Dramatically rising demand combined with increased public expectation and more complex health needs are putting significant pressure on primary care delivery, primary care leaders across England have warned.
A report from the NHS Confederation sets out what primary care will need to recover its services and support its staff, post-pandemic. It comes as recent figures from NHS Digital show general practices across England carried out nearly 3 million more appointments in March 2021 compared to March 2019.
It highlights the increasing and unsustainable workload in primary care, with services working to provide routine care while simultaneously addressing the ongoing needs of patients with long COVID; those with multiple co-morbidities and long-term conditions, including those who are on the waiting list for elective care; and the rising demand for mental health support. This has also been combined with playing an integral part in the rollout of the biggest vaccination programme the country has ever seen, with more than 42 million people in England now having received their first dose of a vaccine.
The paper, Restoring primary care, outlines ten of the most urgent priorities that primary care are urging Government to address. These include the need for:
- Extra investment in infrastructure to make it fit for the 21st century, notably in management support, estates, IT and digital solutions.
- Recognition that to deliver patient-centered care, different solutions will be required that reflect different population needs and to address the wider determinants of health.
- Clarity on national priorities and transparent analysis of local need.
- A clear set of measures that capture the pressure and workload being put on primary care.
- The need to be open and honest with the public about what is achievable.
Ruth Rankine, director of primary care at the NHS Confederation, said: “Primary care is the front door of the NHS and carries out 90 per cent of contact with patients, but the challenges it now faces cannot and should not be underestimated.
“Rising demand, growing complexity, higher expectations, increased administrative burden and the continued challenge of rolling out the largest ever vaccination programme mean primary care is under immense pressure.
“Much of the public debate has been focused on the strain faced by hospitals, but this needs to change. Primary care leaders are committed to working together and doing everything they possibly can for their patients, but an open and honest discussion needs to be had, coupled with a clear set of achievable priorities. Otherwise, there is the very real risk of care becoming disjointed and services being overwhelmed.”
The report warns that while primary care continues to provide huge numbers of high-quality consultations, progress in improving infrastructure has been limited, with innovative multi-disciplinary teams hampered by a lack space in GP premises, as well as processes that are too bureaucratic.
It also calls for a radical overhaul of the GP funding model and stresses the need for increased investment in primary care to ensure that population health can be improved and that overall healthcare costs are reduced in the longer term.
Dr Graham Jackson, senior clinical adviser at the NHS Confederation, said: “Primary care has played a leading role in local responses to COVID-19, and over the last year, has worked tirelessly and innovatively to serve its patients and communities.
“As restrictions continue to ease and the public starts to see services return to normal, we must learn from and build on our experience of the last year. This means working in new ways, innovating and developing local solutions and collaborating across the system for our patients and the public.
“We must use this opportunity to ensure that we emerge with a renewed focus on the health and wellbeing of our staff, real action on health inequalities, and protect the collaborative working that will underpin future system working.”