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11.12.15

Money and workforce alignment vital for primary care – MPs told

Transforming and improving health outcomes will require alignment of workforce strategies and funding flows in primary care, the influential Health Select Committee has been told. 

During an evidence session as part of its inquiry into primary care, committee member Conservative MP Helen Whately asked whether primary care needs to have a greater share of NHS funding. 

Julie Wood, chief executive of NHS Clinical Commissioners (NHSCC), told the group of MPs “the money is absolutely important, as is the workforce”. 

NHS England’s national director of commissioning development, Rosamond Roughton, said that in recent years the level of investment in general practice “has not increased at the same level of hospital services at a point when we are saying strategically that we want to see greater investment in out-of-hospital services and potential for more to be done”. 

“If you look over the last two years, the data shows a much bigger increase,” she said. “We had a 3.6% increase in 2013-14 and a 2.7% increase in 2014-15. 

“This time last year, when our board was making allocations, it made a very deliberate and conscious decision that there was a 4.1% increase in allocations for primary care compared with the 3.4% uplift in CCG allocation. There is a bit of a shift towards a greater level of investment in primary care. That is why the delegation and co-commissioning is so important.”

But Dr Steve Kell, co-chair of NHSCC, said that while co-commissioning is an opportunity, it is not the answer. 

It was noted that, despite it being early days, there is a lot of interest in co-commissioning. In fact, in 2016-17, providing they are approved, more than 50% of CCGs will have delegated commissioning responsibilities – up from 30% this year. 

“We saw primary care struggling around us, and in general practice particularly we saw the opportunity to link up some of those pathways,” he said. 

“It did not make sense that we were commissioning nursing homes – which is a good example, I think – without being able to commission general practice, which provides so much support for those patients.”

Dr Kell added that one of the main concerns for CCGs at the moment is the “sustainability of general practice”. He noted that it is very difficult, as a commissioner, to actively increase out-of-hospital care and to shift funding or support from hospitals towards community services, mental health and general practice for a number of reasons, including financial incentives, tariff and the fact that provider deficit is so high. 

“If we are going to go to member practices and ask them to take on more work, or work in different ways, they need that space and the funding to take on extra staff to do it,” he said. 

Julie Wood added that if “we get the shift of the funding and if part of the solution is about more people, in terms of a broader range of people but more provider services in the community, we need to make sure they are there to pick up the additional services that are needed”. 

She added: “For a number of our CCGs, our members will say it is not about giving them more money at this point, because even if we did they could not find the people to do the work. We need to have the workforce strategies aligned to the primary care strategies and aligned to the funding flows together to transform and improve health outcomes.”

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