Primary care

Funding, staffing and vision: The key challenges identified as part of a radical shift to primary and community care

Primary and community care must be at the heart of the NHS if it is to be effective and sustainable, according to a new report from The King’s Fund.

The authors highlight that, while most patients interact with the NHS through general practice or community pharmacies, the proportion of government spending in primary care has fallen – 8.9% in 2015/16  to 8/1% in 2021/22.

In 2021/22, the largest proportion of funding went to acute services, with £83.1bn spent. Primary care, meanwhile, got £14.9bn.

Acute hospital trusts have also seen their funding grow at almost twice the rate of community trusts since 2016/17. Around 27% for the former compared to 14% for the latter.

A similar pattern is reflected in recruitment as well, with the number of consultants swelling by 18% between 2016/17 and 2021/22. Only a 4% increase in GPs can be observed over the same period.

The King’s Fund says that primary care staffing growth lagging behind secondary care in this way risks patient conditions deteriorating because they cannot get a GP appointment, ultimately leading to more demand in acute hospitals down the line.

“The answer to over-crowded hospitals is not more hospitals.”

Given successive governments have committed to growing and investing in primary plus community care services, the report argues the failure to do so represents one of the most high-profile long-term policy failures in the last 30 years.

The think tank puts the key factors behind these trends as a belief that moving care into the community will lead to short-term financial gains. Other reasons include:

  • A lack of data on primary and community care
  • Funding prioritising hospitals
  • Politicians focusing on A&E waiting times and the elective backlog

“The answer to over-crowded hospitals is not more hospitals,” said Sarah Woolnough, The King’s Fund’s chief executive. “Despite this being well understood for many years, there is now a higher proportion of the NHS budget and staff going into hospital services.

“At the same time, there has been a slow erosion of capacity and confidence in primary and community care.”

The report’s authors propose a number of steps to kickstart a shift to primary and community care.

This includes the need for a clear vision of the path ahead, with all policies geared towards bolstering primary and community care and the political will required to oversee long-term change.

Future funding growth needs to target primary and community services, and an added priority of ensuring investment in this area is funnelled towards buildings and equipment.

Staff should be incentivised to work in primary and community care through pay, status and career progression initiatives. Mandatory training placements could also be explored.

Local health and care leaders should be held accountable for improving patient care and not waiting lists, plus they should be given more flexibility so they can respond to local demands.

Finally, the benefits of bringing care closer to home will not be fully harnessed until the social care system is reformed.

Lead author of the report, Beccy Baird, said: “Like other countries, England needs to bend the curve on the predicted rise in demand for high-cost, reactive and hospital-based care.

“That means supporting people to take care of their health and wellbeing, intervening early and keeping people healthy at home for as long as possible, which can only be achieved by bolstering primary and community services.”

Baird emphasises that, although this will not unlock fast savings as some anticipate, the alternative is more expensive hospitals to deal with acute issues that could have been prevented in primary care or managed better in the community.

The report has been welcomed by health service leaders, with NHS Providers’ deputy chief executive, Saffron Cordery, highlighting the “vital” need for a clear vision in primary and community care.

She said: “Community and primary care services help people to stay well, manage their conditions and live independently, which is better for patients and can help to ease pressure on the rest of the NHS.”

The NHS Confederation’s policy director, Dr Layla McCay, added: “This important report reflects much of what we hear from our members”. It is therefore central to what NHS leaders will ask of the next government, added Dr McCay.

The King’s Fund report also sets out a number of actions that should not be taken. This includes only partially shifting focus to primary and community care – individual measures will not yield the desired progress and only complete realignment will bring change.

Restructuring the current system is also advised against, as it would risk reinforcing hospital-centric healthcare.

Leaders should not expect short-term cash savings from moving care out of hospitals and must not abandon plans if this does not happen.

The full report is available here.

Image credit: iStock

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