GP access not to blame for NHS winter crisis, report finds

The NHS winter crisis was fuelled by soaring demand from growing numbers of patients with multiple long-term conditions rather than problems with GP access, a report shows.

GP waiting room (Photo: Simon Barber)
GP waiting room (Photo: Simon Barber)

Findings from the latest King's Fund quarterly monitoring report show that nearly four out of five NHS trust finance directors identified growing complexity of patients as the key factor driving up pressure on their organisation this winter, compared with around a quarter who said poor GP access was a factor.

The findings come just months after GP leaders slammed prime minister Theresa May for attempting to 'scapegoat' the profession at the height of the winter crisis.

Four out of five CCGs increased primary care funding in a bid to ease NHS pressure this winter, as the NHS crisis forced more than half of hospital trusts to cancel or delay elective care, the report found.

The extra investment was found despite almost two thirds of CCG finance leads not expecting to balance their books in 2017/18, and 84% saying they were unlikely or very unlikely to hit 'productivity gains' targets set out in the NHS Five Year Forward View.

NHS funding

The risk that the DH will breach its constitutional spending limit for 2016/17 has 'grown materially greater' because of an increasing risk that NHS provider organisations' combined deficit will exceed underspends by commissioners, according to the latest King's Fund quarterly monitoring report.

Trusts are heading for a combined £873m deficit for the current financial year, while CCGs had a year-to-date overspend of £437m by the end of the third quarter of 2016/17 - a total deficit well in excess of the £800m risk reserve top sliced from CCG budgets.

GP leaders warned that the think tank's latest findings on the state of NHS finances proved that millions of pounds 'wasted on political projects' such as extended hours schemes should be redirected to properly fund GP and social care services to look after patients in community settings.

A total of 81% of CCG finance leads said they invested in additional primary care capacity during this year's winter crisis, while 78% said they had allocated additional funds to increase community care capacity.

Findings from the quarterly monitoring report show that CCGs have been forced into extra primary care investment as hospitals struggled with soaring pressure this winter.

GPonline revealed last month that many NHS hospital trusts had been on high alerts for much of 2017 to date, signalling that extreme pressure had compromised patient flow or left them unable to deliver comprehensive care.

NHS crisis

More than 50% of NHS trust finance directors said their organisation had been forced to suspend or cancel elective care to cope with increased winter pressure, the King's Fund report found. GP leaders have warned that these cancelled operations have driven up work for general practice, with patients returning for additional appointments.

More than half of CCG finance leads and nearly two thirds of their counterparts in NHS trusts said patient care had deteriorated in their area in the past year.

GPC deputy chair Dr Richard Vautrey said: 'This new report from the King's Fund supports the BMA’s central concern that millions of pounds are being wasted on political projects such as extended hours schemes that are not effective in reducing pressure on accident and emergency units.

'This is partly because the growing number of frail older patients with complex problems are often the key group that are admitted to hospital for specialist care. There is an urgent need to properly invest in social care and GP services to help support these vulnerable  patients in the community.'

King's Fund policy director Richard Murray said: 'It is clear that the NHS pulled out all the stops and the pressures on hospitals would have been far worse without extensive planning, the heroic efforts of staff and relatively low levels of norovirus and flu. Despite this, performance has continued to deteriorate, with waiting times in A&E the worst they have been since the four-hour target was introduced.

'Our survey suggests the key factor behind this is that already overstretched hospitals are struggling to cope with rising numbers of patients who are difficult to treat, rather than an influx of people who are unable to get appointments with their GP. It is also further evidence of the additional pressure that the social care funding crisis is putting on hospitals.'

RCGP chair Professor Helen Stokes-Lampard said: 'We are pleased that this report shows, without any doubt, that the recent winter pressures that have been facing our colleagues in emergency departments have not been because GPs – or any other clinicians in the NHS – aren’t working hard enough, but that the resources and workforce to cope with escalating patient demand simply aren’t there.'

Photo: Julian Dodd

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