Accentuate the positive: politics in primary care

Our new columnist, health journalist Andy Cowper, guesses how primary care might feature in the upcoming General Election battles

The political climate for PCNs is getting hotter. After the local elections showed the Conservatives doing badly and Labour doing well, the rhythm of health policy and politics will accelerate as we head to the next General Election. 

Will the pre-election debate accentuate the positive for primary care and PCNs, as the song goes? Well, there is no clear policy challenge from any major party to the concept of greater integration of health and care services, and more preventive care. And networks are crucial to this.

The Hewitt Review, by Norfolk and Waveney Integrated Care Board (ICB) chair and former New Labour Health Secretary Patricia Hewitt, preached the integration and prevention gospel. It recommended funding for prevention should be increased. It also called for a new framework and funding baseline for prevention work to be agreed by autumn 2023, with all systems reporting their prevention investment by 1 April 2024; with a 1% increase in spending on prevention from NHS system budgets over the next five financial years.

No commitments have followed from the Government.

For PCNs, the recent GP contract update announcement of the new investment and impact fund (IIF) brought the Government’s commitment to improving GP access into sharp focus. The IIF will fund PCNs an average of £11,500 a month in 2023/24 to improve access.

Pulse editor Jaimie Kaffash wrote that the contract papers for the Network DES also reveal there will be just six weeks to develop plans to improve access for a share of a further £74m – around £60,000 per PCN per year. The target is to see 85% of patients within two weeks of an appointment request. NHS England then added a whole seven weeks to this timetable. PCNs may now submit access plans to their integrated care board (ICB) by 30 June.

Some obvious thoughts: getting a GP appointment within two weeks may be all that’s deliverable. But it shows how bad access has become. Also, this is not going to reduce demand. People who need healthcare will carry on trying the GP 8am phone lottery, before heading to a walk-in centre (if they still have one) or A&E. And these are not significant sums of money. Good luck to all 1,250 PCNs in finding a GP for £60,000 a year, and making £11,500 a month go far on access improvements.

So what is the opposition promising? Labour’s Wes Streeting stepped away from his performative policy pyromania in his speech at The King’s Fund, emphasising that previous discussions about an end to GPs’ independent contractor status were not a policy position. He floated Labour’s vision for
a ‘neighbourhood health service’ in which ICBs would lead local delivery and reform. He outlined the party’s plans to use money from abolishing the non-domiciled tax status to train more clinicians, health visitors and district nurses, and double the number of medical school places. He avoided putting a number on the extra GPs because even if Labour wins, none of the new training cohort will be fully qualified by the end of that five-year term. 

Governments can do things: oppositions can announce things. It’s obvious that the doing plans will not improve primary care access. It’s optimistic to think Labour can turn things around. Primary care is stuck in the middle.

Andy Cowper is the editor of Health Policy Insight and a columnist for the BMJ and Civil Service World