£2.4 billion more for the NHS’s gatekeepers

Edmund Stubbs, 21 April 2016

In the words of Maureen Baker, chair of the Royal College of GPs, the government’s announcement of an extra £2.4 billion of funding for general practice is ‘the most significant announcement for our profession since the 1960s’.

This initiative will raise the total expenditure on General Practice from £9.6 billion to over £12 billion (a 14 per cent rise) and comes combined with an extra £500 million investment in the form of a national turnaround package intended to support GP practices. Clinical Commissioning Groups will also contribute additional funding.

The targeted areas where this money is to be spent seem to reflect well informed decisions enhancing what is already in place. 5,000 additional GPs are to be recruited over the next five years which is great news for currently overstretched GPs facing burn-out. There is more good news for British mental health services in the form of 3,000 fully funded, practice based, mental health therapist training places.

GPs often highlight the huge burden of mental health on the community. Many of their daily appointments involve problems that relate to underlying mental health issues. Having a specifically trained team member in their practice to deal with these issues is likely to prove a major asset.

The newly available funds will also support more clinical pharmacists, practice nurses and physician assistants; as well as more managers and receptionists. Support will also be put in place to relieve GPs experiencing burnout while reforms will be introduced with the aim of cutting red tape and bureaucracy, making it easier for GPs to work more easily with hospitals. Money will also be available to fund better surgery facilities and investment in improved information technology.

NHS England’s chief executive, Simon Stevens, has openly admitted that GP practice has faced real problems and this is the reason for the increased funding. He further acknowledges the neglect of general practice which has occurred over the last ten years while the number of hospital specialists has increased – a bizarre situation because, in effect, general practitioners act as the health service’s gatekeepers. Patients cannot refer themselves for specialist treatment. They must first go and consult their GP who will then assess their medical needs and refer them, if appropriate, for further diagnostic or curative services. In health systems around the world where this is not the case, costs can be driven up tremendously as a consequence.

Because of this referral system, GPs are a key component in any proposed efficiency drives. A GP is able to select patients with real need for further services from others who need only minor or no treatment. This saves money. In addition, GPs, in recognising patients who are becoming seriously unwell early, and by referring them on to the correct services, will reduce demand on the system from those patients would otherwise deteriorate yet further before seeking far more costly specialised treatment at a later stage their illness, often at a greater risk to their own long-term health and wellbeing.

Overworked GPs cannot fulfil this essential gatekeeper function properly. Patients are let down when a stressed GP misses a telling symptom, and the health system will consequently suffer logistically and financially in the long term.

This new investment in GP services is cause for optimism. Perhaps we as a nation are moving towards promoting good general health instead of offering damage limitation intervention through acute hospital services. With this new considerable investment from NHS England, GPs will be able do a far better job at promoting and maintaining good health in their local population and perhaps more junior doctors will thereby feel inspired to undertake general practice training. Both these factors will undoubtedly safeguard the general health of the British public.

Edmund Stubbs is Healthcare Researcher at Civitas