General practice unable to support STP proposals without upfront investment

Urgent investment in general practice to reverse 'damage done by years of underinvestment' is crucial to lay the ground for sustainability and transformation plans (STPs) being rolled out across England, primary care experts have warned.

Public health consultant Helene Irvine (Photo: Pete Hill)
Public health consultant Helene Irvine (Photo: Pete Hill)

Primary care academics from Sheffield and Glasgow warned that general practice is 'stretched to its limit', and that without rapid investment to strengthen the profession the 'credibiilty and safety' of the STP programme is questionable.

The GP Forward View, which pledged to increase annual investment in general practice in England by £2.4bn a year by 2020/21, was an 'important statement to GPs of their value', according to an editorial published in the BJGP.

But the academics warn that it 'urgently needs to become a reality at the front line'. GPC chair Dr Chaand Nagpaul has warned that despite the GP Forward View pledge and new funding delivered through the GP contract, general practice remains underfunded by billions of pounds.

GP funding

Citing research reported last year by GPonline from Glasgow public health consultant Helene Irvine - which found that systematic underfunding of general practice and erosion of its 'gatekeeper' function was driving up the NHS deficit - the researchers warned that 'stronger general practice is an imperative for the sustainability of STPs'.

Effective primary care reduces expensive admissions to hospital, the authors warn, with one night in hospital costing up to three times what a year of primary care costs. Erosion of primary care capacity in deprived areas is 'particularly acute', they say.

'It is in these "deep end" practices where significantly more people present with multiple health conditions, and where multimorbidity develops at a much younger age, the authors write. 'Decisions about funding and investment should address the fact that current funding formulae inadequately recognise this greater need.'

Gatekeeper role

The gatekeeping role of general practice is 'critical' to managing NHS costs, the authors point out.

'We therefore propose that a "sustainability imperative" is that appropriate transformation funds are channelled into addressing inequities in provision of general practice and ensuring that a co-ordinated, fully-functioning general practice service is available to all.'

The editorial highlights warnings from the RCGP over the failure of many STPs to address the crisis facing general practice. The college called earlier this year for many of the plans to be rejected because they did not address sustainability and workforce issues in general practice.

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