Reports of a postcode lottery for British patients have drawn attention to the stark differences between general practices across the UK. This invites some reflection as to what factors unify the NHS, and begs the question of whether a one-size-fits-all model of primary care can exist in modern Britain.
When the population is as scattered and diverse as it is in the UK, it is inevitable that primary care services in different areas will need to be adapted to better suit local requirements. What this disparity also highlights is the need to focus more closely on the fundamental issues at the heart of the health service.
In recent years there has been an emerging trend of patients heading straight to A&E rather than pursuing household or primary care alternatives, which might reflect changing social attitudes as much as the limited availability of local GPs.
There are three strategies that could establish a strong model of primary care, all of which would require the implementation of substantial reform. These processes would work together to create an integrated system, and address the problem of needlessly duplicated services.
1 Introduce a tariff
The first reform that would cut costs and establish a more effective model of care is the introduction of a tariff that does not pay for unnecessary treatments. This would alleviate a great deal of strain on both primary and secondary care, and transfer vital services to local medical centres.
2 Redeploy the NHS workforce
Allocating medical professionals to different sectors or levels of care would utilise the diverse skill set present in the NHS and enrich the quality of patient treatment. By redeploying staff to areas that desperately require added assistance we would also be able to remove the need for hospital or walk-in centre visits, which are far more costly to run than GP surgeries.
Recent initiatives to spread more services and NHS employees across secondary and primary care units demonstrate rising concerns about pressure on A&E. There’s clearly wide support for increasing the role of primary care. Although the expansion of medical premises to pharmacies, dentists, and optometrists, as well as modernised consulting rooms, has proven useful in retaining patients and easing the strain on other primary care providers, it is the redeployment of secondary services to frontline care that will have the most significant impact on the NHS.
3 Dispose of NHS assets
The third and perhaps most controversial means of releasing funds and consolidating care is the disposal of NHS assets. The reason for the controversy is the prevalent misconception that closing medical facilities equates to job losses. The reality is that the UK health service possesses a number of valuable assets locked up in estates that are not fulfilling their purpose in an efficient way.
The problematic side effect of pinpointing surgeries in certain areas is that it can detract from the overall issue facing the NHS. Premises development in the NHS needs to return to the public dialogue, as there remains a freeze on funding for building modern, integrated facilities.
In order to meet the rising demands of patients there has to be a viable alternative to A&E. The emergency consultation is the safety net for the central system, but is now often operating as the reluctant first port of call for patients who think there is nowhere else to go.
With figures suggesting that 25% of A&E admissions could have been treated elsewhere, and three-quarters of GP practices are potentially unfit for purpose, high quality primary care premises have to be a priority.
The three-strand strategy for rebuilding the NHS is not a simple one, nor is it a quick fix. It requires some difficult decisions for healthcare legislators and providers as well as a seismic shift in public attitudes to seeking medical attention. However, it is feasible and it is the necessary route towards a sustainable, valuable future for healthcare.