Ground control to Major Tom

16th January 2017

“The patient is sinking while the doctors deliberate”

General Marshall after visiting Europe in 1947

Much has been in the news about the crisis in the NHS. This is no surprise and is a result of years of under-funding of primary care, community and social services so that the only alternative for patients is to attend the emergency department.

Despite years of policy to move more care to the community closer to patients no appropriate resourcing has been put in place to make that happen. Demand in primary care has increased from 300 million to 360 million appointments over the last five years, with no significant increase in funding.

Simon Stevens’ reports “NHS Forward View” in 2014 and “GP Forward View” in 2016 are clear about the vital place primary care plays in the NHS and the promise of further funding and a move of resources into primary care to manage demand. Despite these welcome pledges, as a front line GP it is difficult to see any extra help.

Fortunately, in East Suffolk, we have the GP+ service which has provided over 17,500 extra appointments. This also diverts patients from 111, A&E and the ambulance service.

Unfortunately, some of the claims the Government has made in terms of NHS resourcing have been widely discredited. The NHS Select Committee identified that in real terms the £10 billion increase in funding is just £6.5 billion, with £3.5 billion of that coming from cuts to public health and medical training.  I think patients and staff in the NHS do deserve more honesty from our leaders.

The same can be said for the aspiration of 5,000 extra GPs by 2020.

NHS England’s stock response, that patients can seek help from a pharmacy or phone 111, is misleading. A significant number are directed to emergency departments (some by 999 ambulances).

However, there are opportunities for change. The out of hours contract for which the Suffolk GP Federation is bidding is out in October 2017. The Federation has come up with a comprehensive, integrated service to address both the problems within 111 and involve real links into daytime primary care and the GP+ service.  It is important the CCG takes this opportunity to bring out of hours back into primary care.

Collaborative, integrated working across hospital, community, social and mental health is a possible angle – a key part of the local sustainability and transformation plan – but we need to see actions and a demonstration of this rather than just discussion.

PS: We know many patients attending emergency departments could be managed in a different way, but that requires a more primary care led urgent care centre.  Simply posting GPs in A&E is not the answer to this, as has been clearly stated by the Royal College of General Practitioners’ Chair, Helen Stokes-Lampard.  Putting the consultant at the front door may help.

“Can you hear me, Major Tom?  Can you hear me . . .”

Paul