NHS @ 65: the need for investment in general practice

The NHS is struggling and general practice is one area bearing the brunt of the pressure to meet increasing, and changing, patient needs.

We have a growing and ageing population in the UK. From a GP’s point of view, we are seeing more patients than ever before, making up to 70 patient contacts a day, which previously would have only been seen in exceptional circumstances, such as a flu pandemic.

And these patients are often presenting with complex, chronic and multiple conditions, both physical and mental.

Additionally, another round of structural changes has meant confusion over who is in charge and who should be taking responsibility for and making decisions about crises across the NHS. This is having a terrible effect on patient safety and confidence in the care we provide.

General practice is the most cost-efficient arm of the NHS, currently providing 90 per cent of care in the NHS but only receiving nine per cent of the budget

Instead, decision-makers and policy-makers are embroiled in a blame culture, attributing problems in the NHS to one group one day and another the next instead of taking responsibility, working together and finding a solution in the best interests of patients and the health service.

The Secretary of State for Health, health ministers and think tank leaders must recognise the need for investment in general practice. General practice is the most cost-efficient arm of the NHS, currently providing 90 per cent of care in the NHS but only receiving nine per cent of the budget; this imbalance needs to be redressed.

However, funding in general practice is actually decreasing. The Royal College of General Practitioners (RCGP) figures suggest that if current trends continue, funding will decrease by £200 million in the next three years.

Investment in general practice needs to be two-fold. First, we need more funding and resources – including more than 10,000 more GPs, and more GP nurses. This will allow them to spend longer with their patients, within their communities.

Second, we need investment and support for extended and enhanced GP training in order to meet the increasing health challenges presented by our growing population. Only with this investment in general practice can we ensure a sustainable health service, which continues to provide excellent patient care to all.

Hopefully in ten years’ time, at least 50 per cent of all clinicians will be generalists. General practice is a cornerstone of the NHS and will continue to be essential in the NHS of tomorrow.

The RCGP’s vision: The 2022 GP: A vision for general practice, sets out a future for general practice as the patient’s medical home with GPs working in community-based, multidisciplinary teams to provide patient care in and out of hospital.

This will involve a hub-and-spoke model of integrated primary care and social care providers including specialist teams located in concentrated sites.

Working together across federations of practices would also lead to better out-of-hours responsiveness and allow us to develop different models that are able to address the needs of different populations of patients, such as the frail elderly.

Our vision is of greater personalisation of care with patients being able to talk of ‘their team’ or ‘their practice’ and a focus on prevention as opposed to cure. We also envisage a greater use of technology, to increase the efficiency of care and provide it in a more accessible way.

Without these things we risk moving towards a more chaotic NHS that is more expensive, more fragmented and unsustainable. The NHS must remain free at the point of use. Any alternative is simply inconceivable for the future of health care in the UK.

Dr Clare Gerada is Chair of the Royal College of General Practitioners (RCGP). Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors' own.

This is an extract from Dr Clare Gerada’s contribution to the Nuffield Trust publication: The wisdom of the crowd: 65 views of the NHS at 65. The collection of essays was published on Thursday 4 July 2013.