Sajid Javid has unveiled a plan to help the NHS get on top of the hospital backlog, which resulted from the Covid pandemic (or should we say the past ten years). I find myself wondering if – or when – our leaders will realise the fundamental role that general practice plays in the matter.
Take this week, for example. I must have referred at least a dozen patients into secondary care. From two week waits, to routine referrals, to expediate letters, to acute admissions, to scans. So much of a GP’s work involves managing the demand that passes through to the hospital.
And this doesn’t even include our management of acute presentations – a simple example being timely antibiotics for an infection; preventative medicine; or the enormous workload in managing chronic illness.
Every day that I work, my likelihood of referring a patient into secondary care depends on my capacity to safely manage the patient before me. From the patient who told me this week that in their country they would have been referred to hospital for treatment for their haemorrhoids, to the girl suffering from chronic pelvic pain which appears to be linked to poorly managed constipation.
A recent observational study revealed that continuity of care with a GP is associated with reduced acute hospital admissions, out of hours care, and even mortality. With time, and continuity, a GP can untangle so many of the difficulties that find themselves admitted as an emergency, referred for scans or a specialist opinion. Many of the patients who are presently on a waiting list could be appropriately managed by a GP with more time and resources.
Hence, it is truly astonishing that the incessant discussions over hospital budgets seem to fail to take into account the need to focus attention upstream. Even a comparatively small shift in investment (1% or 2% of the budget?) would reap enormous benefits if spent wisely in general practice and community services. But the most influential players seem transfixed by the crisis facing our hospitals and outpatient departments.
They have not heeded the adage a stitch in time saves nine’, and they fail to recognise the catastrophe unfolding in primary care, which promises to wipe out any gains that are made by the hospitals.
Yet, while our grand and clever leaders continue their debates about the resourcing of the NHS, my fellow GPs persevere in quietly managing the vast majority of the country’s health needs. Still, it is high time that someone deigned to ask us what the priorities should be. Because there is a dam that is just about to burst.
Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West
READERS' COMMENTS [5]
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I am afraid a hospital doesn’t need saving. Why? Tariff. They consume activity. You on the other hand, fixed infinite poor rate. Different models. Don’t save them. It’s pointless. Just move to an employer that works for your ethos and meaning. You know, *my likelihood of referring a patient is now directly proportional to the likelihood the person wants a referral. Simple. Win win. The pandemic has shown you your worth to Government institutes. Their pledge, patient choice agenda. Access, speaks greater than our words sadly now.
£250,000,000 per year extra funding for improving access to Primary Care resulted in no discernible improvement.
Funding may not be the primary problem here.
It has been solved before… but forgotten. For example..1991 Fundholding and then total purchasing. 1998 PMS+ contracting. 2005 practice based commissioning. 2015 Primary Care Homes. Maybe all we need is an organisation with a memory? Ecclesiastes 1:9-10
Agree James – we just go round in circles. As a profession we need to come up with a solution for the “leaders”. Would involve changes to the GP organisational model (David Colin-Thome was talking about this years ago), a different funding/incentivisation model (budget holding and or payment by results), and yes integrated teams/primary care home. Trouble is GPs can’t see beyond current ways of working or think flooding us with money will – did not work when Tony Blair gave GPs a big funding uplift and us not going to happen now unless we give something in return.
Whether it’s cash, re-organisation, more docs, or whatever, Dr. Musgrave’s point is that the majority (volume) of patient care needs are met at the primary GP care level: if that collapses the whole system will go with it.
While the 1960 – 70’s are a long time past, it was commonly said that GP’s managed 95% of patient care and all the specialists put together handled the other 5%. The actual percentages may now be different but probably not by that much.
Hospital care is ‘overwhelmed’ because the UK’s no of hospital beds per 1000 population ratio is 2.5. UK 2020 population is given as 67 million.
Japan has 12.6: Germany has 7.8: France has 5.7.
In 1980, the UK ratio was 8.1 beds per 1000 in a population of 56 million
So In the UK, from 1980 to 2020, there’s been a 70% reduction in beds per 1000 population to cater for a 20% increase in population.
Not that difficult to understand, is it?