Redirecting NHS funding from hospitals to GP practices is ‘not straightforward’ and will happen ‘slowly over time’, the new chair of NHS England has said.
Dr Penny Dash, the Government’s preferred pick to lead NHS England’s board, recognised GPs’ ‘frustration’ about underfunding and said the profession is ‘crying out for change’ such as new neighbourhood teams.
After being appointed as the ‘preferred candidate’ for the NHSE role last month, Dr Dash, who is currently chair of North West London ICB, came under scrutiny from MPs this morning in her pre-appointment hearing.
MPs questioned her on the implications of her previous private sector roles, including 19 years at the management consultancy McKinsey, and whether as NHSE chair she would simply be a ‘mouthpiece’ for health secretary Wes Streeting – a claim she denied.
When asked about the ‘primary impediments’ to achieving the Government’s much-touted goal to shift care from hospitals into communities, Dr Dash said that ‘one thing is changing the patterns of investment’.
She told MPs: ‘One is, as many GPs would say, at the moment, there’s quite a bit of frustration amongst the primary care community […] around levels of investment in that.
‘And if you can look at what’s happened in terms of the money over the last five years, last 10 years, we have ended up spending more money in the hospital sector than in the primary care sector and the community sector. And I think that needs to be reversed.’
This echoes Mr Streeting’s previous commitments to ‘reversing’ the underfunding of general practice, as well as Lord Darzi’s assertion in his influential report that increased GP funding is required as a ‘fundamental strategic shift’.
But Dr Dash admitted that any reversal cannot happen ‘overnight’ and will ‘require quite a lot of changes’ for both GP practices and hospitals.
She told MPs on the Health and Social Care Committee: ‘Obviously, you can’t do that overnight, but slowly over time, that needs to happen.
‘And we need to become more in line with other countries that we would probably aspire to look a bit more like, particularly the Nordic countries, for example.
‘So there’s definitely a bit about changing some of those investment patterns and doing that, and of course, that is not straightforward to do, and that’s going to require quite a lot of changes, both in terms of – I don’t particularly like the term “out-of-hospital” – but in terms of local care, as well as in terms of the hospital-based care. So one thing is changing the patterns of investment.’
When pressed on whether this will mean the Government has to ‘pull money out of hospitals’ to give to GPs and other community services, Dr Dash told MPs that this will be necessary if total funding does not increase substantially.
‘If we want to change the relative balance, either we make differential investment decisions as the amount of money in the system goes up, but in a world where we’re not anticipating vast increases in the amount of money going into the system, then that would mean starting to transfer funds.’
Dr Dash also emphasised the importance of neighbourhood working, on which she said the upcoming 10-year health plan would provide more clarity.
She was questioned on previous comments she had made about ‘vested interests’ which hold back attempts to reform primary care, such as integrated neighbourhood teams.
The incoming NHSE chair pointed to both hospitals and the BMA as potential vested interests, telling MPs it is a ‘complicated landscape’.
‘Hospitals aren’t standing up at the moment and throwing money back at the ICB and saying “please spend more on primary care”, even though they themselves would absolutely say that they would like to see a better functioning model of neighbourhood care,’ Dr Dash said.
She was not able to say what ‘challenge’ she might expect from the BMA, but added: ‘My sense is that in terms of what the GP community is saying, the GP community is crying out for change.’
Dr Dash’s current ICB came under fire last year after Pulse revealed its plans to effectively mandate the use of same-day hubs by introducing them to the ‘single offer’ of enhanced services for GP practices.
She also led the damning review of the CQC which found ‘significant failings’, including that there is a ‘lack of consistency’ and transparency in ratings of GP surgeries.
Alot of nothing .
Too slow and there will be no General Practice to move any funding to.
I’ll believe it when I see it the money has been going in the opposite direction and no doubt will continue to do so.