NHS England’s planning guidance for the coming financial year ‘once more’ appears to ignore the importance of general practice, GP leaders have warned.
Operational planning guidance issued by NHS England for 2025/26 has halved the number of national targets and ‘minimised’ ringfencing, giving ICBs more flexibility over where to spend funding.
But there is little mention of general practice in the 19-page document, GPs noted, despite the notion that it should be ‘central’ to the ambition of moving care closer to home.
In setting out the priorities for 2025/26, NHS England says ICBs should improve ‘patients’ access to general practice’ and experience.
And action plans should be in place by June 2025 ‘to improve contract oversight, commissioning and transformation for general practice, and tackle unwarranted variation’.
ICBs are also expected to Increase the percentage of patients with hypertension treated according to NICE guidance, and the percentage of patients with GP recorded CVD with cholesterol levels in line with NICE recommendations.
More specific directives for other parts of the health service include a target to reduce the time people wait more than 18 weeks for elective care to 65% by March 2026.
And new benchmarks for improving A&E waiting and ambulance response times as well as speeding up care for people referred for urgent cancer checks.
The focus will mean hundreds of thousands of patients will get faster access to NHS care, NHS England said.
Yet Doctors’ Association UK (DAUK) said there was ‘little evidence’ that NHS England, Government or NHS Leaders have considered the need to support GP practices to deliver care to patients.
Dr Steve Taylor, DAUK GP spokesperson said: ‘With so much talk of moving care into the community to reduce demand on secondary care services one would have thought that general practice would be central to this, given 1.4 million people a day consult GP surgeries, more than all other the services combined.
‘Yet time and again there is little evidence of NHS England, Government or NHS leaders have considered the need to support practices deliver care to patients.’
He added that the top-down approach from NHS England was more costly and less efficient as seen in examples such as virtual wards costing £665 on average for a four day ‘admission’, whilst cutting district nurse provision by 42% and increased ARRS staff while GPs were looking for work.
‘It’s increasingly hard to watch the failure of NHS Leaders, as they fail to see the vital role GPs play in providing preventive, safe and cost-efficient services.’
Under the plans, ICBs will be expected to deliver a further 4% overall improvement in productivity as part of a ‘financial reset’ within systems that must not spend over their allocated budgets.
Yet the continued emphasis on elective care and accident and emergency ‘will inevitably mean other services get deprioritised’ one think tank warned.
In its response to plans to allow more freedom for ICBs to direct funding, the King’s Fund said while local priorities in Blackpool and Cornwall will not be the same ‘the worry is that the spending that often gets pared back is on services to keep people healthy’.
‘These are exactly the areas that need most investment to ensure a health service that is sustainable into the future.’
Sarah Woolnough, chief executive of The King’s Fund, added there was little movement in the plans towards the aim of a community-based health service.
‘The Government’s forthcoming 10-year plan for health will need to show greater radicalism if ministers are to deliver their commitment of an NHS fit for the future.’
The guidance notes that the NHS will need to reduce or stop spending on some services and functions ‘and achieve unprecedented productivity growth in others’.
NHS England said they would back local leaders to take tough decisions, ‘where they are clearly rooted in the needs of their populations’.
A key focus for 2025/26 will be digital transformation with all providers proactively offering NHS App-first communications to patients (with due regard to digital inclusion), as a matter of default.
All GP practices are also expected to have enabled ‘all core NHS App capabilities’, including health record access, online consultations, appointment management, prescriptions management, online registration, and patient messaging.
Separate guidance on the further development of neighbourhood health services with a focus for 2025/26 on those with the most complex health and social care needs who make up almost half of hospital costs.
To free up resources, ICBs are expected to develop specific plans around adults with frailty, including dementia, those with palliative care needs, adults with complex disabilities or multiple long-term health conditions, children and young people who need wider health input and anyone who is a high intensity user of emergency departments.
Yesterday NHS chief executive Amanda Pritchard and chief financial officer Julian Kelly were grilled by MPs about their response to a report from the Public Accounts Committee which concluded there had been a lack of ‘fresh thinking’ and ‘decisive action’ to meet policy ambitions to shift funding away from hospital to the community.
The report recommended that year on year NHS England should ensure a ‘greater proportion’ of its funding is spent in the community, including general practice, ‘in line with its own policy ambition’
After the session, Health and Social Care Select Committee chair Layla Moran said they had been left ‘disappointed and frustrated’.
‘We had hoped for a sharpness in witnesses’ responses but were exasperated by the lengthy and diffuse answers that were given to us and will be writing to them to seek the clarity that we expected to hear in the evidence session,’ she said.
An NHS 10-year plan expected in the spring will be ‘underlined’ by a shift from ‘hospital to community’, on the basis of Lord Darzi’s report which said increased general practice funding should be a ‘fundamental strategic shift’ for the NHS.
The next GP contract is also due in the spring and will be backed by an extra £889m ‘on top of the existing budget’ for general practice.
In a statement accompanying the planning guidance, Ms Pritchard said the NHS was providing more appointments, tests and treatment than ever before, helping to cut long waits – but we know there is much more to do.
‘The NHS must go further and faster to improve and reform care, and today’s guidance aims to deliver more timely treatment for hundreds of thousands of patients.
‘In what will undoubtedly be another tough financial year, the NHS will continue its relentless focus on boosting productivity and driving efficiencies for the benefit of patients and taxpayers.’
Thank goodness for the ‘action plan’ General Practice is saved🙄