Calls for radical reform of the NHS as major report demands social care and GP crises resolved to ‘free up hospitals’
The failure to properly invest in general practice and social care is one of the biggest policy blunders of the past thirty years, a report today claims.
England’s health and care system needs to be ‘radically reoriented’ away from hospitals if it is to be ‘effective and sustainable’, it adds.
The King’s Fund, a health think tank that produced the report, said officials should put primary and community services at their centre.
It highlights that the ‘vast majority’ of interactions with the NHS are with GPs, pharmacists and community nurses.
But taxpayer money and staff have been disproportionately directed toward hospitals, leading to inefficiencies and delays.
The figures, combined with the fact that an average of 46,201 staff were sick per day last week, mean the NHS is under increasing pressure in December, experts have warned.
The authors urge health chiefs to bring more care ‘closer to home’ and emphasize that ‘the answer to overcrowded hospitals is not more hospitals’.
They warn that patients who struggle to make appointments with their GP risk their condition worsening and need to urgently seek care from already overloaded emergency departments.
There are now more than 876,164 GP appointments in the NHS every day, which is an increase of 34,219 since 2018/19.
But despite this increase in demand – and repeated pledges to boost out-of-hospital care – the share of Department of Health and Social Care spending on primary care has actually fallen from 8.9 per cent in 2015/2016 to 8 .1 percent in 2021. 22.
This has fueled the daily struggle at 8am for an appointment with the GP and contributed to declining patient satisfaction with general practice.
In 2021/2022, the majority of spending, £83.1 billion, went to acute hospitals, while primary care received just £14.9 billion.
The NHS has received extra funding in recent years, but while acute hospital trusts have seen their funding grow by 27 per cent since 2016/2017, community trusts have benefited from only half that level of growth, at 14 per cent.
Workforce trends show a similar pattern, with the number of NHS consultants growing by 18 per cent between 2016/17 and 2021/22, while the number of GPs increased by just 4 per cent over the same period, the report said.
There has also been a significant increase in the number of vacancies for social care staff, from 110,000 in 2020/21 to 152,000 in 2022/23.
The researchers say progress is being hampered by “urgent challenges” such as emergency department wait times and planned care backlogs, which are often the priority for politicians “seduced by quick fixes rather than fundamental improvements.”
Other factors include a lack of data on primary and community services, leading to a ‘cycle of invisibility’, and funding streams that prioritize hospitals.
The King’s Fund warns that strengthening primary and community care should not mean closing hospitals, noting that England already has fewer hospital beds per capita than other countries.
Instead, it calls for future funding to be focused on a ‘comprehensive plan to refocus the health and care system towards primary and community care’.
They warn that a piecemeal approach to a ‘cherry picking’ policy ‘will not miraculously bring about change’.
Sarah Woolnough, CEO of The King’s Fund, said: ‘Many people across the country will have personal experiences of struggling to get a GP appointment, trying to connect with other services, and when all options have been exhausted, with reluctance to go to the emergency room.
‘It feels like all roads lead to the hospital, but our hospitals are already full.
‘To achieve an effective and sustainable health and care system, politicians and national leaders must implement a radical and large-scale reorientation of the health and care system towards primary and community services.
‘By doing this, hospitals will have the space to treat the patients they are best placed to treat, thanks to many more people in the community being diagnosed and cared for.’
Beccy Baird, Senior Fellow at The King’s Fund and lead author of the report, said: ‘Like other countries, England needs to bend the curve based on the predicted increase in demand for expensive, reactive and hospital-based care.
‘That means supporting people to look after their health and wellbeing, intervening early and keeping people healthy at home for as long as possible, which can only be achieved by strengthening primary and community services.
“While these changes may not deliver the rapid savings that many wrongly expect, the alternative is to build more expensive hospitals to address acute needs that could have been prevented or better managed in the community.”
The report says civil servants should encourage staff to work in primary and community services by offering them higher pay and career development; leaders must be held accountable for overall patient care, rather than focusing on the wait list; and it calls for reform of the ‘ailing’ social care system.
Saffron Cordery, deputy director of NHS Providers, which represents NHS trusts, said the care provided in the community is ‘too often overlooked when headlines and political priorities focus on a limited number of acutely targeted targets’ .
She added: ‘But prevention is better than cure and with the right funding and workforce, community, primary and social care can play a vital role.’