While it is true that there is currently too much variation in opening times across practices in England, it is not enough to simply increase access. We must also enhance the capacity and capability of general practice; and that means significant investment in primary care and its estates.
According to the BMA, general practice could deliver more services for patients, but is restricted from doing so ‘due to lack of funding both for the provision of care and investment in premises’. While the announcement earlier this year from David Cameron regarding a £50m ‘challenge fund’ to improve access to general practice services was a welcome one, we do have to ask how effective a one-off payment can really be. We must remember that the ability to strengthen the delivery of a responsive and effective primary care system requires sustained capital and revenue resourcing.
With overstretched emergency departments being increasingly used by patients for non-emergency care, pushing for extended in-hours care is a possible solution. However, increased GP hours is not going to address the problem if they are still operating from inadequate premises, with the consequent restrictions on what services they can offer. GPs are naturally nervous at the prospect of the increased pressure that additional opening hours will bring, so we also need to ensure that the issues of a sufficient workforce, appropriate skill mix, work-life balance and the wellbeing of the busy professional and their families are also addressed.
Too many times in the past we have seen policy that is not grounded in a strong evidence base or that builds on current best practice. This sometimes then results in a ‘reinvention of the wheel’, where time and precious resources are wasted in the pursuit of unclear outcomes. A strategic approach to the improved access and availability of GP services needs to be developed.
For primary care to deliver some solutions for the better management of both urgent and planned out-of- hospital care, a sustained programme of support for the development of this vital part of our NHS is required. It also needs to focus on the triple aims of improved patient outcomes, patient experience and value. An investment of £50m is helpful for pioneering new models of primary care. However it doesn’t address the issue of maintaining the level of service required long term, as pioneers usually are expected to leave a trail for others to follow.
The current primary care estate needs to be brought up to scratch to enable the completion of more episodes of care, and this can only be done with sustained funding released from current inefficient or unnecessary services. It may start as a gesture, but ultimately the expected benefits to patient care and the NHS will only be realised with a firm long-term governmental commitment to this sector.