Rescuing the NHS – the top ten priorities

Posted by jchoules

Professor John Campbell, Professor of General Practice and Primary Care, University of Exeter Medical School

The NHS is deeply embedded in the social and cultural DNA of the nation – because it’s a caring, accessible, high quality service for all, and so is publicly funded through the tax system. The NHS is massively respected and valued  by the public, but the healthcare system is in crisis with particularly serious problems facing general practice, the ‘jewel in the crown’ of the NHS, and an essential part of health and social care in the UK. GPs deliver care which is cheaper than many other internationally-recognised models, and which results in improved clinical and patient-experience outcomes for the UK population. Whilst the Government, the BMA and the RCGP have produced a ten-point plan, many of the proposed solutions are, while laudable, just sticking-plaster options. A fundamental change in approach is needed and here’s my 10 priorities for change.

1. Fund the system properly: if necessary raise taxes; prioritise GP funding with a target of 11% of healthcare spend.
2. Revalue general practice and general practitioners: get rid of the drive towards 7 day working, it’s neither necessary nor desirable and it’s fundamentally flawed in evidence; manage the media- they are destroying general practice; pay GPs properly; use targets such as those in the Quality and Outcomes Framework for patient benefit, not to manage GPs.
3. Reinvent ‘urgent’ and ’emergency’ care – and provide the highest possible quality accessible service for people who need such care.
4. Expect ‘self-care’ – provide high quality support and resources and help for people who manage their own care and use the system well; support individuals and families in achieving this goal; reinvent personal responsibility for health; avoid patients being passive passengers.
5. Invest in high quality social care for people in their own homes and community settings – fund care for older people and pay community-based carers properly.
6. Use the available skill-set – encourage, support and fund the development of new roles and build on the existing high quality skill-set – for example, developing new career opportunities for pharmacists, physios, and nurses; use the high quality NHS management that is currently available; ensure NHS management’s organisational memory and expertise is recognised and retained.
7. Examine healthcare spending carefully – invest in high quality treatments that will enhance people’s health and wellbeing; disinvest in massively expensive treatments that offer only marginal benefits.
8. Work with experts – the BMA, the Royal College of General Practitioners, universities, and patient representative bodies – to help sort the problems; stop making GPs the scapegoat for a failing system of care; act on the recommendations of Health Education England’s Primary Care Workforce Commission.
9. Train doctors better, in the kind of care needed by NHS patients – focusing on the complex care of an ageing population in which people with many co-existing health problems are the norm; medical students need more exposure to high quality, motivated general practice in programmes of training which are properly funded. Fund high quality training for doctors choosing general practice as a career (Health Education England is, like many public services, facing substantial cuts in budgets, and threatening to reduce spending in GP training at a critical moment in NHS history).
10. Develop the health and healthcare evidence base by doubling funding in the high quality health research programmes delivered by the National Institute of Health Research, the research and development arm of the NHS which is funded by the Department of Health.

Professor John Campbell
University of Exeter Medical School

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