This is the first in a series of blogs to amplify ideas and stimulate debate on NHS reforms, partly based on “The future for the general practice in England” a keynote seminar organized by Westminster Health Forum, 7th Dec 2017.
As a result of the increasing demands for health services, the high expectations of the population and the changing demographics, there is an urgent need to consider healthcare models able to meet the needs of the UK population in the 21st Century.
Before 1948, the poor feared ill health. Not for the reasons we fear it now, but because they had no means to pay for the treatment. The creation of a universal healthcare system, free at the point of delivery, was Britain’s greatest post-war achievement.
But from the start the NHS made an error building service around treatment rather than prevention. The ramifications are there for all to see. By seeking to treat ill health rather than tackling its causes, successive politicians and health planners have lost sight of the path to secure a sustainable NHS. A shortage of doctors, nurses, beds and care services for the elderly means that red alerts, trolleys in corridors and dangerous safety levels are at a peak, the sickness/treatment model is at breaking point.
On the funding issues there is some progress on the implementation of NHS England’s General Practice Forward View, and key issues for general practice part of NHS England’s Next steps on the Five Year Forward View - including the potential impact of £2.4bn increased funding by 2020/21 and the goal with 5,000 more GPs by the year 2020. But funding is not the entire story. There is an urgent need for a health service model that meets the needs of the new demographics.
Dr Michael Dixon is the National Clinical Champion for Social Prescribing health service model. The model is described as a health service not a sickness/treatment service, based on multi disciplinary approach, delivered by mixed skill teams and focused on prevention.
Dr Dixon started his presentation by painting a bleak picture of what the future could look like for the NHS, but as his talk went on it became more optimistic. These are highlights of what he said:
- Most of the effort and resources over the past few years have gone into secondary care not primary care;
- There are three times as many patients over 85, escalating long term diseases with increasing demands on GPs from hospitals and patients;
- The number of specialists in hospitals has grown by three times to meet this extra demand, at the same time the number of GPs per patient has remained more or less the same, with the consultants outnumbering GPs, and the trends are getting worse. The NHS is locked into an institutionalized specialism for a number of reasons:
First, medical schools are funded through hospitals, and designed to produce specialists. General practice isn’t taught as a specialty – it is just assumed that if you do all the specialties then you know what General Practice is. Unsurprisingly only 20% of new doctors become GPs, the NHS need 50%. Postgraduate GP education fares little better with barely 50% of fully fledged GPs entering general practice in some areas.
Second is tradition. Specialist medicine has been historically the “senior service” with all the serious managerial and clinical jobs in hospitals. If you want income, status, a professorship, honours or even a peerage then you become a specialist.
Third is funding. The Five Year Plan speaks of supporting health and care based in communities but somehow the money always goes in the opposite direction. Any spare cash is used to top up hospital financial deficits. Hospitals are saved - none has gone bankrupt -while GP practices go under and close. Politicians, health planners and the media are stuck in a narrative that undervalues, undermines and then under funds primary care services for a sustainable health care model.
Good news from Westminster Health Forum, two follow up seminars on Tuesday 20th February, 2018 “Next Steps for Delivery of Sustainability, Transformation and Partnerships: Funding, patient engagement and providers-purchaser split", for the full agenda click here http://www.westminsterforumprojects.co.uk/agenda/sustainability-and-transformation-partnerships-18-agenda.pdf
Wednesday 21st March, 2018 “Social Prescription: Health delivery model”, for the full agenda click here http://www.westminsterforumprojects.co.uk/agenda/social-prescribing-2018-agenda.pdf
Watch this space