GP gatekeeper role disabled at worst possible time for NHS, warn researchers

Erosion of funding for GPs and key related services over the past decade has undermined the profession's gatekeeper function at a time when it is needed more than ever because of the UK's ageing population, according to primary care academics.

GPonline reported last month that in findings to be presented at this year’s RCGP Annual Conference in October, researchers from NHS Greater Glasgow and Clyde will show how slipping targets for NHS finance and performance across the UK are directly linked to cuts in GP services.

But Dr Helene Irvine, a lead author of the research, has told GPonline that the timing of this withdrawal of funding from general practice, with the UK population ageing rapidly, could not have been worse.

The share of NHS funding spent on general practice has slipped from around 11% a decade ago to less than 8% now, and the researchers say this must now be reversed.

GP gatekeeper role

Dr Irvine said that the baby boom after the first world war - a boom talked about far less than the post-second world war boom - created a large cohort of patients who are now in their eighties and nineties. These people were exactly the patients most reliant on GPs, district nurses and social care services to keep them out of hospital, she said.

But GPs and district nurses were among the only health professional groups that had seen a decline in numbers and investment over the past decade, added Dr Irvine, while cuts to local authority funding in recent years have led to sharp reductions in social care support.

'If you starve those components - while expanding everything else - you reduce the ability of the service to prevent admission, the gatekeeper function,' she said.

Patients who can no longer be supported adequately by underfunded GPs and the key services around them are winding up in A&E and often end up being admitted to hospital, Dr Irvine argued. 'The evidence I have is that people are coming into A&E – the key entry point to hospital. My evidence shows the age of [patients coming in to A&E] is increasing more rapidly than the age of the population. The steepness of the 85-plus curve is going up twice as fast as the population - they are ageing twice as fast as they should be.'

This was particularly evident since 2010, she added, which 'indicates a decline in another component – social work'. Social work has 'been starved since 2009', Dr Irvine said. 'Once we did that, old folk had nowhere to go to except A&E.'

Social care cuts

She said: 'We have messed it up, taken away the GP and district nurse and social care at the very time that the elderly would need them most, when many 1920s baby boomers are still alive and now in their nineties.

'We cut the district nurse who could deal with ulcers and many other problems, and cut back on GPs. The DH got it wrong, and other UK countries have mimicked policy from England.'

Freezing social care at the same time had been a disaster for this group of patients, she added. 'We need social care people to go in and give them 15 hours a week - if not they go into A&E and end up in beds. The NHS is full of patients, but if you invested in GPs, district nurses and social care, a lot more could have stayed in their homes.'

Working on the assumption that the government would not increase overall NHS funding dramatically, the case for increasing the share spent on general practice was unavoidable, she argued.

'Assuming the budget is not going to go up we need to shift money into general practice - without that we are doomed. We need to control use of all these other health professionals, because at the moment the gatekeepers are disabled.

'We need to rescue general practice, by raising the percentage to 11% - and bring it back to what it used to be.'

Full details of Dr Irvine's research, carried out with information analyst colleague John Gomez, will be presented at the RCGP conference in Harrogate. But the findings were derived from data collected routinely by the NHS.

The researchers found that an increase in the number of per capita hospital consultants and a drop in the per capita provision of GPs had resulted in rising overspends to cope with a greater demand for hospital care and recruitment and retention problems for GPs.

Find out more about the RCGP Annual Conference 6-8 October and book your place in Harrogate

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