Primary and community care services have been promised an extra £3.5bn a year in real terms by 2023/24.
The additional cash – which builds on the £20.5bn funding increase for the NHS announced in June – has been received with mixed reactions by the sector.
While there is a general agreement that the extra funding will benefit patients, healthcare leaders are perplexed about whether or not it really means that the balance will be tilted more in favour of primary and community care.
Benefits to patients
Professor Joe Harrison, chief executive of Milton Keynes University Hospital, says: ‘Investment in primary and community care is vital in keeping people healthy throughout their lives.
These are services we all rely on day-to-day and, if we are to avoid people coming into hospital or staying longer than they need to, investment in primary and community care provision is crucial.
‘Getting the right care in the right place is important for all of us as patients and for the sustainability of the health and care service overall and so I’m delighted to see this investment being announced.’
Dr Sam Everington, GP and chair of NHS Tower Hamlets CCG, believes the new investment will help patients in three areas in particular.
He says: ‘I am incredibly welcoming of this announcement. What is particularly welcome is the recognition of the importance of investment in out of hospital services. There are three big areas which we think are critical for patients.
‘The first one is terminal illness. Typically, 50-60% of patients with terminal illnesses will be dying in hospital and we know that the vast majority would choose to die either at home, surrounded by their loved ones, or in hospice and [this investment] makes that more possible.
‘The second area is about outpatients. We estimate that, using modern technology, different financial mechanisms and enablers, we could reduce the need for patients to go up to outpatients, by probably 50% and get a specialist opinion far more quickly. We think that is entirely possible with investment in the community.
‘The third area is the whole issue of frail elderly staying in hospital beds. We know that the impact on an 80-year old in a hospital bed for 10 years, losing 10% of their muscles is the equivalent of 10 years’ of inactivity.
In other words, it is absolutely critical that we stop [people] going and [that we] get them out as soon as possible. That is about building up and developing community and social services for patients.’
‘Supporting people’s wellbeing at home’
Julie Ogley, vice president of the Association of Directors of Adult Social Services says they have long advocated that public services should first focus on keeping patients well at home.
She adds: ‘The best way to reduce pressure on hospitals is to provide care which means people don’t end up sick or injured and needing hospital in the first place.
‘We look forward to spending plans being drawn up with local adult social care systems, and with local health and wellbeing boards.
‘Resolving adult social care funding would significantly help planning around community health services, and enable health and wellbeing boards and local systems to deliver the most impact.’
A larger slice of the pie?
Little was said about how the extra money will be allocated and if it truly represents an increase in current primary and community care budgets.
Sally Gainsbury, senior policy analyst at the Nuffield Trust, said this money does not represent ‘a big shift in funding towards out-of-hospital services’ but will ‘simply allow GPs and community services to keep up with demand over the next five years’.
She added: ‘The new money is not going to lead to a significant change in the way that people experience healthcare.
‘What’s more, even if this money did represent a major boost to primary and community services, there are serious questions about whether the NHS has the right staff in the right places to carry this out.’
Her concerns are shared by Amber Jabbal head of policy at NHS Providers: ‘It is not clear from this announcement whether the additional funding amounts to a significantly increased share of the overall NHS budget for primary and community services. We look forward to detailed confirmation that this will be the case.’
Reach frontline staff
Richard Vautrey, chair of the BMA GP Committee, said that it is also little clear whether the money ‘really is new investment for general practice’.
He said: ‘We will want early discussions on the detail of where the money will be spent.
‘The Government has said this funding will reach £3.5bn a year by 2023, but it is also imperative that there is no delay in it reaching the frontline as soon as possible.
Hard-working doctors are leaving the profession as they battle rising demand and unsafe workload, while patients are facing longer waits to be seen, so five years may well be too long to wait if we are to see a reverse in this worrying trend.’