Lord Darzi has been warned by GP leaders of risks to continuity of care, insufficient funding, and rising workload dump, in his Government review of the NHS.
Last month, health secretary Wes Streeting revealed that Professor Lord Ara Darzi will lead an ‘independent investigation’ into the state of the NHS, in one of his first announcements following Labour’s win at the general election.
The findings from this ‘rapid’ review, expected in September, will inform a new 10-year plan to reform the NHS.
Lord Darzi has now received evidence from organisations across the healthcare sector, including the BMA, Londonwide LMCs, the RCGP, and the Doctors’ Association UK.
Issues in general practice featured heavily in the BMA’s submission, which argued that the lack of GPs and ‘inadequate resource’ are ‘negatively impacting continuity of care’.
The union emphasised the importance of continuity of care in general practice, citing evidence that it improves mortality, patient satisfaction and also efficiency.
It said: ‘The crisis in general practice is fuelled by an insufficient supply of GPs to meet demand and inadequate levels of resource being directed to primary care.
‘By compromising continuity of care, through practices being less able to provide patients with consistent access to the same GP, opportunities to reduce hospital admissions are lost.’
On workforce, the BMA said there has been an ‘appalling loss of GPs’ which requires ‘active intervention to reverse through better and urgent agreed contract changes’.
The evidence to Darzi also highlighted ‘dwindling trainer capacity’ which is ‘undermining training commitments’, and criticised policy decisions which ‘undervalue the medical profession’, such as the deployment of physician associates (PAs).
‘The way in which Medical Associate Professionals have been extrapolated beyond being doctors’ assistants has led to avoidable conflict and needs urgent resolution,’ the BMA argued.
Meanwhile, Londonwide LMCs, whose members make up over a fifth of English GP practices, told Lord Darzi that GPs have ‘insufficient funds’ to deliver core services, while there are ‘growing reports’ of GPs struggling to find work.
London GP leaders pointed out the risks of workload dump, citing their workforce survey which suggests that three quarters of practices believe safe patient care is impacted by ‘unresourced, under-resourced or non-contracted workload shift from other providers’.
They also drew Lord Darzi’s attention to the recent controversy over North West London ICB’s now-shelved plans to impose a same-day access model on GP practices.
‘The lack of consultation on imposed single access models for same day access in North-West London led to significant analysis of potential harm and inequity exacerbated by the model being financially incentivised.’
The Doctors’ Association UK (DAUK) highlighted the high workload in general practice, compared with low levels of funding.
According to their submission to Lord Darzi, GP practices receive ‘just £23 per appointment’ while acute hubs and Pharmacy First both receive £48 per consultation.
‘As workload for GP practices has increased by 20%, funding has decreased by 20% [in pounds] per patient,’ DAUK claimed.
The doctors’ organisation had previously written to Lord Darzi urging him to take GP underfunding and pressures into account in his review.
DAUK GP spokesperson Dr Steve Taylor told Pulse that addressing the ‘drop in funding’ for GP practices should be the priority for Lord Darzi in his review, as well as an ‘improvement in GP to patient ratios’.
He said that that any reforms to general practice should avoid ‘too many targets’ and ‘give practices a bit more of a free rein to do the work, and trusting them to do it’.
On whether the review is likely to make a difference, Dr Taylor highlighted that the health secretary has been ‘quite clear’ that he plans to shift funding from secondary to primary care, and for this reason there is ‘definitely hope’.
However, on Lord Darzi’s background as a former Labour health minister, he told Pulse: ‘I think there is certainly some caution. I’ve got concerns, and I think other GPs have got the same concerns, that because he’s coming from a secondary care background, his viewpoint isn’t based around general practice.
‘He failed to listen when Labour were last in – whether he’s listened since is a question.’
‘I think misunderstanding what partnerships do is a problem – it was a problem for Labour back then, and it might be problem in this situation now,’ Dr Taylor added.
The RCGP stressed that the long-term workforce plan, which aims to increase GP training places by 50% by 2031, ‘lacks a proper retention strategy’.
As highlighted in a letter to the health secretary last month, the college repeated its concern that the long-term workforce plan only aims to increase the number of fully-qualified GPs by 4%, compared to 49% for hospital doctors.
The college told Lord Darzi: ‘General practice remains one of the most efficient parts of the NHS, and if properly and equitably resourced, can play a key role in alleviating pressures across the NHS.’
Lord Darzi, a surgeon who holds the Paul Hamlyn chair of surgery at Imperial College London, was asked by Mr Streeting to produce a ‘raw and honest assessment’ of the state of the NHS.
He is well-known in general practice for Labour’s previous GP ‘polyclinic’ model – known as Darzi centres – which was later scrapped by the Coalition Government.
One of Labour’s manifesto promises was to trial ‘neighbourhood health centres’, which seem to resemble the Darzi model, with the aim of improving out-of-hospital care.
Lord Darzi has also argued more recently that GP services should be brought ‘into the fold’ with a salaried model, as the partnership model is out of date.
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Darzi has already demonstrated his complete lack of understanding of General Practice, and in particular the partnership model of care. But rather than being consigned to the bin his report will shape the future of the NHS. The BMA and GPCE will need a very clear strategy to ensure General Practice is not sidelined while the lion’s share of funding stays in secondary care.
The warnings and advice from BMA, LMC, DAUK etc appear to be well appointed. The same cannot be said for Lord Darzi leading this review.
Darzi has form and cannot claim to be independent. Darzi is wedded to the industry-led Global Health Initiative, and as a WEF 2012/13 steering group leader, remains zealous advocate. This is significant and highly relevant. See McKinsey.
Not only is Darzi far from independent, he is one of the most inappropriate professional choices to lead any review into general practice. He’s clearly undaunted by a complete lack of nuance and understanding of the benefits of general practice and, particularly, Partnerships.
Hard to imagine him seeing lessons learned as anything apart from how to avoid the bureaucracy of objections to a second iteration of polyclinics, salaried service, and a downskilled dysfunctional vision of General Practice.
Any genuine shift of care from secondary to primary care will inevitably entail new investment and costly double-running. Acute sector cannot tolerate cuts in order to permit this ‘shift’ of care. The lessons of Thatcher’s 1990 ‘Care in the Community’ have still not been learned nearly 35yrs on. Half-arsed policies – seen as “savings” and “better care” for patients – have repeatedly proved to be false economics: producing neither better value nor care; worse, actually. Valdo Calacane foretold by Christopher Clunis.
The future of community care looks increasingly like GHI: digital remote care, serviced by non-professionals. Outsourced and privatised. irreplaceable loss of NHS skills, staff, and institutional memory.
With the appointment of Darzi, Milburn, and Corrigan, the sense of déjà-vu and doubling down is inescapable.
This guy got it very wrong before..its worrying the current lot don’t appear to know this. He’s an “old name”, from a “previous labour era” that otherwise has become regarded as a “good time” for the NHS. Thats as far as the analysis goes. Thats why hers back. Thats the only reason. Structural stuff the labour party did to primary care back then with QOF and their absolute obsession with micromanagement and set up the dying service we have today. This guy was there at the time, happily dismembering everything. Here he is again, is that a syringe driver I see in his bag? Time will tell