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Fund the basics, the bells and whistles can come later


jaimie kaffash 2 duo 280x131px

jaimie kaffash 2 duo 280x131px

Remember the halcyon times of early January when, for a few glorious days, Brexit was knocked off the front pages? In its place were headlines announcing gene tests for every child with cancer, Skype GP consultations for millions of people, and even an ‘NHS fit for the 21st century’. You’d have to be a curmudgeon to find fault with such prospects.

Luckily, being a curmudgeon is an essential job requirement for the editor of Pulse. So I saw plenty of promises in the NHS long-term plan that I don’t think the NHS can fulfil.

The fact is that the trumpeted £20.5bn funding increase is only enough to keep the NHS ‘standing still’, according to the Health Foundation, due to rising patient demand.

Yet this plan’s clear message to patients is ‘we’re going to be offering you a lot more’. We are going to offer you the chance to self-refer for cancer, far more screening to catch cancer earlier, lower thresholds for referral, easy digital access to your doctor, more and better Health Checks, mobile CT scanners in car parks and – of course – you’ll still be able to book a routine GP appointment seven days a week and in the evenings.

This is the opposite of what the plan should be doing. Instead of these new, headline-friendly priorities, let’s make the most of the tried and trusted care the NHS already provides.

Take lowered cancer thresholds. They will mean a greater number of lower-risk patients using cancer diagnostic services. Yet this comes at a time when trusts are consistently missing their current targets for treating urgent GP referrals within two months. So how about we don’t lower thresholds and instead spend that funding on making sure current standards are upheld, and the higher-risk patients get the timely care they need?

And what about cancer self-referral? A great idea taken at face value. But actually, the current system of GPs as gatekeepers is pretty good. The problem is that there aren’t enough of them. So how about we use that funding on making general practice more attractive so there are sufficient qualified people to decide whether or not a patient needs a referral?

And smoking services. Yes, the extra emphasis on smoking cessation services is great, but the smoking cessation services in the community were also effective. Unfortunately, many have been so underfunded that they have had to close.

I could go on.

It hardly needs to be said that most of these innovations have yet to be endorsed by the likes of NICE and the National Screening Committee.

This is not to disparage the whole long-term plan. It has some good ideas and the fact that most are not new is because it is the culmination of coherent thinking. NHS chief executive Simon Stevens has been championing integrated primary and secondary care since he took office.

But we shouldn’t be shy in making the case that a lot of the NHS is already pretty efficient. The problems stem from a lack of funding, so let’s put the money into existing services before promising shiny new ones. It’s not a sexy message, but it’s one I think patients will appreciate.


Jaimie Kaffash is editor of Pulse

Follow him on Twitter @jkaffash or email him at