Richard Sloggett is the Founder and Programme Director of Future Health Research, and a former Special Adviser at the Department of Health and Social Care.
The waiting list numbers for NHS treatment are scary and rising. Rather than New Labour’s anthem ‘things can only get better’, Sajid Javid used the Conservative Party Conference in Manchester to say that ‘things will get worse’. The Health and Social Care Secretary said that the number of people waiting for treatment could rise as high as 13 million if all those who did not seek it during the coronavirus lockdowns now come forward. Such ballooning figures were the backdrop to the bold recent move to break the Tory tax lock.
This is seen as sensible, centre ground politics, narrowing options for Labour who have struggled to respond. An NHS plan on how the elective backlog will be tackled with the new money is due later this year. By the next election, it is hoped waiting lists will be back to a more manageable level, and that the Government can show that the new money is delivering as part of its re-election package.
This plan would makes sense if it did not ignore the fact that this is not how the public sees and uses the NHS. Indeed, most interactions with the health service come through GPs and primary care, where there are over 20 million appointments each month. This bit of the system is creaking. It always does during winter and flu season, but what is most troubling is that it has been struggling during the supposed quieter summer months.
Recent polling shared with Future Health Research reveals that 48 per cent of people have found it fairly or very difficult to book a GP appointment this summer. Nearly six in ten found have said that this has got worse since the pandemic. And as for levelling up, the numbers get worse in the North East and Yorkshire and Humber. The latest GP data show that the number of appointments this August was over 23 million and higher than in August 2019 before Covid.
Speaking to a Conservative MP at conference, the response I got when posing the question about the biggest issue facing the party was simple: ‘access to a GP’. His mailbox was filling up.
The Government’s new health and social care levy does nothing to address this problem. Indeed, Ministers appear far more focused on hospital waiting times, building or upgrading hospitals and integrating bits of the health and social care system around hospitals (known as Integrated Care Systems).
The recent Build Back Better: Our Plan for Health and Social Care document did make reference to prevention (and a concept around the NHS Health Check of a national prevention service) and Javid has spoken eloquently on the social backlog and health disparities. But concrete action is lacking.
Primary care has been disrupted in a number of ways through the pandemic, and accelerated trends that were already being seen. It is completely false and misleading to argue that GPs were seeing patients face to face before the pandemic, and have suddenly switched to digital and remote care afterwards. The proportion of telephone consultations has trebled since Covid, but the model has been mixed for some time: for example, there were over three million telephone consultations in August 2019.
Patient surveys indicate that this mix of care is needed and wanted – nearly two thirds of people would rather have a video appointment than wait for a face to face. Moving more people to face to face will restrict rather than enable access. More GPs are needed as well as retaining those we have, but this is a long term structural challenge, that will do little to alleviate pressures in the winter months.
The Government needs a new urgent plan for primary care to support the service. This is a plan that requires a combination of public engagement, investment, flexibility and technology.
The plan should include a new awareness campaign of how to access the help and support patients need. The pandemic has made it confusing for patients on what to expect with regards to access, the Government and NHS needs to step in and explain the different types of services and how they work. Doing so will make the most of the capacity available right across primary care including pharmacy.
The Government needs to not get on the wrong side of the digital argument in a bid to placate vocal critics. Digital appointments are popular with patients and increase capacity. They also help those who cannot necessarily see a GP in normal working hours accessing care. Not everyone is in a position to take time off work during the working day and visit a GP practice. Indeed, increasing digital appointments will help free up face to face appointments for those who need and want them. The key is choice – a word that has fallen out of favour in health policy but needs to be re-asserted given the challenges faced.
The Government should also make new winter pressures funds available to tackle variation in access across the country. The manifesto committed to providing 50 million more GP appointments but delivering on this ambition will be futile if in doing so there are still big delays in seeing a doctor. Currently eight per cent of people in London seeing a GP wait longer than 14 days. In the South West, the figure is nearly double at 15 per cent, despite the Chief Medical Officer noting that some of our nation’s poorest health is in coastal communities.
New funding must look to better join-up and encourage collaboration between emerging larger Integration Care Systems and smaller more localised Primary Care Networks to increase overall system capability. By looking at greater scale there will be opportunities for increasing short term capacity through workforce sharing, technology and in delivering efficiencies in the pathways of care being delivered.
The health and care levy may have been the right move to fix hospitals. But a bigger political threat in health looms this winter if people cannot see their family doctor. Post-Manchester, the Government’s health focus needs to re-balance to address this.