I wish all members of the NHS family and GPs in particular a merry and restful Christmas and the very best for 2015. But just how restful is the festive period likely to be?
A&E departments are cracking under extreme pressure, with the number of patients waiting longer than four hours at a record high. The number of delayed discharges in hospitals across the country has increased and the admission rate is higher than ever.
The extra £700m allocated by health secretary Jeremy Hunt to help the service cope this winter will not be enough to head off potentially serious failings, especially if there is severely cold weather. Outside of hospitals, GP surgeries are struggling to cope with unprecedented levels of demand. The cash does not guarantee extra staffing nor does it help with planning.
Sticking plaster solution
When will politicians realize that a ‘sticking plaster’ solution to these problems is no solution to fundamental issues. The urgent care system needs a holistic approach with a long-term programme if it is to meet the challenges it faces and any short-term funding, though welcome, is not helpful to plan effectively.
It has been suggested that a lack of access to GPs could be a factor but there hasn’t been much evidence to back this up. There are now 40m more consultations a year in general practice than there were even five years ago and GPs are routinely working 11-hour days and seeing up to 60 patients in a day to try to meet the demand.
GPs are stuck between a mismatch of rising demand and a shrinking capacity to provide care. Further, primary care has seen consultations soar in the last 10 years but the percentage of the NHS budget spent on this area has fallen continuously.
NHS reform impact
The NHS reforms have categorically failed to address this issue, and indeed might have indirectly contributed to the rising tide of emergency admissions by reducing resources within the NHS. Factors that have aggravated the crisis include well-documented cuts to councils’ social care budgets, which leave elderly patients stuck on hospital wards.
The consequences include a significant increase in cancelled elective surgery, longer waiting times for patients, less time for doctors to discuss treatment plans with patients, and serious safety issues, including increased mortality.
To tackle this, the government must develop long-term and short-term strategies to address the staff shortages across the NHS, and invest in systems and measures that direct patients to the service or setting that is right for them.
Multiple causes
The blame game is pointless - there are lots of causes. Patients will always go where they can have prompt one-stop care 24/7. My thirty years' experience as an NHS doctor which includes work in A&E tells me that some really ill people arrive there, but a lot more have not had a serious accident and are not experiencing an emergency.
What we need is improved funding for primary care, community services and social care to work collectively to ensure patients have alternative access to care, rather than defaulting to A&E.
Happy Christmas all - it may be a very busy one!
