britain’ – including GP contract reform.