Local Hero Dr Mark Sanford-Wood
Today marked the release by the CQC of their much awaited ’State of Care in General Practice’ report. This has been some months in the writing and is a summary of the findings by CQC across the whole of English general practice over the last three years. Every inspection in every practice the length and breadth of England has informed the figures, observations and conclusions presented in this commentary.
What is immediately striking is the incredible quality offered by English general practice to the public we serve. General practice far outstrips the performance of any other sector in health and GPs should be rightly proud of their achievements in the most challenging of circumstances.
According to a new BMA analysis of general practice finances, funding for practices has fallen to a record low of just 7.5% of NHS spend and despite many, many promises new figures also released this week suggested that the Government has not fulfilled the GP Forward View’s pledge to significant increase the proportion of the NHS budget being spent on GP services. Yet despite this shortfall GP practices have delivered astonishing value. The total annual budget per patient for all care in general practice is less than that for a single out-patient appointment and yet the CQC report quotes many examples of quality beyond compare.
Of particular interest to policy makers should be the conclusion drawn by CQC that funding in general practice is directly linked to the best outcomes in NHS-wide improvement. If you want to improve the NHS then invest in general practice. That is evidence based policy and it should be at the centre of every government initiative and STP plan from Berwick to Bude.
But all is not well in the land of the expert generalist. In every corner of the country we see practices teetering on the edge of extinction. In footballing terms, the Premier League performance noted by CQC has been delivered on non-league budgets. And that cannot be sustained. The CQC warns that investment in general practice is vital if we are to maintain delivery. It notes the substantial increase in workload and complexity in recent years and comments that this has not been matched by growth in funding or workforce. Just a few weeks ago the BMA surveyed GP practices and found more than half were in such a desperate state they were considering applying to NHS England to temporarily close their practice lists to new patients. Four out of ten thought they might have to make this a permanent arrangement. The warning to the Government is clear: invest in general practice or preside over the disintegration of your greatest asset. It is a message GPC will be hammering home at every opportunity.
CQC has had a chequered history with the profession over recent years. Many, including GPC, have criticised their processes and methodology. There have been justifiably irritations over registration and other administrative obstacles, and GPC has argued consistently to reduce the regulatory burden and achieve proportionate regulation. Notwithstanding these criticisms of CQC’s methodology and processes, we finally have a government-inspired, centrally-funded, independent assessment of the profession I love, and the verdict is alpha-plus performance on omega resources.
This report must herald a rapid wind of change. If policy is to be evidence based then it must respond to the scientifically proven facts staring us in the face. General practice is the Koh-i-Noor of jewels in the NHS crown. But it is under imminent threat. From Bridlington to Folkestone, it is disintegrating before our eyes through neglect and underfunding. Both of those areas, at opposite ends of the country and treating very different patient populations, have in the last year either seen GP practices close their lists or their doors for good. Thousands of highly performing practices in villages, towns and cities across the country are one retirement away from oblivion. This report could not be clearer. We need urgent investment and we need it now. GPC will push hard for this and in the light of this report we ought to be pushing at an open door.
Dr Mark Sanford-Wood is deputy chair of the GPC, and is a GP in Devon