The bedrock of the NHS

“Primary care is the bedrock of the National Health Service and the setting for ninety percent of all NHS patient contacts. It is highly valued by the public but is under unprecedented strain and struggling to keep pace with relentlessly rising demand.”

Thus opens The House of Commons Health Select Committee report on Primary Care published in April 2016 which makes an interesting read. Its analysis of the challenges facing primary care is unlikely to hold any surprises for those working in general practice yet it can look stark on the page.

The report focuses on the experience of primary care,  new models of care, Building the new team and Funding. The committee examined long-term solutions to improve access to services and patient care, presenting 40 conclusions and recommendations. Sixteen of the recommendations relate to workforce issues – multi-disciplinary teams, workforce planning, selection of undergraduates, tackling local shortages, nursing, training and education, workforce and federations and GP leadership.

The workforce elements are summarised in these extracts from the opening summary:

“The priority for government should be to train, develop and retain not only more GPs but wider multi-disciplinary teams working within a more integrated system of care.”

“In line with the recommendations of the Primary Care Workforce Commission, multi-disciplinary teams can harness the skills not only of GPs but physiotherapists, practice nurses, pharmacists, mental health workers and physician associates. We support the Commission’s vision of teams of professionals using their skills to meet the needs of patients much earlier in their journey through the NHS. This would allow GPs to concentrate on those aspects of care that only they can provide. We expect GP leaders to be at the forefront of the development of multi-disciplinary teams.

Patients need more health professionals from a range of disciplines to choose careers in primary care. Existing medical education does not encourage graduates to do so and greater attention must be paid to the needs of patients in designing training pathways and incentives across the entire NHS workforce. It is far from certain that sufficient numbers of GPs and nurses will be available to build new teams and improve patient access. Much greater efforts to recruit, train and retain the primary care workforce will be necessary if the vision of the Primary Care Workforce Commission is to be achieved.”

The Committee’s statements and recommendations on funding may be of some interest.

“Despite the rising demand for services and a consensus on the value of primary care, its funding has fallen behind as a share of the overall NHS budget. The five year funding settlement provides only a very limited uplift in expenditure on primary care. We believe that it should receive a larger proportion of overall NHS spending in order to improve access and services for patients.”

It is crucial not to overlook that there are causes for celebration in the report. Again these will offer no surprises to those working in primary care, yet it is also good to pause and ‘take these in’ as important elements within the report.

“During the course of this inquiry we heard many examples of innovative practice which give cause for optimism that patients’ access to and experience of primary care can be improved.”

“Although difficulty in accessing general practice continues to frustrate patients, GPs consistently receive highly positive patient satisfaction ratings.”

Sue Lacey Bryant
Workforce Development Tutor, Thames Valley
Health Education England
sue.laceybryant@thamesvalley.hee.nhs.uk