A failure to properly invest in general practice and social care is one of the biggest policy blunders of the past 30 years, a report claims today.

The health and care system in England must be ‘radically refocused’ away from hospitals if it is to be ‘effective and sustainable’, it adds.

The King’s Fund, a health think tank which produced the report, argues officials should be putting primary and community services at the core.

It highlights that the ‘vast majority’ of interactions with the NHS are with the likes of GPs, pharmacists and district nurses.

But taxpayers’ cash and staffing has been disproportionately directed to hospitals, leading to inefficiencies and delays.

The figures, combined with the fact that an average of 46,201 staff per day were off work sick last week, means the NHS is under mounting pressure going into December, experts warned

The authors urge health chiefs to move more care ‘closer to home’ and stress that the ‘answer to over-crowded hospitals is not more hospitals’.

They warn that patients who struggle to get appointments with their GP are at risk of their condition deteriorating and having to seek urgent help from already over-stretched A&Es.

There are now more than 876,164 GP appointments in the NHS every day, which is an increase of 34,219 since 2018/19.

But despite this rise in demand – and repeated pledges to boost out-of-hospital care — the proportion of Department of Health and Social Care spending on primary care has actually fallen from 8.9 per cent in 2015/16 to 8.1 per cent in 2021/22.

This has fuelled the daily 8am scramble for an appointment with a family doctor and contributed to to patient satisfaction with general practice plummeting.

In 2021/22 the largest proportion of spending, £83.1 billion, went to acute hospitals, while primary care received only £14.9 billion.

The NHS has received additional money in recent years, but while acute hospital trusts have seen their funding grow by 27 per cent since 2016/17, community trusts have benefited from just half that level of growth, at 14 per cent.

Trends in staffing reveal a similar pattern, with the number of NHS consultants growing by 18 per cent between 2016/17 and 2021/22, while the number of GPs has increased by just 4 per cent over the same period, the report says.

There has also been a significant jump in social care staff vacancies rising, from 110,000 in 2020/21 to 152,000 in 2022/23.

The researchers say progress has been hampered by ‘urgent challenges’ such as A&E waiting times and planned care backlogs, which are often the priority for politicians ‘tempted by quick fixes instead of fundamental improvement’.

Other factors include a lack of data about primary and community services, which lead to a ‘cycle of invisibility’, and funding flows that prioritise hospitals.

The King’s Fund cautions that bolstering primary and community care should not mean closing hospitals, noting that England already has fewer hospital beds per capita than other nations.

Instead, its calls for future funding to be directed into a ‘comprehensive plan to refocus the health and care system towards primary and community care’.

They warn that a piecemeal approach of cherry-picking policies ‘will not miraculously unlock change’.

Sarah Woolnough, chief executive of The King’s Fund, said: ‘Many people across the country will have personal experience of struggling to get a GP appointment, trying to contact other services, and when all avenues have been exhausted, reluctantly going to A&E.

Cancelled operations targets missed

One in four NHS patients is not being treated within 28 days of an operation being cancelled.

The NHS constitution states those whose surgery is put off for non-clinical reasons should be offered a new date within four weeks.

But NHS England statistics show there were 20,372 cancellations between October and December last year, of which 4,913 or 24.1 per cent were not treated in the target time-frame.

This is up from the 21.6 per cent for the same period last year and is the second highest rate since 1994 when records began. It is beaten by the January to March figure from last year of 25.4 per cent. The Liberal Democrats, who analysed the figures, claimed the results show patients are being ‘catastrophically let down’ by a government that is allegedly allowing NHS targets to be missed on an ‘industrial scale’.

Lib Dem MP Daisy Cooper added: ‘To have an op-eration cancelled is bad enough but not to have it rescheduled on time adds insult to injury.’

It comes amid widespread disruption to NHS services, caused by repeated strikes by junior doctors. NHS England were asked to comment.

‘It feels like all roads lead to the hospital, but our hospitals are already full.

‘To achieve an effective and sustainable health and care system, politicians and national leaders need to embark on a radical and wholesale refocusing of the health and care system towards primary and community services.

‘Doing so will free up hospitals to treat the patients they are best placed to treat, thanks to many more people being diagnosed and cared for in the community.’ 

Beccy Baird, Senior Fellow at The King’s Fund and lead author of the report, said: ‘Like other countries, England needs to bend the curve on the predicted rise in demand for high-cost, reactive and hospital-based care.

‘That means supporting people to take care of their health and wellbeing, intervening early and keeping people healthy at home for as long as possible, which can only be achieved by bolstering primary and community services.

‘While these changes may not unlock the quick-fix savings many mistakenly expect, the alternative is to build more expensive hospitals to manage acute needs that could have been prevented or better managed in the community.’ 

The report says officials should incentivise staff to work in primary and community services by offering them more pay and career progression; leaders should be held to account for overall patient care, rather than focusing on waiting list; and it calls for reform of the ‘ailing’ social care system.

Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, said care provided in the community ‘is too often overlooked when headlines and political priorities focus on a narrow set of acute-focused targets’.

She added: ‘But prevention is better than cure and with the right funding and workforce then community, primary and social care can play an essential role.’

A Department of Health and Social Care spokesperson said: ‘This government wants to end short-term thinking and we are taking the long-term decisions that will mean everyone can access high-quality care that enables choice, control and independence.

‘We commissioned the first ever NHS Long Term Workforce Plan to train, retain and reform the workforce, and put primary and community care on a sustainable footing.

‘Backed by more than £2.4billion, the plan will increase the number of GP training places by 50 per cent by 2031.

‘We have also delivered our commitment to provide 50 million more GP appointments per year, rolled out the Pharmacy First service to reduce pressure on GPs, and made up to £8.6 billion available over this financial year and next to support the adult social care workforce and help people leave hospital on time.’

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