It will only support a broken systemby Alexander Hitchcock / January 18, 2017 / Leave a comment
If the winter healthcare crisis seems acute this year, imagine how it would feel if the NHS didn’t exist. Figures from the Office for Budget Responsibility released yesterday show that, on the current trajectory, our spending on healthcare cannot be sustained. It is projected to rise from 6.9 per cent of GDP in 2021-22 to 12.6 per cent of GDP in 2066-67. This rise cannot be explained by any single reason, but a significant driver is that people are living longer, with more long-term health conditions.
The time-honoured response is to argue for more money. This dominated the Brexit debate and is supported by people across the political spectrum. If so, yesterday’s OBR figures beg the question: what do we want to cut? Social care, which will be 2 per cent of GDP in 50 years? Education, which will be 4 per cent?
Yesterday’s projections should provide fresh impetus for ministers looking to deliver an NHS that can meet the needs of 21st-century patients. The government has an ambition to deliver more care outside of hospitals, but recent Sustainability and Transformation Plans have focused largely on meeting deficits in NHS trusts.
More money will only support a broken system. A new approach is needed. One answer is to keep people out of the system in the first instance. An estimated 63m GP appointments (17 per cent of the total) are delivered to the “worried well.” Mobile apps, some driven by artificial intelligence, can triage these patients to information or self-care, freeing up room for GPs to deliver care to patients otherwise waiting two weeks or more.
Alongside this, a 21st-century model of care is needed. Larger general practices can deliver urgent care, diagnostics and even minor surgery. This is better for patients, who can avoid trips to hospital and receive quicker referrals to specialists. It can also save money for the whole system. In Northamptonshire, urgent care is delivered at the third of a cost of an A&E appointment in primary care—a price that could deliver savings of £1.1bn across England, according to Reform research.
To facilitate this, GPs should make better use of the healthcare workforce. Nurses, pharmacists and physiotherapists could deliver up to 50 per cent of today’s GP appointments, freeing up to 140m appointments for GPs to focus on the complex problems posed by those with long-term conditions. If nurses or pharmacists deliver the 15 per cent of appointments that relate to common conditions, savings could top £700m.
For this approach to succeed, the NHS needs a new mentality: one in which the system acts as a whole to deliver care to patients in the best place possible, at the lowest cost. This requires new contracts for healthcare, aligning clinical incentives with business incentives. Fixed annual payments per patient for GPs alongside activity payments in hospitals incentivise care being delivered in the latter. Contracts are needed to align responsibility for patients across the healthcare system, to incentivise care that will avoid the need for patients to end up in surgery.
Reform has always been needed in the NHS to meet the needs of patients at lower costs. Yesterday’s OBR figures up the stakes: reform is now needed to ensure the existence of the NHS. Politicians and healthcare leaders must push change now to avoid the ultimate winter of discontent.