Crisis-hit GP services struggling to keep people well will see A&Es full as we head into winter, NHS bosses have warned.
Health leaders say “collective action” by GPs limiting appointments is only making the situation worse as patients deteriorate with viruses as well as heart and mental health emergencies. Trust chief executives have also warned they won’t be able to start hitting waiting targets in time for this winter under Labour’s funding plans.
One chief executive of a major NHS trust, speaking on the basis of anonymity, said: “In our part of the world demand [on 999 services] is up almost 10% this year compared to last year. “The only explanation we can come up with as to why that is happening is primarily because primary care doesn’t have the capacity to actually look after all the people on the patient lists, and people are getting sicker and then accessing emergency care. It looks like it’s going to be a really tough winter.”
The NHS leader suggested hospital consultants, paramedics and mental health specialists could be drafted in to help at struggling GP surgeries.
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The NHS has experienced the busiest summer ever for A&Es in England amid fears for how it will cope during winter. There was record demand at A&Es in June, July and August combined, with 6,776,150 attendances – up 240,776 on the same period last year Speaking in September, NHS England’s medical director Professor Sir Stephen Powis said: “The NHS has just come out of the busiest summer on record for A&Es across the country, and preparations are already underway for what is expected to be an extremely difficult winter with significant strain on urgent and emergency care.”
GPs are having to squeeze in more appointments and have less time with patients, who are presenting with more complex illnesses. A record number of ‘patient contacts’ are being delivered with over 30 million last month in England.
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The NHS leader continued: “If you say that there’s a capacity issue in primary care to NHS England, they say that the volume of primary care appointments has just gone up astronomically. But if you look at patient satisfaction with primary care it’s gone massively down. And I think we have a complete mismatch of what patients want and what the system is counting. I think the system is counting lots of email interactions and lots of telephone interactions with GPs, where what patients actually want is to see somebody.”
It follows repeated Tory promises to increase GPs by thousands over the last decade when numbers actually went down. In protest at funding cuts and increased workload more than two-fifths of England’s GP practices are limiting appointments as part of “collective action”. A poll by Pulse found 41% of 660 practices allow just 25 patient contacts per GP a day. A similar survey by the same trade magazine last year found GPs were conducting 37 patient contacts a day, with some doing as many as 50.
British Medical Association doctors voted overwhelmingly for collective action in the summer The BMA issued a list of actions for surgeries to consider, including limiting patients seen each day or refusing to carry out work GPs are not formally contracted to do. It says GP services have seen a real-terms cut of £659 million in the past six years and only get 6% guaranteed funding as a proportion of the overall NHS budget. The BMA is demanding this is gradually increased by 1% year on year to 15% – “while protecting existing funding across the wider system”.
A new poll of NHS trust leaders shows 71% say it is “unlikely” the NHS can meet the constitutional standards over the next five years. Many of these, such as the four-hour A&E target, have not been met since 2015.
Saffron Cordery, deputy chief executive of NHS Providers, which conducted the poll, said: “The NHS has had its busiest ever summer and won’t get a moment’s respite as it heads into another gruelling winter. Despite this, trust leaders know the health service needs to work differently to improve care for patients. But after years of underinvestment and severe staff shortages, there needs to be realism about how quickly this will happen.”
Patricia Marquis, executive director of the Royal College of Nursing in England, said: “This means packed hospitals and patients lining corridors. There must now be mandatory reporting when patients are treated in such conditions to show the scale of the problem. Nursing staff and managers agree shifting more care into the community is the right thing to do. They also agree severe staff shortages are holding those same reforms back. Recruitment is collapsing whilst thousands are leaving the profession early each year. Ministers need to wake up to the crisis in our profession and deliver new investment.”
In her autumn Budget, Chancellor Rachel Reeves described the £22.6 billion increase in the day-to-day health budget as a “down payment” on the 10-year plan. She also insisted it will “bring waiting lists down more quickly”.