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Government must invest in primary care to save the NHS, warns influential think tank

Government must invest in primary care to save the NHS, warns influential think tank

Priority ‘must be given’ to investing in primary care and community services to stem the decline of the NHS, an influential think tank has warned the Government in a scathing report.

In a report for the King’s Fund, Professor Sir Chris Ham pointed out that ‘increases in NHS activity and funding since 2000 have been much greater in hospitals than other services’, particularly singling out primary care as an area desperately needing investment.

The report pointed out that ‘the share of NHS expenditure accounted for by hospitals increased from 62.7% to 65.2%, and the share accounted for by primary and community services fell from 20% to 19.4%, between 2015/16 and 2018/19 (NAO 2020a, p 37)’.

This unbalance has ‘hindered ambitions to deliver more care in people’s homes or closer to home’, said Professor Ham, who has been one of the UK’s most senior policy influencers for several decades.

‘Priority’ must now be given to ‘investing in primary care and community services’, according to the report ‘in order to anticipate people’s needs, promote independence and offer alternatives to hospitals’.

‘The Government and NHS leaders share responsibility for rebalancing expenditure,’ he added.

The report placed the blame on for the decline of the NHS on ‘the coalition Government from 2010 to 2015 and successive Conservative Governments since then’, who were also guilty of ‘neglect of workforce planning’.

The successive governments ‘have failed to heed the warning signs of deteriorating performance’ and preferred to use ‘short-term fixes’ rather than seek long-term solutions, Sir Chris said in a scathing comment.

Professor Ham said that the improvements that occurred between 2000 and 2010 demonstrate that the NHS ‘is capable of reform’ if governments take a long-term perspective.

He added: ‘NHS revenue funding should increase in line with the long-term average. There should be realistic targets for efficiency savings, and spending on capital, education and training, and public health should be given priority.

‘The implications for the future are clear. If current pressures are to be addressed, NHS revenue funding should increase in line with the long-term average.

‘Spending on capital, education and training, and public health must be given priority. The case for change has been set out in various policy documents and reports in the past decade, including the Forward View and the NHS Long Term Plan.’

Professor Ham added that a ‘credible and fully funded’ workforce plan for the NHS and, ideally, social care, must now be published.

The report said: ‘Failure to invest more in services in the community hindered efforts to reduce demand for hospital care and respond to the changing burden of disease.

‘One study noted that growth in the workforce was greater in hospitals than in general practice, resulting in “more capacity for doctors to refer patients and to undertake outpatient procedures as technology advanced”.

‘This study found that elective procedures grew by 9.6% each year compared with growth of GP consultations of only 0.7% year between 2000/1 and 2017/18.’

Health secretary Steve Barclay has been expected to publish a ‘primary care recovery plan’ imminently, while the long-awaited NHS workforce plan was supposed to be released in the upcoming weeks, following lengthy delays but so far neither has surfaced.

Professor Ham, who was knighted in 2018, was chief executive of the King’s Fund from 2010 until 2018. He has held posts at the universities of Birmingham, Bristol and Leeds and is currently emeritus professor at the University of Birmingham. He is an honorary fellow of the Royal College of Physicians of London as well as the RCGP. He was also director of the strategy unit in the Department of Health between 2000 and 2004.



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Mark Cathcart 13 April, 2023 12:31 pm

Is there similar data available for the devolved nations as I have a feeling that spending on gp and community services in Northern Ireland is much much lower than 19%?

Some" Bloke 13 April, 2023 2:50 pm

Think they mean all primary and community services, not only General practice, eating 19% of the pie. Still feels like it’s less than that in England. Although I don’t know, agency staff for community teams, IAPT, PCLS etc might be terribly expensive, who knows…

Cameron Wilson 13 April, 2023 2:52 pm

Should be shameful reading for Jeremy, Matty Boy, plus the Quislings of NHSE. All totally true and a report we could have saved the Kings Fund thousands, by anyone on the Primary Care front line, penning similar for the past 10years!
No doubt, will be answered by the usual nonsense of” We are investing record amounts…” certainly until next GE!
When we get career Politicians posted into positions of Power, have no clue, or indeed interest, in their remit beyond getting a soundbite to further their own ambitions, this is what results. Will be interesting to see what Wes has to say on the matter!
It’s not just Health that this afflicts, suspect MOD, Judiciary, Education will have similar gripes. The only difference with health is that the fall guys for their wilful ineptitude is the workforce who pay with their own health and potential litigation, see Dr BG for details.
Sad thing is when you look at Politicians, there doesn’t appear anyone who has the honesty or ability to make the decisions required, no wonder the juniors are packing their bags!

Darren Tymens 13 April, 2023 5:09 pm

Please don’t conflate general practice with either primary or community care, which are different things.
Funding for general practice peaked at 11.5% of the NHS total funding in around 2005, and now sits at around 7.5%.
Please also look at workforce numbers and capacity: hospital doctor numbers have almost doubled since 2005 (up by 80%), whilst number of GPs have declined (by around 5%) in the same period.
The numbers explain, very simply, where the NHS has gone wrong.

Douglas Callow 13 April, 2023 5:26 pm

A colleague of mine is forever reminding me ”Please could we take care when we use the term ‘primary care’?
Primary care is not the same as general practice.
It includes dentists, optometry services, community pharmacies, PCN services & crucially, community service providers too.
When we mean general practice, we should say general practice!!

very true

Adrian Millman 14 April, 2023 10:28 am

Agree wholeheartedly with all of the above. Secondary care is the Government’s priority, and has been for years. The explosion in consultant numbers mirrors this emphasis towards a specialist care model. Medical students & Juniors are turned off General Practice, it seems , in their training and the current situation with the GP workforce and low moral makes more of those who could be inclined to a carer as a family doctor, think again.
It may change with a change in political direction- but don’t watch this space. The damage is deep seated. In the meantime, the current political incumbents will further their own careers & simply don’t understand seemingly don’t care.