The recently published Darzi Review on the NHS in England was commissioned to provide a background context for the new Labour government’s ten year plan for the NHS which is due to be launched in spring 2025.
It highlights the damage done to primary care in England by the previous Tory governments and their failure to recognise the strategic role that primary care must play in a sustainable health and care service.
It is very critical of the failure of under-investment, the Lansley “reforms” (Health and Social Care Act 2012) and lack of public and professional engagement but it fails to understand the continuing role of the market in perpetuating many of the problems it identifies.
This paper is a response to the Review by Doctors in Unite and is a contribution to the wider debate on what should go into the ten year plan particularly from the perspective of general practice.
Key messages:
Investing in primary care services is cost effective at a societal level. Worldwide evidence is that the stronger the primary care system, the stronger the overall health system is to improve health outcomes, reduce costs, and maximise equity for the population. The NHS Confederation estimates that for every £1 invested in primary care at least £14 is delivered in productivity across the working community.
Investment in public health similarly is highly cost effective. Most health care interventions that improve life expectancy and healthy life expectancy are delivered at community levels with primary care as the crucial partner.
Market failure must be recognised and addressed. The Government role is always one of stewardship of a health system for its population. There are many different models of financing and providing such services globally. In the UK, General Practice is commissioned by the NHS via a variety of contracts. This has inherent risk of market failure, which carries a high price for patients, especially for those with the greatest needs. A national NHS salaried contract must be introduced. It is not sufficient to rely on the independent contractor route to ensure equitable access and quality of care.
Continuity of care: continuity of care must be at least as important a goal as access to care because it reduces mortality and inequalities in health outcomes.
The GP is crucial and not just a cog in the multi-disciplinary primary care team. The role of Specialist Generalist as the clinical leader for the primary care team is fundamentally what makes primary care in the UK so efficient, cost-effective and highly productive. It cannot be fragmented and adequately replaced by transactional encounters with a multitude of professionals. A multidisciplinary team without GP leadership is more expensive and less effective.
A primary care pilot of joint general practice / public health posts should be undertaken.
Resources should be allocated according to need, using more sophisticated methods than the outdated Carr Hill formula to ensure that capacity distribution is planned and not left to the vagaries of the market.
The main document can be sources here:-