Health and social care

General practice

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.

Adult social care

Adult social care in England – the provision of support and personal care (as opposed to treatment) to meet needs arising from illness, disability or old age – is either paid for publicly or privately, or provided voluntarily, typically by family and friends. Unlike the NHS, adult social care is not free at the point of use – local authorities only provide care services for those who pass centrally-set needs and means tests.

Local authorities face substantial pressures to maintain current access to publicly funded adult social care services – let alone to restore it to 2010 levels. Public spending on adult social care in England has fallen by 5% in real terms since 2010, even as the number of people aged 65 and over increased by 19%. On top of this, requests for support from the working age population have also risen by 5% since 2016. Local authorities have not been able to meet all the needs of the growing number of adults eligible for social care: fewer adults receive publicly funded care now than in 2010. As a result, adults with care needs have increasingly relied on unpaid care – care provided informally by family and friends.

Despite repeated cash injections since the 2015 Spending Review, local authorities still face two obstacles to maintaining current performance – ensuring the financial sustainability of the private companies and charities that provide most care services and recruiting and retaining enough care staff. Local authorities are currently paying private and voluntary providers approximately 10% less than the actual cost of provision for each care home place, and staff vacancies and turnover in adult social care have steadily risen since 2012/13.

In his first speech from Downing Street, Boris Johnson promised that he would “fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve”. But there few signs that this plan, or even short-term funding to ease pressures, will be unveiled today.