The new labour government commissioned a report into the current state of the NHS from Lord Darzi as one of its first acts. Whilst there will be many people who roll their eyes at yet another report with recommendations, there is no doubt that it lays bare some astonishing statistics. It also contains many sensible ideas. The question, as always, will be how many of them can be implemented successfully, and by when. 

This article examines the report’s take on what will be the two most important areas for readers of this blog: primary care and general practice. It explores some other statistics from areas of the NHS which impact on GPs and primary care either directly or indirectly. Finally, it ends with what Lord Darzi says needs to happen next, taken verbatim from his report.

The Situation in General Practice

General Practice is how most people commonly interact with the health service. It is rightly known as the “jewel in the Crown of the NHS”. The overall trend is for more GP appointments than ever before, with GPs working harder and seeing more patients. However, there are many areas of challenges and poor functioning:

•    Lots of frustration from GPs and staff who see more tasks being shifted from secondary care to primary care, with increasing demands for follow-ups – at a time when the hospital workforce has grown to amongst the highest in the world.
•    The current GP contracts are too complex, and too often mean that doing the right thing for patients can require doing the wrong thing for GP income. That cannot be right.
•    Crumbling real estate – 20% of it predates the founding of the NHS in 1948. 53% is more than 30 years old. GPs have too little control offer property thanks to of LIFT (PFI-type) schemes.
•    Supporting roles in the GP practice like pharmacists and occupational therapists are positive, but they should be a supplement to a GP, not a replacement for one
•    There are too many variations across ICBs – especially in terms of patients per GP
•    Data sharing is not good enough – it does happen in patches like the OpenSAFELY programme which integrates GP data from across the country – but its potential is mostly untapped

The Wider Context - What the Report Says About:

•    The NHS App: although 80% of adults are registered on it, less than 20% use it monthly. It was designed to be transformative, but astonishingly, just 1% of appointments are managed using the App. 
•    NHS 111: GP remains the number 1 destination users are advised to go to: 43 per cent told to contact their General Practice, 12 per cent advised to attend A&E or other urgent care and 12 per cent given an ambulance response. Self-care remains a relatively small proportion at less than 1 in 10 callers. But abandoned call rates are too high – the target is 3%, but it currently stands at 11.3%.
•    Access to dentists: Only 30% of NHS Dentists are currently accepting new child patients, and only 40% accept adults. The problem is not the supply of dentists – it is that not enough of them want to do NHS work. 
•    A&E: long waits are likely to be causing an additional 14,000 more deaths a year—chillingly, that is more than double all British armed forces’ combat deaths since the health service was founded in 1948.
•    The HSCA 2012: Here, Lord Darzi is scathing. The Health and Social Care Act of 2012 was "a calamity without international precedent". It proved disastrous. By dissolving the NHS management line, it took a “scorched earth” approach to health reform, the effects of which are still felt to this day. Some sanity has been restored by the 2022 Act which put integrated care systems on a statutory basis. BUT - Across ICBs, there are differing understanding of their roles and responsibilities, including how far they are responsible for the performance management of providers, and quite how and at what level they should tackle population health.

Things that need to happen: What Lord Darzi Prescribes:

“Re-engage staff and re-empower patients. Despite all the challenges and low morale, NHS staff are profoundly passionate and motivated to raise the quality of care for patients. Their talents must be harnessed to make positive change. The best change empowers patients to take as much control of their care as possible.

Lock in the shift of care closer to home by hardwiring financial flows. General practice, mental health and community services will need to expand and adapt to the needs of those with long-term conditions whose prevalence is growing rapidly as the population age. Financial flows must lock-in this change irreversibly or it will not happen.

Simplify and innovate care delivery for a neighbourhood NHS. The best way to work as a team is to work in a team: we need to embrace new multidisciplinary models of care that bring together primary, community and mental health services.

Drive productivity in hospitals. Acute care providers will need to bring down waiting lists by radically improving their productivity. That means fixing flow through better operational management, capital investment in modern buildings and equipment, and re-engaging and empowering staff.

Tilt towards technology. There must be a major tilt towards technology to unlock productivity. In particular, the hundreds of thousands of NHS staff working outside hospitals urgently need the benefits of digital systems. There is enormous potential in AI to transform care and for life sciences breakthroughs to create new treatments.

Contribute to the nation’s prosperity. With the NHS budget at £165 billion this year, the health service’s productivity is vital for national prosperity. Moreover, the NHS must rebuild its capacity to get more people off waiting lists and back into work. At the same time, it should better support British biopharmaceutical companies.

Reform to make the structure deliver. While a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable, there is more work to be done to clarify roles and accountabilities, ensure the right balance of management resources in different parts of the structure, and strengthen key processes such as capital approvals. Change will only be successful if the NHS can recover its capacity to deliver plans and strategies as well as to make them.”

The next plan to be published for the NHS is expected in the spring; there will be no quick fixes here, but the new government is clear with its message: in its own words, the NHS must reform, or die.