Here it is Merry Christmas
Everybody’s having fun
Look to the future now
Its only just begun
Merry Christmas Everybody Slade (1973)
1. Adequate funding for health and social care
It is clear that current levels of funding for health and social care services are not enough. Pressures on the health service are exacerbated by lack of social care through years of budget cuts. This has had the opposite effect of increasing costs, while more patients have also been admitted to hospital or forced to stay longer because of inadequate social care. This was entirely predictable. We need an honest debate about funding.
2. Moving resources to primary care/preventive care
This has been in every government’s NHS plan since I qualified but was recently highlighted by Simon Stevens in the Five Year Forward View (GPFV). It is also mentioned in our local STP plan. Hospitals changing to a fixed contract may concentrate the mind, but as yet we see no clear evidence of anything substantial happening on the ground. The goal of breaking down barriers between health and social care, primary and secondary care, physical and mental care in the GPFV is still a long way off.
3. Data sharing
As more services are developed it makes sense for clinicians to be able to access patient records, both for safety and indemnity purposes. The current approach of asking every patient for permission to access their records is never going to work and substantially threatens the viability of services. An appropriately resourced widespread campaign about data sharing is likely to be far more effective and informative for patients.
In East Suffolk we are lucky that most practices use one computer system (SystmOne). In West Suffolk and North East Essex there is more of a split. Despite years of promises there is still no easy integration of these systems. This really needs to be sorted out with urgency at a high level because it hinders development of coordinated services across practices.
5. Demand management
Frontline clinicians need to be supported when inappropriate demand is placed upon them e.g. there needs to be a more consistent approach in challenging work from secondary care and other sources. There needs to be more support for colleagues who decline to prescribe antibiotics and then are faced with a complaint, and for making cost-effective management decisions. NHS England and our clinical commissioning groups need to support practices when we are open and honest with patients about what service they can expect.
6. High strength alcohol tax (and sugary drinks)
Scotland is leading the way, as with smoking, in addressing high strength alcohol. The evidence is clear that this has a significant impact, with immediate and long term gains. It is incomprehensible to me why this is not being more aggressively pursued in England.
7. Contractual levers
Many of Suffolk GP Federation’s initiatives in trying to encourage practices to work together or develop a new service are constrained by archaic GP contract clauses. We need a ‘fit for a purpose’ infrastructure and support services.
This remains the biggest threat to primary care. Work is ongoing, but the number of GPs and practice nurses is unlikely to increase anytime soon. Much more needs to be done to encourage (and break down the barriers) preventing a greater skills mix within primary care. Many of these are contractual and related to inflexibilities in indemnity and professional bodies. There needs to be honest communication to patients that seeing a GP is going to be harder in the future.
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