Thérèse Coffey’s “Our Plan for Patients” will not save the NHS or social care from the coming winter crisis, warns Stuart Hoddinott
With the NHS set to come under serious pressure this winter, new health secretary Thérèse Coffey has wasted little time in setting out how she plans to help. In a statement to the Commons and an accompanying policy paper – Our Plan for Patients (OPP) – Coffey focused on the NHS workforce and a promise to speed up the time it takes for patients to get an appointment with a GP. Laudable aims, but in both cases her plan falls short.
The centrepiece of her announcement is the target for all patients to see a GP within 14 days. Setting aside the efficacy of this target for now, its most remarkable feature is its lack of ambition: in the 12 months to July 2022, 86.1% of patients had an appointment within 14 days, with 44.1% of appointments taking place the same day. The plan also aims to free up three million extra GP appointments by either recruiting more primary care staff or increasing clinical pharmacists’ prescribing power. It is unclear whether either of these build on previously announced measures but even if the NHS meets this goal, it would only represent a 1.9% increase in appointments compared to 2021/22 – an amount which does not come close to meeting the scale of demand that the service is facing.
She also made much of a “national endeavour” to support both health and social care. While not fully articulated, it seems that this involves increasing the number of volunteers in both services and encouraging recently retired staff back into service. With an estimated 100,000 vacancies in the NHS and a further 110,000 in social care, this is unlikely to solve either workforce crisis.
The government’s plan is for more GPs and more staff in the wider primary care network to alleviate pressure on GPs, with OPP outlining an ambition to deliver one million more GP appointments by “freeing up funding rules to widen the types of staff that work in general practice”. However, it is unclear if this is in addition to the Additional Role Reimbursement Scheme (ARRS) announced in 2019. The NHS was already on track to meet the ARRS target of recruiting 26,000 more direct patient care staff by March 2024 before her announcement. It is unclear, therefore, if the one million appointments announced today are really “new”, and if they are, the government needs to explain how they will be delivered without additional funding for more staff.
The government has not had the same success with its plans to recruit more GPs and has already admitted that it will not meet its target to recruit 6,000 more GPs by March 2024. While the number of GP trainees increased by 939 between August 2021 and August 2022, the number of fully qualified GPs continues to decline, with 369 fewer in March 2021 and March 2022, a 1.1% drop. Despite this fall, the number of GP appointments increased by 5.0% in the same time period, meaning fewer GPs carried out more work. But the government and the NHS cannot rely on ever-increasing GP workloads to meet appointment targets, as this risks increasing GP burnout and forcing doctors out of the service.
Recruitment by itself is not enough; the government must also focus on retaining GPs. A first step should be to change doctors’ pension rules that currently discourage them from staying in the service – an aim that is stated in OPP, but which the government must now carry out as a matter of urgency.
The announcement of the 14-day target demonstrates once again the government’s reliance on targets to improve performance. As previous IfG work has made clear, targets can work, but only in specific circumstances. The NHS already has too many priorities and targets. According to Jeremy Hunt, GPs alone have 72 targets already. Adding another one is unlikely to improve performance.
The government has made no additional resources available for meeting this target and outlined no clear plan for how it will be met. In this context, many GPs will likely only be able to meet the target by gaming the system by, for example, stopping taking any appointment bookings beyond the next 14 days.
The target also seems toothless, with no repercussions outlined if GPs do not meet it. This is probably because doing so would require the government to rewrite the GP contract – something it will be unwilling to do. Instead, the government announced its intention to publish practice-level appointment data, a decision which the Royal College of General Practitioners has criticised as the creation of ‘league-tables’ that “do not work in improving access or standards of care”.
While the government focuses on primary care, there are other areas of the health and care system where attention and investment could generate greater returns. Social care is experiencing a sustained workforce crisis, with a vacancy rate of 10.7% in 2021/22. Investment in this workforce has the potential for quick wins – care workers require less training than nurses and doctors, and the recent exodus from the service means that there is a ready pool of potential workers who could be convinced to come back if pay and working conditions improved.
The government did make some steps towards this with the announcement of a £500m Adult Social Care Discharge Fund, designed to facilitate quicker discharge from hospitals and improve recruitment and retention of staff. This money should be welcomed in a severely strained service, but unpredictable and time-limited pots of money will not fix the systemic issues in social care. It also appears that this is not new money and is instead being moved out of NHS funding – a decision which will mean poorer performance in another part of the health and care system.
It is good that the government is acknowledging the problems that the NHS face this winter, but the ambitions laid out in OPP are not achievable without a willingness to invest in an expanded recruitment and retention push across both services. Until then, we can expect to see a continuation of the issues that Coffey rightly identified today.
- Government on track to deliver 26,000 more primary care staff - GOV.UK (www.gov.uk)
- GP numbers pledge: health secretary admits government won’t deliver | The BMJ
- Parliamentlive.tv - House of Commons
- More expectations without addressing GP workforce shortage not best way forward, says RCGP
- Vacancy information - monthly tracking (skillsforcare.org.uk)
- (20) Dave West on Twitter: "On the source of the £500m: It is NOT new money from outside of DHSC/NHS budget. DHSC says the dept and NHS are making [it] available from within existing budgets- incl by recycling funding originally provided to enable NHS to pay the health & care levy, now being been repealed" / Twitter