By Brenda Allan, Keep Our NHS Public
In late November, Keep Our NHS Public (KONP)’s primary care conference brought together patients, GPs, academics and campaigners to prioritise the key changes needed to rescue the service, and how to campaign effectively to achieve them.
The government pays lip service to restoring the family doctor and prevention, but its policy and funding march in the opposite direction. It has not reversed the longstanding decline resulting from underfunding, deskilling, dilution and privatisation.
Patient campaigners, Muge Dindjer and Raj Tiwari, from Just Treatment, and Diane Paice, a Haringey PPG member who helped expose problems with Operose contracts (some of which were subsequently terminated) were joined by GPs David Wrigley, Lancashire GP & Deputy Chair of the BMA GP Committee, and Helen Salisbury, an Oxford GP, writer and campaigner. Steve Taylor and Sarah Jacques from Doctors Association UK also participated.
Briefings highlighted the problems despite primary care’s core role in healthcare.
Despite seeing 90% of all patient contacts, primary care receives only 8% of the NHS budget (the OECD average is 14%), yet it’s a core bargain: £1 invested in it yields £14, so crucial infrastructure investment.
Additionally, more GPs per capita improves life expectancy and reduces hospitalisation, as does continuity of care with a known GP; continuity raises GP productivity and job satisfaction, which are crucial to retention.
However, the UK has 16% fewer full-time-equivalent GPs per capita than most OECD countries. GP leavers exceed joiners, practices are closing, and some GPs are under/unemployed because practices lack the funds to recruit them. Counterproductively, until recently, the Additional Roles Reimbursement Scheme only funded non- GP staff.
Hospitals are facing cuts, so reducing the over 7 million patients on waiting lists, is a dream, leaving both primary and secondary care struggling.
David Wrigley highlighted the higher patient/GP ratios, but inadequate numbers of hospital beds, resulting in an increasing number of frail and sick patients at home, dependent on their GPs. Helen Salisbury stressed the value of continuity, the importance of smaller-scale primary care, and GPs seeing patients, rather than supervising large multi-disciplinary teams in remote neighbourhood hubs.
Muge Dindjer and Raj Tiwari stressed the importance of patient stories to highlight shortcomings in primary care and to grab the attention of decision-makers and the media. Just Treatment’s experience confirms the importance of sharing personal experiences, attending meetings, standing up to bullying, using research skills, becoming familiar with jargon, persistently following up non-responses, and forging alliances.
Diane spoke of the stressful time she and colleagues had faced as PPG members confronting the difficulties at their GP practice run by Operose (a company set up by US health corporation Centene, and now owned by venture capitalists T20 Osprey Midco Ltd, part of the HCRG Care Group/Twenty20 Capital) and the hostility and harassment they had faced when highlighting poor practice. Campaigners and PPG members run risks and need support, and PPGs must be strengthened to be more than just CQC tick-box exercises.
Aims and priorities
To be effective, primary care needs to be easily accessible (phone, online, walk-in), welcoming, staffed by sufficient GPs to offer timely access and continuity, with seamless and timely referrals to other colleagues and services, and NHS-funded and delivered.
This requires:
- Larger NHS budget, with an increased proportion devoted to primary care, rising to the OECD average. This will necessitate double running costs for a period to enable hospitals to cut the waiting list backlog while building up primary care capacity.
- Increased numbers of funded FTE GP posts, to reduce list sizes, ensure timely access and continuity of care and make general practice an attractive career again. Digitalisation and the involvement of other professions can enhance primary care, but are no substitute for in-person contact with a known GP.
- Effective incentives to attract GPs to areas struggling to recruit, often rural or poorer areas.
- Halting of the proposed reintroduction of Public Private Partnerships (PPPs) to build new neighbourhood centres, with funds given to NHS providers instead – PPPs cannot be tweaked sufficiently to differ from their predecessors, which were scrapped because they were poor value for money. It is also unclear that the new centres are a priority, and with no new funds, and ICBs facing 50% cuts to operational staff and capped budgets, they risk diverting scarce capacity from core general practice.
- General practice and primary care NHS-funded and delivered – Mandatory APMS tendering has resulted in contracts usually awarded to private companies, often in the less regulated shadow banking sector (private equity and hedge funds), and subsequently traded like commodities, with questionable value for public funds and quality for patients. Maureen Mackintosh from the Open University was present and is investigating the scale and growth of private sector involvement in primary care.
- Patients, carers and others involved from the start in the design, monitoring and evaluation of services, with increased independent scrutiny and accountability to ensure accessibility, acceptability and effectiveness. Halt the abolition of Healthwatch, strengthen PPGs.
- Technology used in primary care and for data sharing must be of proven value, safe, patient-friendly and regulated. There are UK and European alternatives to Palantir and other US tech companies. A NICE system for tech would curtail the current ‘wild west’.
Campaigning for change
There was unanimity on the value and now necessity of patients, doctors and others campaigning together, sharing perspectives, and engaging more with MPs, councillors, local NHS leaders, patient and GP bodies, and the public.
The message must be tailored for different audiences, e.g., public, media, government, ICBs, Trade Unions and others, and we need to be opportunistic as new situations/policies arise, locally or nationally, seizing the chance of quick wins. One GP suggested a fight to reinstate the free earwax removal service -if we can’t win that, what can we do?
We must be alert (and ensure others are) to changes badged as ‘no change’ or ‘improvements’, reform, transform, closer to home’ – euphemisms for cuts. Many MPs and councillors are blithely unaware of the impact of cuts to their local services.
Use all sources of information to boost the message, e.g. GPs Steve Taylor and Sarah Jacques from Doctors Association UK, mentioned the wealth of data DAUK hold on the NHS, useful for other campaigners, and their campaign Your Doctor There for You.
Previous successful campaigns, e.g. North West London’s fight against Same day Access Hubs and North Central London’s campaign against Operose, confirmed the need for:
- Multiple approaches to targeting decision-makers directly, and appealing to what’s in it for them?
- Public campaigning to build public support, ascertaining what really resonates with the majority of the public, who have busy, often not easy lives, to influence policymakers.
- Engaging better with the media – developing memorable campaign names, simple hard-hitting messages, persuasive press releases, and interviews.
- Forging alliances that can be powerful and supportive, and being flexible to handle inevitable, unanticipated, or negative responses and adapt.
A list of some of the main targets for campaigning, allies, and possible actions was drawn up, with no real surprises or revelations, but people found it was useful to have an aide memoire. KONP has also published resources on primary care.
Perhaps a surprise to the government, the message that emerged was that most patients and GPs want the same thing – a resilient, resourced, caring and effective primary care service.
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