It is clear that our NHS is the envy of the world, but it is also clear that in its current form it is unsustainable. An ageing population and advances in medical treatments have resulted in an explosion of demand which has placed unprecedented pressure on the NHS workforce and led to a crisis in both health and social care. This, together with the issue of significant underfunding, is impacting negatively on patient outcomes. The system is crying out for change but the government is in denial and seems determined to turn a blind eye.
Greater investment in the NHS is undoubtedly needed, but the problems will not be fixed by money alone. It is important we change the way we view the whole issue of healthcare – we must shift our focus from illness to the promotion of good health and wellbeing.
Wellbeing and the prevention of ill health begins in the lives that people live and in the communities, where they live. The decisions of individuals need to be supported by a properly funded department of public health and they need to be able to access health advice in the community. Where illness is present it needs to be diagnosed and treated promptly, with hospitalisation being a last resort. Every month we hear of ambulances queued outside Accident and Emergency Departments, patients left for hours on trollies on hospital corridors and bed shortages. Much of these problems could be alleviated by empowering primary care. This would leave hospitals to deal with the most serious medical procedures.
For too long primary care and general practice have been synonymous. We have to move on from this and develop a wider primary care team that maximises the abilities of a range of health professionals, ensuring that patients are seen in a timely manner by the most appropriate medical professional.
The NHS is currently losing GPs to retirement and other professions faster than new GPs can be trained. Back in 2016, the government recognised that there was a shortfall of 5,000 GPs – this figure is now closer to 6,500. We are going backwards and we will continue to haemorrhage GPs, until steps are taken to relieve the intense pressure which this surge in demand has created.
An obvious starting point, in my view, would be to mobilise the community pharmacy sector, to be all that it can be. This is a sector of which I have extensive personal knowledge and it is a fact, that the sector is well placed to step up and support GPs. Various pilot schemes across the country have demonstrated the value of permitting community pharmacists to take on extended roles supporting GPs, not just with medicine management but by undertaking responsibility for the month to month management of patients with long term chronic health conditions; by the introduction of minor ailment schemes; and by introducing pharmacy led hospital discharge services preventing unnecessary hospital readmissions. Where such work has been piloted, it has been found to be hugely successful freeing up GP appointments, reducing hospital admissions and most importantly has led to better patient outcomes.
Of course, mobilising community pharmacy could lead to fully utilising the skills of a range of health professionals including specialist nurses, health visitors, physiotherapists, occupational therapists, geriatricians and paediatricians, as part of a highly skilled, joined up primary care team. This could transform services for patients and relieve pressures in the wider NHS.
The above-mentioned healthcare professionals working in the community also have a massive role to play in the prevention of ill health – for example, occupational therapists working with older patients can reduce the number of falls, or community pharmacists can monitor blood pressure in at risk groups and are well placed to advise on healthy lifestyles. They can also help to ensure compliance with prescription medicines, improving efficacy and reducing waste.
I would also advocate the creation of a primary care infrastructure that links health professionals and the community via social prescribing. Where social prescribing is used it has been shown to significantly reduce pressure on GP services, hospitals and mental health services.
Developing and empowering the primary care team at the heart of the NHS would undoubtedly require additional investment in the first place and also some switching of resource from secondary care, but it has the potential to deliver better patient outcomes, reduce future costs and truly transform the health of the nation.