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Primary care funding slipping

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Funding for general practice is due to fall by 17 per cent by 2017/18, while patient consultations are set to rise by 69 million according to research published by the Royal College of General Practitioners (RCGP).1

The study, conducted by Deloitte, showed that if current trends continue, funding for general practice across the UK will fall to just 7.29 per cent of the NHS budget by 2017/18.

The study also found that the number of patient consultations in England is estimated to reach 409 million - up from 340 million in 2012/13.

Although currently general practice deals with 90 per cent of patient contact, it only receives 8.39 per cent of the overall NHS budget, the RCGP has said.

Dr Maureen Baker, chair of the RCGP, also made headlines recently by revealing that many GPs are reaching breaking point, and are considering early retirement. The reductions in funding coupled with the increase in patient consultations are having a knock-on effect on practice nurses. Secretary of state for health Jeremy Hunt and the Department of Health have said that more care will be moved into the community to meet the needs of patients and to ease the pressures on A&E and hospital departments. It is now more important that general practice is funded and resourced adequately to be able to cope with these extra pressures.

Jenny Aston, the chair of the practice nursing forum at the RCGP, says that GPs cannot deal with these pressures alone. 'The lack of funding and resources is as much a problem for practice nurses as it is for GPs. There is no doubt that nurses are under pressure too, as they are picking up the workload from hospitals as well. The workload is getting bigger for everyone in general practice.'

Another RCGP report released earlier this month forecast that 34 million patients will be unable to get general practice appointments if the level of funding does not increase. (Independent Nurse, 3 March, p3).

A BMA public health survey, found that more than half of public health staff have recently considered leaving their profession. Staff blamed the recent health reforms for failing to benefit the public's health and more than half of all the clinicians questioned (590) had considered leaving the profession.2

The results of these surveys and reports signify problems in general practice, including an impending GP and practice nurse workforce crisis, a fragmented and variable public health service, and a lack of independence and leadership. Dr Penelope Toff, co-chair of the BMA's public health medicine committee, says: 'It is particularly worrying that so many public health specialists are experiencing unsupportive working environments, where they feel that their skills are not understood or valued. This report leaves us in no doubt that we will be facing a recruitment crisis, worsening the serious public health effects of austerity.'

The Government's budget announcement at the beginning of March was a missed opportunity to address the 'massive funding gap in general practice,' the RCGP believes.

It has started a campaign to increase the amount of funding going into general practice from 8.39 per cent to 11 per cent of the total NHS budget by 2017. The Put Patients First: Back General Practice campaign is being run in conjunction with the National Association for Patient Participation.

Dr Baker says that the campaign is about increasing the funding for general practice as a whole not just general practitioners.

'The extra money that is being campaigned for is to be fed into the whole of general practice. In particular we would love more practice nurses and community nurses. It is an issue on a practice level as to how to best use practice nurse time. Nurses are highly valued colleagues of GPs.'

Innovation and efficiency

Practice nurses have a range of skills that could be used to improve efficiency by spreading the GP workload and qualifying in specialist areas so they can take on more responsibilities and use them throughout the practice. Ms Aston says that CCGs need to make sure there is enough funding available for nurses to be able to do this. 'The QOF could also incentivise practices for practice nurse training,' she says.

Dr Baker believes that federations could be a way to use practice nurses skills effectively across a number of different services. 'For example a family planning nurse within a federation could organise family planning clinics across a number of practices and that could happen across a number of different clinical areas. So that is something that hasn't developed much yet, but is one way in which practice nursing could develop over the next few years.'

Encouraging nurses to oversee vaccination programmes is another way that nurses can help to increase efficiencies in general practice.

Practice nurses at Peninsula Community Health (PCH) in Cornwall will offer the BCG vaccination against tuberculosis (TB) to all newly registered patients, particularly children. They will carry out the assessments and referral processes and determine who will receive the vaccination.

Alison Blake, PCH's TB service team leader, said: 'Since changes to the BCG vaccination programme in 2005, BCG is only offered to those children identified in certain risk groups. We now encourage practice nurses to assess all new patient registrations and children attending for routine vaccinations and refer those who are eligible and not previously vaccinated for the programme.'

Mr Hunt's intention to return to named clinicians for the vulnerable and elderly, and health minister Dan Poulter's suggestion that district nurses could help to bear this extra workload, means that nurse resources need to be invested in to meet demand.

References

1. Under pressure: The funding of patient care in general practice.RCGP. April 2014. http://www.rcgp.org.uk/campaign-home/news-and-blogs/2014/april. Accessed April 2014.

2. Findings from the Public Health Survey. March 2014. BMA. http://bmaopac.hosted.exlibrisgroup.com. Accessed March 2014.

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