It is widely accepted, including by NHS England and other bodies, that general practice has had to cope with a decade of underinvestment at a time when patient consultations are increasing, the population continues to grow, and patients are living longer with more complex health needs. Problems such as these not only affect general practice, but also extend across the health service leading to an overall pressure that doctors in primary care and secondary care alike are struggling to cope with. To address this issue, the BMA has been clear in calling for an increase in funding for the NHS overall to match health spending in equivalent European countries.
In 2005/06, the proportion of the NHS budget devoted to general practice (excluding drugs reimbursement) was 9.6%, however, that figure is now shown to have dropped to a mere 7.9% in 2016/17 . This decline in funding has been compounded by an increase in the total number of patient registrations of more than two million since 2013 , inevitably leading to an increase in workload and further cost implications on practices.
Whilst commitments set out in the General Practice Forward View (GPFV) to invest in general practice over the coming four years by at least £2.4bn are welcome, they remain wholly insufficient to either restore the share of NHS funding allocated to general practice to 2005/06 levels, or reach the BMA’s 11% target, which this year leaves a funding gap of £3.7bn . Although this gap will improve slightly by 2020/21, an additional investment of £3.4bn on top of the £2.4bn promised in the GPFV will still be needed to reach the BMA’s recommended target.
General practice is facing an unprecedented crisis with inadequate resources to fund an expanded workforce, manage workload levels safely, and meet growing public demand. The proportion of patients waiting more than two weeks for an appointment has risen to a record high of 20% – up from 12% five years ago.
Despite GPs consulting more, the needs and expectations of patients are increasingly being unmet, largely due to the failure to address increasing staff shortages and insufficient funding. With nine out of ten GPs reporting that their workload is unmanageable, future services are currently at risk . Increasing numbers of practices are applying to close their lists as they simply cannot deliver a safe service to a growing population with the limited resources provided to them.
- A firm commitment from Government to increase the overall proportion of NHS spend in general practice to at least 11% in response to the rising workload in general practice, reaching a total funding target of £14.6bn by 2020/21. This must be from new investment and not as a result of diverting funding away from other NHS and public health services.
- A change from multiple, short-term, non-recurrent funding schemes, to sustainable, recurrently funded schemes that enable long-term planning.
- Recurrent funding for working at scale arrangements to recognise the management costs associated with these structures.
- A general increase in funding for health and social care services in line with equivalent European countries. The BMA has estimated that health funding in England is £7.3bn behind the average spent by comparable European countries and this could rise to over £11.6bn by 2020/21.
- Publication and transparency of information on what money CCGs are investing in general practice on an annual basis.
- Clearly tracked and documented investment in general practice to ensure resource delivery adequately matches resource planning.
Source: BMA Investment in General Practice report, September 2017
Note: Projections for the total cost of drugs reimbursements is based on figures from 2011 – 2016
Outcome for patients
With more funding, general practice could invest in premises, expand services, increase the workforce, lengthen consultation times and reverse the current trend towards increasing numbers of patients having to wait more than two weeks for an appointment. A general practice supported by 11% of the NHS budget could offer greater continuity of care to patients, and would be able to help deliver a more sustainable future for the NHS as a whole.
With recurrent and sufficient funding, general practice could meet the needs of our growing and increasingly ageing population and provide the continuity of care that patients deserve. GPs could work alongside an expanded workforce and develop more community based services delivered from practice premises fit for the 21st century. Sufficient funding would enable practices to ensure quality and safety levels are maintained and that they have the capacity to be open to all those patients who wish to register with them.
Next: Workforce strategy
Saving general practice
With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.