General practice treats common medical conditions and refers patients to hospitals or specialist units if they require urgent or specialist treatment. General practice is best known for providing patient consultations although it also provides vaccinations, diagnoses, simple operations, and helps people manage complex medical conditions. General practice is the ‘front door’ of the NHS, and staff work closely with health visitors, social care staff and charities.
Spending on general practice fell slightly in real terms between 2010/11 and 2012/13, but then increased over the past five years. As of 2017/18, spending was 16% higher in real terms than in 2010/11 but workloads – primarily medical consultations – have increased faster. Performance has largely been maintained but the proportion of patients waiting a week or more to be seen after requesting an appointment rose from 13% in 2012 to 20% in 2017, suggesting that GPs are struggling to provide the same access to care. Public satisfaction with general practice fell by 14 percentage points, from 77% to 63%, between 2010 and 2018.
There is some evidence that continuing to maintain current performance will be difficult though, due to workforce pressures. The percentage of GPs responding to a survey that they have a “high” or “considerable” intention of leaving direct patient care within the next five years increased from 22% to 39% between 2010 and 2017.
Part of the NHS funding boost announced last summer will be allocated to general practice and, in his first speech as prime minister, Boris Johnson pledged that he would reduce waiting times. But there has not yet been any detail on how he intends to do this, and it is not clear whether the funding allocated will be enough to reduce waiting times or improve workforce satisfaction.
There are five different types of ‘trusts’ which provide health treatments in specific geographies in England: acute, ambulance, community, mental health and specialist. Our performance analysis focuses on acute hospitals – these account for the majority of hospitals and provide specialist diagnoses, emergency treatments and surgeries.
Spending on hospitals increased by 19% in real terms between 2009/10 and 2018/19, although the number of pre-booked elective and emergency non-elective admissions to hospitals rose faster – by 24% and 26% respectively – over the same time period. There are now clear performance pressures in hospitals. Hospitals have run an overall deficit every year since 2013/14 and waiting times for treatment – from waits in A&E to waits for cancer treatment following referral from a GP – have increased.
The rise in the percentage of hospital staff who say that they feel unwell from work-related stress (from 28% in 2010 to 39% in 2018) and the rise in the number of voluntary resignations among doctors and nurses, which rose from 6,700 in 2011/12 to 18,600 in 2018/19, suggest that the spending squeeze has created unsustainable working conditions.
Last summer, the government announced that the NHS would receive a real-terms increase of 3.4% each year for the next five years – just above the 3.3% that the Institute for Fiscal Studies and the Health Foundation thought was required to meet demand and maintain performance as of 2015/16. This should allow hospitals to maintain that level of performance, but it is unlikely to be enough to reduce waiting times or improve working conditions.