NHS general practice turns 68 today, which is a cause for celebration and a time to reflect on its place in the family of national institutions. But it feels like the mood of Government has turned from looking at general practice as a wise and valued guide through life, to seeing it as a burdensome hanger-on from a past age.
In reality, the generation born at the same time as the NHS need it more than ever, a good GP will guide them through the health challenges that come with living well into their 70s. This period of life frequently involves managing multiple, long-term illnesses, which interact with each other in complex ways. But this need isn't reflected in how GPs are funded. In the last 10 years spending on general practice has fallen from 10.4% of the NHS budget to 8.1%. But the proportion of the population over 65 has grown from 15.9% to 17.6% over the same period.
NHS general practice also has a proud history riding at the forefront of social change. Activist Harry Lesley Smith remembers the 1920s when even former servicemen had no automatic right to state healthcare. He saw "the dying and mentally ill... denied medicine and solace because they didn't have the money to pay for medical services".
Universal healthcare isn't the only area where GPs have taken the lead; they have been far ahead of many other high-skill professions in building a workforce which represents society. Today the numbers of male and female GPs are almost equal, currently 49% of registered GPs are men and 51% women. There are now also more than a fifth of registered GPs who qualified outside the UK.
Other roles in practices have been given more responsibility as GPs have recognised the ability of the practice team to provide care, especially practice nurses. Nurses can now prescribe drugs and are frequently responsible for monitoring conditions such as heart disease and diabetes.
What general practice offers has changed to reflect the medical needs of society as well. In 1961 GPs began prescribing the contraceptive pill, giving women control over family planning; by 1969 more than a million women were being prescribed it. Complex conditions are now treated and managed closer to home thanks to general practice. It used to be the case that diabetes, asthma and heart disease required regular attendance at outpatient clinics, putting particular strain on those without easy access to transport. These advances in general practice care have often been delivered in spite of funding for them barely covering costs.
As we celebrate the NHS's birthday, it strikes me that marking the passage of time shouldn't just be about revelling in former glories; but about looking ahead and preparing for the challenges of the future. Today the NHS is rated as the best healthcare system in the world, by no less than the Commonwealth Fund, an American think tank. And within the NHS, a properly supported general practice service is vital for the provision of first-rate care.
World Health Organisation projections suggest that 74% of UK men and 64% of women will be overweight by 2030. They also say 36% of men and 33% of women will be obese by the same year. The money used in treating the complications of obesity is immense, for example where it results in type 2 diabetes each patient costs about £3,700 per year in drugs and hospital care. A patient, who sees the same GP each time and sees them for longer than a standard 10 minute appointment, can build up the relationship needed to get to the bottom of the factors driving their weight issues. As one London GP diabetes expert puts it, we need to break the cycle of despair which leads to poor weight management, before patients end up needing complex hospital care.
If Government, the profession and the NHS work together they can free general practice from top down pressure to put paperwork ahead of patients; financial uncertainty; and a crippling workforce crisis resulting in an inability to meet patient demand. With these addressed, general practice will thrive and live to a ripe old age: reflecting the population it serves; providing patients with continuity of care; and rewarding staff. If not, then we may be facing a sorry decline and a belated and regretful inquiry. I know which I vote for!
So as the NHS blows out all 68 candles on its birthday cake, let's keep fighting for it and for general practice. Let's ensure that patients are still benefiting from the highest quality care, delivered by doctors and nurses who know them like no other clinician does, when the NHS gets its telegram from the Queen (or King) by its 100th birthday.
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