Primary care as it stands is ‘no longer fit for purpose’ and needs an extensive rethink, according to a comprehensive report on NHS sustainability by the House of Lords.
The NHS said in its Five Year Forward View, published in 2014, that primary care would remain ‘the foundation of NHS care’, but the Lords wrote in their Long-term Sustainability of the NHS report – published 5 April – that they received evidence of pressures within primary care which impacted several other parts of the healthcare system.
Despite an increase in demand for primary and GP care, investment in general practice has fallen from 10.7% of overall budget in 2005/06 to 8.4% in 2011/12 – a record low.
It was found there were 2.7 full time equivalent practice nurses for every 10,000 patients in England in 2014/15. This was the same ratio as 2010/11, meaning there are fewer nurses for the country’s growing population.
The Nursing and Midwifery Council (NMC) welcomed the Lords’ report, citing is criticism of the ‘over-burdensome regulation’ from the nine main professional regulators, such as the NMC, which it said requires ‘urgent reform’.
Chief executive and registrar for the NMC Jackie Smith said: ‘I have long maintained the NMC’s legislation is out of date and in need of major change to help us become a modern, dynamic regulator.
‘It is vital that the government pushes ahead with establishing a shared vision for future regulation.’
In the report, the Lords criticised the government’s decision to cut primary care’s funding share and allow the number of hospital specialists to grow three times faster than GPs, putting pressure on general practice workloads.
They expressed support for the ‘Multispecialty Community Provider’ model of primary care, giving patients direct access to aspects of healthcare usually only available when referred by a GP.
Speaking to the Lords, NHS Providers chief executive Chris Hopson said: ‘The structure of single-handed practices led by individual GPs is unable to provide the kind and scale of primary care that we now need.
‘People are coming together in GP federations which make it easier and more effective to then link up all these different parts of health and social care.’
The report concluded that NHS England should work alongside the Department of Health to develop a review to ‘examine alternative models and their structural implications’ in the interest of improving NHS sustainability.