Crises accelerate rapid adoption of new technology and processes, and the use of telemedicine has expanded over the last 18 months far faster than even the keenest advocates might have hoped. However, whilst a boon to GPs and patients alike throughout the pandemic, there are many situations where only a face-to-face visit will do. Recent data from NHS Digital illustrate the change with only 58% of patients being seen face-to-face in August as compared to over 80% before the pandemic (link).
Yesterday, the NHS announced a blueprint for improving access to GP appointments, including an additional £250m funding “to boost their capacity to increase the proportion of appointments delivered face to face” (link).
This sounds dramatic but it is important to put this in context. As Dowling noted fifty years ago, primary care is the Cinderella of healthcare. Every year, the NHS publishes the amount of payments made to GP practices, with new data for 2020/2021 due to come out on 25 November. The most recent data for 2019/2020 shows that GP practices received £9.5 billion from NHS England, just under 8% of the total budget for NHS England of £125.4 billion. There are approximately 7,000 GP practices in England, so funding of primary care works out at £1.33 million per GP practice, or £155.46 per registered patient.
It means that the additional funding committed by the NHS to primary care in England represents an increase of only 2.6% - an additional £35,700 per GP practice or an increase of £4.50 per registered patient. This calls into question how much more capacity GP practices can provide with this funding to enable more face-to-face consultations, particularly given that there may be no further resources to provide this additional capacity.
These changes happen already at a time of great change, thanks to COVID-19 specifically and to the NHS Long Term Plan more broadly. The GP contract for 2020/2021 released in January 2021 illustrates how demands on GP practices are changing given the shift to Primary Care Networks in 2019 and a range of different initiatives relating to recruitment and retention (link).
Within that publication, one of the sections highlights GP out-of-hours services and the amount of funding provided. Out-of-hours is typically between 6:30pm to 8am on weekdays and all day weekends. Out-of-hours services cover a whole range of different activities, such as the following:
GPs - working in A&E departments, or Minor Injury Units
Healthcare professionals working in primary care centres, A&E departments, or Units
Healthcare professionals making home visits
Ambulance services moving patients to where they can be seen.
Over 90% of GP practices have contracted out of out-of-hours GP services. Whilst you would expect the vast majority of activity and cost to take place when GP practices are open, it is bewildering that only 4.8% of the total funding provided to GP practices is meant to cover all of the out-of-hours GP services.
Whilst we hear so much about the undoubted strain that A&E departments and GP practices are under, it is perplexing why we do not hear more about those providing out-of-hours GP services, covering as they do more than 2/3rds of the time every week - somehow managing within a budget of £7.50 per annum for each and every one of us. If you prefer percentages - just 0.4% of the total expenditure of NHS England.
They deserve our immense gratitude, but also they deserve better funding!