Exclusive: Hospitals won't stop primary care investment, says Stevens

The NHS England chief executive has indicated he is determined to shift funding into general practice, in spite of opposition from hospitals.

Simon Stevens told GP that general practice risked ‘being weakened’ unless more than a decade of relative underinvestment was addressed. 

‘We need funding for primary care services, GP services in particular, to go up,’ he said.

Mr Stevens said primary care funding had risen in real terms in each of the two years of NHS England’s existence, and this would continue in 2015/16.

Additional NHS funding had ended up in expensive parts of the service, he added, sometimes for ‘bad’ reasons because rising demand in general practice was not recognised in the hospital sector.

‘There are some difficult decisions here,’ said Mr Stevens, ‘and some of the big teaching hospitals are not happy with the decisions that have been made for 2015/16 to use more of the money in primary care and in mental health than has been the case in the past.’

Read more: full Simon Stevens interview

In January, providers of 75% of NHS services rejected a proposed hospital tariff which cut prices by 3.8%.

In the Five Year Forward View published last year, NHS leaders recognised primary care services had been under-resourced compared with hospitals.

Mr Stevens suggested he did not expect the big two political parties to commit before the general election to the £8bn-a-year funding increase by 2020 required to plug a projected £30bn NHS funding gap.

The RCGP and other medical royal colleges have called on all parties in the general election to commit to the funding increase.

The Liberal Democrats have already said they would find the extra funding. Mr Stevens said whoever forms the next government will have to confront the question of higher funding in the spending review following May’s election.

The Five Year Forward View said savings of £22bn by the end of the next parliament could be made through new integrated care models and efficiencies.

The NHS would have to ‘get very serious’ about efficiency, Mr Stevens said. The biggest cause of hospitals’ budget overspend in 2014/15 was temporary nurse staffing. If hospitals do not manage to convert those posts to permanent positions, said Mr Stevens, ‘that will end up pre-empting through overspends money we would otherwise have wanted to invest in primary care’.

The chief executive’s comments followed the announcement earlier this month of the first 29 vanguard sites which have been awarded funding to set up new integrated care models. Fourteen GP practice-led multispecialty community provider groups will work to provide more care outside of hospitals, while nine primary and acute care systems (PACs) will see hospital providers integrate GP, community and mental health services.

The schemes could see radical redesign of frontline service provision, including changes to the clinical workforce, development of new contractual models and changes to service procurement.

But Mr Stevens told GP the plans did not mean more reorganisation. The plans were led by local clinicians including GPs, he said. ‘It is not messing around with CCGs, trusts, changing the headed notepaper of the NHS. This is about the way clinical care is being provided to patients led by front-line clinicians,’ he said.

‘It is going to be a redesign of care. But that is not the same as changing the management superstructures.’

Partnership

Where there are vertical integration PACs, he added, those must be a ‘partnership of equals between general practice and hospitals’.

GPC chairman Dr Chaand Nagpaul said the new care model vanguards represented a radical change to the way patient care is delivered in the NHS.

But, he warned, NHS England must ensure resources moved into primary care along with work moving out of hospitals, and general practice must retain its identity.

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