Viewpoint: The role of primary care in responding to the current plight of the NHS

Recent announcements have revealed a rise in mortality rates in hospitals across the country, thought to be largely due to inadequate staffing levels and limited provision during the weekend, write leading GP Dr James Kingsland and Graham Roberts, CEO of Assura Group.

improved access to GP and other services in the community will reduce the burden on hospitals.'
improved access to GP and other services in the community will reduce the burden on hospitals.'

As a result, we need to refocus on the role that primary care can play in relieving the pressure on secondary care. It may be over simplifying, but improved access to GP and other services in the community will reduce the burden on hospitals significantly, particularly with an increased focus on preventative care. Primary care should be recognised as critical to rectifying this situation as opposed to being part of the problem.

As our society evolves along its consumerist path, we are seeing an ever-increasing demand on public services, with an expectation for immediate access to everything from our bank balance to consumer goods and not least to healthcare. Waiting lists and pre-booking appointments do not fit well with improving response times and rapid access.  Too many people now prefer to seek help for a range of non-urgent health needs from an A&E department. Whilst they can at least guarantee that they will be seen on the day, they can wait for up to four hours (or more, when the national waiting time target is breached) for what may not be the right care.

Poor access to general practice

This means that the distinction between serious illnesses requiring urgent attention and those that would be better scheduled through an appointment system are blurred, and hospital staff are put under a greater strain than is necessary.

Many blame this ‘crisis’ on poor access to general practice and the consequences of the 2004 GP contract, which saw most GPs opt out of out-of-hours care. However, this only identifies one small part of the wider picture of increasing demand but poorer management of this, demographic changes, societal expectation and technological advances (to name but a few). Since 2004 there has in fact been an eight-fold increase in out-of-hours activity in some areas, which suggests that there are other issues that need to be addressed aside from an alteration in working hours.

A significant problem is that many GPs do not have the facilities to enable them to increase provision and extend care facilities. Too many practices are still based in cramped converted dwellings, and whilst often in residential areas this actually adds to the restriction on the extension of services.

Expanding and equipping our GP surgeries to provide services that may have traditionally rested within hospitals is a major step in solving the current plight of the NHS. Integrated primary, community and social care centres, with room for third sector services, as well as housing diagnostic facilities and minor surgery suites and serving a registered population must be the future of primary care if we are to continue to enjoy an NHS free at the point of delivery. International evidence consistently reports that a strong, well-resourced system of primary care reduces the risk of hospitalisation. The good news is that this vision already exists, but is still a minority of general practices.

Resource and equip GPs to do more

The NHS, now 65 years old, is still continuing to develop and grow. We would be naïve not to build on the best of what we have already, and what is widely recognised as the cornerstone of the NHS. The less well-informed response to the healthcare crisis is to create alternative, poorly evaluated services. This is not the answer, as was the case with the walk-in centres and NHS 111, which have risked fragmenting precious available resources and often add questionable value for the public purse.

Ultimately, in order to increase efficiency in the NHS and meet the public’s top priorities of waiting and access, GPs need to be resourced and equipped to do more. They also need to build teams to perform and complete more episodes of care in their primary care setting in modern purpose built 21st century facilities. It is extremely difficult to change the expectations of the general population, but what we can do is ensure that healthcare practitioners are working in the right environment to respond to the demands effectively.

* Dr Kingsland is a Merseyside GP and NHS clinical commissioning community lead. Mr Roberts works for primary care property developers Assura Group.

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