With all this talk of the latest budget giving a huge amount of money to the NHS, it is now necessary to look at how this amount of money can be spent in order to rescue the health of this country. 

So far, the BMA ( the doctors’ trade union) has said, “New funding for the NHS is welcome, but what is glaringly absent from today’s Budget is a concrete plan to rebuild general practice, which is the front door of the NHS”.

This has been a constant refrain in the health service,  When I was working as a GP, and also as a medical manager in the local health board, what always struck me was when there was any extra funding available, how quickly the local hospital trusts managed to get their hands on it.  Their needs were always said to be greater than ours (the GP’s)  and there were always new developments and improvements in medical care in hospitals which should  be given priority. It was more exciting to have more shiny new equipment which might save lives, or saving eyes if you were an ophthalmologist, than to improve the facilities and expand the remit of general practice. The consultants’ committees and  connections to politicians seemed to work extremely fast and efficiently, but GPs were always waiting for crumbs from the table.  

At one time when  I worked in medical management, I was tasked with reducing unnecessary referrals from GPs to hospital consultants. I found that indeed there were some referrals which were inappropriate or unnecessary, but the main problem was that the consultants were very unwilling to let go of the some of the work which could be done in primary care,For instance  In the 1980s  there were extremely long waits for a first orthopaedic appointment (as there are now of course) but at that time the main reason was that physiotherapy was  a hospital based speciality that could only be accessed by a referral to Orthopaedics. We GP’s campaigned long and hard for years to get access but we were always refused. The reason given — the consultants wanted to keep physiotherapy to themselves because they could then refer patients to physios when they could not help the patient surgically. It was such a backward idea. Patients need physio first to prevent their condition getting worse, and sometimes to cure the patient, but not at the end of surgical procedures which actually would not have been needed if the patient had had physio first! That battle was eventually won and now it is normal for physios to  be attached to GP surgeries  and patients get better much more quickly. And now many other services are available in primary care, but many more services can and should be moved out of hospital and put into local hubs. Though there wasn’t much about this in the budget,  there is a lot of talk about this in both the medical press and I am sure some of this will happen, if the money is provided.  But so often there is talk about doing this (there was a lot of talk about it when I was working), but the money always went to the hospitals and got siphoned off into acute care.  

The other place the money needs to go is into joint social care and community services.  If we don’t fix social care, the NHS doesn’t stand a chance. I remember helping to organise a joint venture for a rehab centre in our town that was to be funded jointly by the hospital trust, the local council and social services. All the plans were made, and the new centre was set up. But at the last minute the hospital trust refused to pay its share, as it said they didn’t have the money. And the council and social care  had to fund it, and I expect still do. It still works well to get patients out of hospital immediately after an operation or after an emergency and get them fit enough to go home, so the hospital benefitted enormously from it.  At the moment the problem of people being well enough to leave hospital but can’t because of lack of rehabilitation facilities or home based care, is threatening the whole system. 

So it is absolutely essential that the new money coming in is not spent exclusively  on funding waiting lists, new developments and more activity in acute hospitals, exciting and worthwhile though they may be.  It is the usual story of the best being the enemy of the good.  I am in favour of local initiatives in the community for specific routine operations, even by the private sector, so long as it isn’t leaching on the NHS (see previous article).  More money must be put into prevention.  But we were talking about this constantly 30 years ago, and it hasn’t happened. It MUST happen this time, or all the money will just disappear down a black hole. 

 GPs are the front door of the NHS, and the BMA asked the Government to increase their funding by at least £40 per patient per year – just 11p per day. However, the increase in employers’  NI  contributions will again squeeze GP practices while the hospitals are unaffected. 

“Funding general practice properly saves money.  It leads to better patient care and fewer people needing to go to hospital, consequently reducing pressure on the already overstretched NHS.”