Submission to new All Party Parliamentary Group Primary Care and Public Health Inquiry

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Londonwide LMCs has been invited to submit evidence to the All Party Parliamentary Group on Primary Care and Public Health’s new inquiry into managing demand in primary care. As we know (and our new workforce survey reveals starkly) we are experiencing a state of emergency for London general practice.

The first week of January saw 65 out of 152 hospital trusts in England declaring major alerts, unable to cope with the extra demands of winter pressures. A&E departments have been particularly affected resulting in the Red Cross being drafted in to help with what they described as a “humanitarian crisis” in the NHS.

The Secretary of State for Health said that people have to recognise what A&E is for, calling on GPs to help with the “40% of people in A&E that don’t have to be there” (data shows there are 3.7m visits to A&E for conditions such as flu and muscle sprains which could be self managed).  Primary care however, also faces challenges in managing demand.  According to the GP Forward View, published in April 2016, GPs and their staff report that “workload is their single biggest issue of concern”.  The number of GP consultations increased by 15% between 2010/11 and 2014/15 whilst, according to the Health and Social Care Information Centre (HSCIC), full-time GP numbers fell by 2% in 2015 in England.

Tackling avoidable GP consultations, of which there are said to be 27%, were thought to be one way of managing demand. Educating people on how to look after their own minor self-limiting illnesses and long term conditions was identified as a way to reduce the number of GP consultations over time. The GP Forward View has promised a £30m investment initiative, “Releasing Time for Patients” which will help equip the workforce with tools and skills to manage workload, but are the right levers in place to implement this?

Managing demand in the NHS has been an issue since its inception but it has now reached a critical point, not helped by a fragmented health service which creates inefficiencies and disrupts patient flow through the system. A number of health policy documents have sought to manage demand and to create a “whole-systems” NHS, including the Five Year Forward View, but are we any closer to achieving this goal?

The inquiry poses a number of specific questions:

  1. What needs to happen and who needs to be involved to help assist people in looking after their own (a) minor self-limiting illnesses and (b) long term conditions?
  2. Is it necessary to commission self-care and how can this be done effectively?
  3. What training is necessary to support primary care staff in educating people to look after themselves and who is providing this training?
  4. How can local health expertise such as pharmacy, health coaches, patient groups and charities, etc be incorporated into the system to help manage demand?
  5. What else has to happen to improve joint working locally to engage people in their health and wellbeing and so reduce service demand?
  6. What impact have Government policies such as the Five Year Forward View and GP Forward View had in managing demand and how can we move towards that much sought after whole-systems NHS?

We have accepted the invitation to work with the Group and submit written evidence to the inquiry and would welcome your thoughts on the areas that the MPs and Peers plan to discuss (outlined above).

Please send your thoughts and comments through to Patricha Forrest, PA to the Chief Executive, by Thursday 16 March so that we can reflect them in our pan-London response.