Our response to the Health and Social Care Committee inquiry on the future of General Practice.
Health systems with strong primary care as their foundation are more efficient, more cost effective, more equitable and have better patient outcomes than systems based on specialist care. In the NHS, general practice encourages good health – via screening and health promotion – and plays a key role in disease diagnosis, management and monitoring.
Pressures on general practice are long-standing, significant, and growing. Changing population health needs, including growing numbers of people with multiple chronic conditions, and requirements to deliver a wider range of services are compounded by longstanding workforce shortages. COVID-19 has made things worse. General practice is dealing with the clinical care of COVID-19 patients, addressing pent-up demand from lockdowns, delivering key elements of the vaccine programme, and supporting patients caught in secondary care backlogs. Meanwhile, general practice is expected to pay a central role in new Integrated Care Systems, expanding access to services via a broadened range of allied health professionals, and helping develop more integrated models of care.
This submission focusses on two related themes – access and equity – and makes the following key points:
- Current pressures are unsustainable. GP workload and consultation rates are higher than pre-pandemic, but the number of permanent, fully-qualified GPs has fallen since 2015.
- The biggest barrier to improving access to general practice is a lack of GPs. Current attempts to recruit GPs are unlikely to meet their targets. Recruitment and retention of GPs in socioeconomically deprived areas is particularly difficult. Core features of general practice – such as continuity of care – are threatened, but can be supported with focused action.
- In areas of high deprivation, general practice is under-funded and under-doctored. General practices in poorer areas are less likely to perform well on all major markers of quality.
- Current policies for funding and staffing general practice risk widening existing health inequalities. Focussed action to correct disparities in funding and workforce between deprived and affluent areas is urgently needed.