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NHS needs a ‘radical and wholesale’ reform towards primary and community services

To reduce A&E waiting times and planned care backlogs, researchers at the King’s Fund have called for shifting the focus from hospital care to primary and community healthcare services.

The NHS needs to be ‘radically refocused’ from hospital care to primary and community care services, according to a new report by a leading think tank. ‘Making care closer to home a reality,’ by the King’s Fund states if this shift in focus does not happen, more expensive hospitals will need to be built to manage people with acute needs that could have been prevented or better managed.

‘The answer to over-crowded hospitals is not more hospitals. Despite this being well understood for many years, there is now a higher proportion of the NHS budget and staff going into hospital services. At the same time, there has been a slow erosion of capacity and confidence in primary and community care,’ said Sarah Woolnough, chief executive of The King’s Fund.

The report by the King’s Fund found that despite the majority of interactions with the NHS through primary and community services, the proportion of Department of Health and Social Care (DHSC) spending on primary care has actually fallen. In 2021/22 the largest proportion of DHSC spending, £83.1 billion, went to acute hospitals, compared to £14.9 billion spent on primary care. 

On average there are more than 876,164 GP appointments in the NHS every day, an increase of 34,219 appointments a day since 2018/19. However, while acute hospital trusts saw 27% funding growth since 2016/17, community trusts saw just half that level of growth, at 14%. The report states the key reasons for this could be lack of data about primary and community services and urgent challenges such as A&E waiting times and planned care backlogs becoming the priority for politicians, rather than fundamental improvement.

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‘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,’ said Woolnough.

However, the researchers caution 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, they call for funding and policies to be directed into a comprehensive plan to refocus the health and care system towards primary and community care.

The researchers have proposed crucial steps for this change. It requires clear policies and a strong political will for reform; targeted funding for innovative technology (remote monitoring, AI), estates and better equipment at primary and community health services; better pay, status and career progression to incentivise staff to work in the sector and a less top-down approach, with more autonomy given to local health and care leaders.

This report has been positively received by leading experts in the healthcare sector, with organisations like the NHS Confederation welcoming the report’s recommendations for ‘longer-term investment in capital to enable integrated care services to make decisions that best meet the needs of the communities they serve.’

Responding to the King’s Fund report, Dr Layla McCay, director of policy at the NHS Confederation said, ‘the economic case for investing in primary and community care is clear. Every £1 invested in these services brings back £14 to the economy in gross value added (GVA). Investing upstream is critical for the sustainability of services and reducing pressure on hospitals and moving to more preventative models of care.’