The NHS has no choice but to shift funding into general practice, prevention and community care if it is to survive, an independent report commissioned for the NHS 75th birthday has concluded.
There is growing consensus that tackling chronic ill health and an ageing population means moving NHS priorities into prevention, personalised care and care closer to home but this is not happening at ‘sufficient scale and speed’, the report from the NHS Assembly said.
Authored by Professor Dame Clare Gerada and Professor Sir Chris Ham with input from NHS staff and ICB leaders, the report said universal general practice as a foundation for co-ordinating high-quality, continuous care was a real strength of the NHS.
But changes in resource allocation are needed to bolster general practice, wider primary care and community services, it concluded.
As outlined in the Fuller stocktake it means ‘ensuring that primary care has the digital and physical infrastructure, training opportunities and leadership capacity to fully achieve’, they concluded.
It follows a King’s Fund analysis by Professor Ham in April that found investing in primary care and community has to be a priority after a decades of much greater funding increases to secondary care.
The NHS Assembly report was commissioned by NHS England to look at where the health service has come from and how it needs to change to meet future needs.
It noted that 5.4 million of the English population are over 75 – when demand for healthcare is greatest – compared to under 2 million in 1948 when the NHS was founded.
Care for common conditions such as diabetes, high blood pressure and heart disease, previously only delivered in hospitals, now takes place in primary care, with around 100 million more GP appointments every year, a 50% increase compared to 25 years ago.
Yet almost a fifth of the primary care estate (GP practices) was built before the NHS was founded.
Improving access to treatment and making it easier for people to navigate and communicate with different NHS services should continue to be priorities.
‘Above all, greater value hinges on investing in general practice, delivering more care closer to home, and intervening early to prevent the onset of ill health.
‘By providing more care in lower cost settings, the NHS will be able to deliver better outcomes with the resources at its disposal,’ it concluded.
But many of the factors that affect health are not within the NHS’s direct control, with inequalities in employment, income levels, housing quality, green spaces, air pollution, diet and education all have a much greater collective impact on health and wellbeing than treatment of illness, the report added.
The Government should use tax and regulation to promote health and encourage activity, it stressed, around smoking, misuse of alcohol, gambling, and excess sugar and salt in processed foods.
‘The challenges posed by obesity and excess weight, and their unequal impact in society, are a good place to focus,’ it said.
Speaking with Pulse, Professor Gerada said she felt more hopeful now than ever that things would change and that this would be a ‘turning point’ for general practice.
‘The shift in funding has to follow. There has to be a shift in funding of people and estates,’ she said. ‘There also needs to be additional funding for public health and data transformation. Everyone knows this has to happen.’
She added that the report did not really say anything new, many others had made the same points before but they were bringing it together into one place.
‘This is going to be used by NHS England to help ICSs and ICBs do what they know needs to be done to make these major shifts.’
The BMA will use negotiations on the upcoming 2024/25 GP contract to demand that QOF, IIF and PCN DES monies are all moved into one simplified core general practice funding stream.