Devon GP Dr Michael Dixon, president of NHS Clinical Commissioners, which represents CCGs, has called for a central push for more resources for primary care to ensure that services move out of hospitals into the community.
He said that the ‘easy answer’ would be to say that England’s 211 CCGs could ensure this happens. But he said it needs a ‘central steer’ because the funding for primary and secondary care is divided. He said this is because CCGs are responsible for hospital funding while NHS England holds the GP contract.
Dr Dixon said: ‘I said 50% of work needs to move out of hospitals because we know that 50% of hospital admissions in Devon are for the over 80s. That age group is going to double in the next 10 to 15 years, so one would assume that admissions will double with it. It is a time bomb in many ways. Quite a few of them have dementia and it is really quite inappropriate that they are going to district general hospitals.
‘One big area that we can start looking at is the frail elderly. A second group is outpatients. Why are they going to hospital? They wouldn’t if they were in Europe or America. It is much more sensible to have some specialists and consultants working alongside GPs.
‘The third level is diagnostics. We could do much more diagnostically in the community. This could be done in primary care.’
Dr Dixon also called for patients with long-term diseases to be equipped to monitor themselves, rather than going to hospital.
‘The health service can’t afford more hospitals,’ he said. ‘We know that the number of GP partners is going down when the number of consultants is going up. In the last 10 years, the number of consultants has increased twice as much as GPs. We have been putting our doctors in the wrong place. We need to redress the balance.
‘It needs a stir from the top otherwise the danger is that we burden general practice with more work without putting any more resources into it.’
GPC chairman Dr Richard Vautrey said the shift of work is already happening but that the resources are ‘not moving at all’.
‘In fact the proportion of NHS funding spent of general practice compared with hospitals is falling,’ he said: ‘This is the area that CCGs need to focus on. Talk about shifting work is cheap if they don't shift resources to be able to deliver the work properly.
‘Whilst there is scope for doing more work in the community if the right level of support is also present, talking about an un-evidenced based 50% cut in hospital activity, particularly when most GPs face daily challenges admitting patients to hospital, potentially alarms patients rather than winning them over and could undermine their confidence in GPs ability to manage local health budgets.’
He said that current reconfiguration plans are heading in the right direction but that commissioners must show the changes as 'inevitable consequence of changing technology, changing patient conditions and patient demands' to get the public and professionals onside.