The Blog

How the New Government Can Transform Primary Care

The NHS featured prominently in the general election campaign and will continue to be headline news throughout this parliament.

The NHS featured prominently in the general election campaign and will continue to be headline news throughout this parliament.

A big challenge facing the new government will be primary care, the part of the NHS that is most-used by patients but one that is often inefficient and faces unsustainable pressure at present.

With an ageing population, increasing numbers of people with a long-term condition and problems getting a GP appointment leading to many unnecessary hospital admissions, the need to unblock the system is significant.

The good news for the government though is that a plan is in place to address that problem.

NHS England's Five Year Forward View (FYFV), published by its chief executive, Simon Stevens, offers a roadmap for reform that has gained support from across the political spectrum.

Within the plan is a greater emphasis on keeping people well in the first place through preventative measures and support for people with long-term conditions; and proposals to offer patients a broader range of health professionals as their first point of contact.

But what will this mean for patients?

How will the NHS look to us all when we access it in our communities?

Taking my own profession as an example, it should mean more patients being able to refer themselves directly to physiotherapy without having to see a GP first.

Making this approach as widely-available in England as it is in Scotland and Wales could cut waiting times, save money and free up more than 100m GP appointments a year.

There should also be a greater focus on prevention across the board to keep people well and out of hospital.

This could mean falls prevention classes, public health initiatives designed to get people active, and work-based schemes that reduce sickness absence.

Much of this is already happening - with great success - across the country.

But rolling it out to all areas is another matter, with significant - but in no way insurmountable - obstacles.

Firstly, there is the question of funding. While measures like self-referral will actually save money, the system as a whole needs a significant injection of cash.

The Conservatives pledged to fund the additional £8bn a year Mr Stevens identified as being needed by 2020 and David Cameron repeated his commitment to this on Monday.

That was welcome, but it is important to remember that £8bn was a minimum required figure and also relies on a further £22bn of savings to be identified in an NHS already stretched to the limit.

Furthermore, Mr Cameron's plans for a fully seven-day NHS will require significant investment to ensure resources earmarked for five days are not simply stretched over the week.

Less tangible, but as important, will be the change in mindset that is required to make this plan a reality.

We must stop thinking only in terms of recruiting more doctors and more nurses.

The examples given earlier - about prevention, about patient choice, about seeing the right person at the right time - all rely on the NHS recognising the full range of talents at its disposal.

Physiotherapists are currently underutilised, but so too are other allied health professionals and with resources so stretched, this makes little sense.

We need a collaborative system, built around the needs of patients, not based on traditional roles and structures.

Finally, Mr Hunt's approach to galvanising the service's dedicated but demoralised workforce will be critical.

These brilliant professionals kept the NHS going during the toughest of times during the last parliament, accepting pay freezes and working under enormous pressure against a backdrop of budget cuts and the major reorganisation brought about by the Health and Social Care Act.

Mr Hunt's decision to reject an independently recommended one per cent pay rise for NHS staff this year was therefore a poor one.

There is a clear link between quality of services and staff morale, so to veto what in any case would have been a limited increase was a potentially damaging act.

It will also make it harder for Mr Hunt to take staff with him on any service transformation and he will need a more conciliatory approach this year.

A new parliament should mean a fresh start, however.

And while immediate talk about restricting the established right of public sector workers to take industrial action was an ominous start, the FYFV does at least offer a plan with a broad consensus on which to build.

If the steps I've outlined are taken, we may yet see a genuine transformation that is good for patients, for primary care and for the public purse.

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