While some of the major health think tanks such as The King’s Fund say the announced 3.4% increase in annual NHS spending is not enough – and I would agree with that – can we at least use the additional NHS funding more efficiently? I would say it might be worth looking at changing some long-established patterns of patient care.
Let’s start by looking at primary care. Currently it is estimated that around half of all GP appointments are for just two kinds of conditions – musculoskeletal (MSK) problems (accounting for a fifth of all GP appointments) and mental health problems (accounting for a third of appointments). Imagine if all these patients were directed straight to appropriate healthcare professionals for their treatment, rather than having to see their GP first: MSK patients being seen by an NHS physiotherapist (who could also refer them on to a specialist if required), and patients with mental health problems being seen by an NHS psychologist or counsellor for ongoing support.
In some areas, patients can already self-refer to physiotherapy services, the benefits of which have of been well set out by the physiotherapy profession, but this model is not available across the board. If up to 50% of GP appointments could be diverted straight to such specialised NHS services, affected patients would get the urgent care they need more quickly. This model could potentially also be extended to a number of other conditions, such as chronic pain management – after all people don’t need a referral to go to the dentist! This approach was touched on in the 2015 report Making Time in General Practice, but changing patient pathways could go even further.
Such a change would also leave GPs with more time to see other patients. If patient appointments could be extended to say 15 minutes (currently the average appointment time is 10 minutes), GPs could assess patients more thoroughly – especially valuable for those with long-term conditions or presenting with more complex symptoms. At an event on improving cancer outcomes I was involved with last year, one of the speakers talked of a patient with pain who went to her GP seven times before being diagnosed with cancer. Longer appointment times might mean serious health conditions would be picked up more quickly – or ruled out earlier; outcomes could be improved; and overall costs even potentially reduced, as diseases caught early usually need less drastic and costly treatment. This approach would also help to facilitate the NHS’s new Get it Right First Time Programme.
The simple heart of the new approach therefore, would be to get patients through the system as quickly as possible with speedier access to specialist care if required, rather than the current situation where GPs are required to act as ‘gatekeepers’, with access to specialist care being restricted. In rare cases, clinical commissioning groups have even incentivised GPs not to make referrals.
The average cost of a GP appointment is around £40 and an outpatient appointment £120, so accessing secondary care is more expensive, but money would be saved in the long run with less ‘false starts’ and unnecessary repeat visits to the surgery (although primary care would, of course, have an important ongoing patient management role). Streamlining patient pathways would make better use of the available healthcare workforce and scarce financial resources. However, patients would also have to commit to acting responsibly and using NHS services appropriately – and should potentially be charged if they fail to turn up for appointments. Last year missed appointments cost the NHS £1b – that is also completely unacceptable.
Finally, some of the increase in funding also needs to go on prevention – we absolutely need to do more to keep people healthy.
* Judy Abel has worked in the health information and policy sector for more than ten years, including managing the All-Party Parliamentary Health Group for three years until April 2018.
* Judy works for a think tank in London, specialising in health policy