Thursday, 29 October 2015

NHS crisis: Government ignores real problems facing GPs.

When governments run out of ideas or wish to avoid major funding decisions they introduce measures that sound good but in practice do little to address the real problems.  The Secretary of State for Health has announced the introduction of 'Osted-style' ratings for GP practices in England.

The announcement received a no-nonsense response from the BMA. Dr Chaand Nagpaul, BMA GP committee chair, said:

“We do not believe that simplistic Ofsted style ratings will lead to any improvement in patient care or give an accurate picture of services in local areas. The Secretary of State needs to also listen to the report from the Health Foundation, which he himself commissioned, which advised strongly against composite indicators which mask the details of quality of care, and which he is proposing now to introduce.”

An ageing population with complex health conditions has increased the burden on front-line services at a time when social care services have been cut.  Cuts in social care has a huge impact on the NHS, where each year £669m is being spent because older people are finding themselves trapped in hospital for days or even weeks.  It also increases pressure on front-line general practice. Since 2010 funding for social care has been cut by 25% leaving a massive deficit in meeting a growing need.  Families are left unsupported.  

Age UK estimates there are more than 1 million left struggling each day without proper support and the numbers continue to grow as cuts in funding leave local authorities struggling to meet needs. A report published by adult social care chiefs (Association of Directors of Adult Social Service (ADASS) earlier this year warned of £1.1bn budget cuts to the sector. Additional funds, it said, are urgently needed to protect services after "almost unendurable" cutbacks in the past five years. Spending on the NHS has remained static at best, whilst funding for social care has been cut by 10.7%. It is a false economy.

This demand is likely to increase as the number of people aged over 65 is predicted to reach 15.7 million by 2031.  We need to fundamentally rethink how this can be met. But we need also to bite the bullet that it will require more and sustainable funding.  The GP crisis is the front line of this deeper problem.

General practice is currently facing a tough financial climate. Since 2008,  General Practice income has declined by 11%  whilst the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists) has risen.

When we hear about GP incomes being high we should take account on one sobering fact.  The cost of running a practice now accounts for 61.6 per cent of total GP income. 

Little wonder then that many GP practice buildings have not seen serious investment for many years, leaving many facilities cramped and inadequate to meet the demands of patients.  A recent survey by the BMA found that  four out of ten GP practices feel that their current facilities are not adequate to deliver basic GP services to patients.

The number of GPs per head has declined from 62 per head in 2009 to 59.2 in 2012 whilst the demand for services increases.   In some parts of the country it is difficult to recruit sufficient GPs to meed local needs. 

As Dr Nagpaul of the BMA has warned,  "GP practices are struggling to deliver enough consultations to their patients because of the unprecedented strain from rising patient demand, falling resources and staff shortages."

The government continues to bury their collective head in the sand in face of this crisis with their false objective of deficit reduction.  It ignores the real issues.  It tinkers at the edges of the NHS and social care problem in England.  Ofsted-style assessment will by like cutting off the legs of a donkey and seeing how it walks.


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