Inquiry Report in Winter Pressures
LMC Commentary, June 2014
This report is unique in my experience as going as far as making two rather unexpected recommendations. One is that the NHS should actually consider not treating patients in A&E who do not have emergency conditions. The second is even more ground breaking: recommendation nine is that primary care should get some of the "extra money" that governments always seem to spirit up to "tackle" the latest crisis. Unfortunately there are no ideas about how this might be achieved other than reminding us that funding is finite and so allocations must be made with careful thought on the impact on patient care, rather than say, GP pay? There is all the familiar talk about integrated strategic thinking, sharing of IT across the sectors and planning to ensure sufficient staff and capacity to deal with sudden spikes in demand. This may be possible in secondary care but of course in most practices this simply means, to quote Shaun Green of Somerset CCG, "you work harder." Self care education is much vaunted as a way to reduce demand on primary care and A&E for common ailments and long term conditions. How this sits against a background of what this reviewer considers to be the progressive infantilisation of the public on health matters, with the answer to every question no matter how remote the chance of a serious problem, being to "see your GP," is as usual not addressed.
Apparently there is (or was) an NHSE campaign called "The earlier the better" which seeks to reduce emergency admissions by encouraging self care and seeking advice from pharmacists. There is also an RCGP initiative called Treat Yourself Better Without Antibiotics to which the college could not attribute any change in prescribing because, as the BMA contributors put it, campaign efforts have "not yet achieved visibility." But awareness has been raised, so that's all good. The challenges in general practice are well recognised with 40 million more consultations each year now than five years ago. It cannot be stated often enough that practices are undertaking 340m consultations annually compared with 22 million in A&E. Primary care received 8.39% of NHS funding in 2013/13 and this is predicted to fall to 7.29%.
These figures should be emblazoned on every LMC man and woman's heart and quoted at every available opportunity.
Dr Barry Moyse
Deputy Medical Director