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Poor investment in general practice risks patient safety

Investment has risen – but not enough to secure sustainability of general practice, say GP leaders

Louise Prime

Friday, 21 September 2018

The BMA has warned that the current level of investment in general practice risks both the sustainability of general practice and the safety of patients, as the latest official figures show only a small real-terms increase over the past year. It called for further investment and a “concerted effort to tackle this recruitment and retention crisis” as an increasing number of older doctors are choosing to retire early and trainees are opting for other specialties.

NHS Digital has published its detailed report* on the investment in general practice and the reimbursement of drugs dispensed in general practices from 2013-14 to 2017-18, based on figures obtained from the health departments of each country and other published data.

It reported that for 2017-18, there was a real-terms increase in the total investment in GP practices of 4.93% in England, 4.59% in Wales, 1.36% in Northern Ireland and in Scotland 3.17%. But the total spend on general practice excluding the reimbursement of drugs was:

  • £11,889.6m in the UK as a whole, compared with £11,210.0m in 2016-17, an increase of 6.06%, which in real terms is 4.28%
  • £10,197.2m in England, compared with £9,603.7m in 2016-17 – an increase of 6.18%, which in real terms is 4.40%
  • £506.4m in Wales, compared with £473.5m in 2016-17, an increase of 6.94%, which in real terms is 5.14%
  • £280.2m in Northern Ireland, compared with £271.5m in 2016-17, an increase of 3.22%, which in real terms is 1.48%
  • £905.8m in Scotland compared with £861.3m in 2016-17, an increase of 5.17%, which in real terms is 3.41%.
The BMA warned that, although it was positive to see an increase in investment, the current level of investment in general practice is still not enough and risks both the sustainability of general practice and the safety of patients. It pointed out that the headline figure is not reflective of the money actually reaching practices and their patients because it includes drug reimbursement and other initiatives including services in A&E departments.

Dr Richard Vautrey, BMA GP committee England chair, said: “Potentially misleading the public in such a way is not acceptable.

“Today’s real investment figure of £10.2bn (an increase of 4.4% since last year) represents 8.1% of the NHS budget going to general practice – falling £3.6bn short of the BMA’s target of 11%. This is money that could be spent supporting practices and improving patient care at a time when surgeries are buckling under the pressure of increased demand, unmanageable workloads, and the rising costs of premises and indemnity costs.”

He added: “A general practice supported by 11% of the NHS budget could offer greater continuity of care to patients, and would be able to help deliver a more sustainable future for the NHS as a whole.”

Dr Vautrey pointed out that the prime minister has outlined her ambitions for a long-term funding plan for the NHS, and he said it is imperative that this includes a significant boost to general practice that meets the needs of doctors and their patients.

He said: “As the first point of contact many will have with the NHS, GPs continue to be highly valued by the public. Recent research has shown that the vast majority of people are happy with the service they receive at their practice, but this is clearly at risk as the wait to see a doctor grows unacceptably long.

“GPs share their patients’ frustrations, as is clear by the increasing number of older doctors choosing to retire early and trainees opting for other specialties. Without further investment and a concerted effort to tackle this recruitment and retention crisis, it will be patients, as well as GPs who will continue to bear the brunt.”

*Investment in General Practice - 2013/14 to 2017/18, England, Wales, Northern Ireland and Scotland. A report prepared by NHS Digital, 20 September 2018.

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