The chancellor’s decision to spare the public sector from the increase in national insurance but not to include general practices, where 90% of patient contacts happen, is a clear example of the Treasury’s failure to support much-needed change (Services for most-vulnerable people at risk after NICs rise, charities say, 1 November).
The Treasury chief secretary, Darren Jones, justified this by saying that many GP practices are private businesses, but a way must be found to ensure that investment in GPs and their staff is not continually held back. It is difficult to see Wes Streeting achieving his desire to see primary care playing a greater role while taking away money from general practice.
A failure to match the number of GPs to the increase in the number of patients registering with them has led to practices operating triage systems that allocate patients to the first available clinician and thereby reduce continuity of care, which is shown to improve both outcomes and patient satisfaction. Triage can reduce waiting times appropriately for more urgent needs, but quicker access to a clinician who does not know you is not what many patients want or need.
A past focus on making savings has led to hospitals becoming less efficient too. In order to save money, beds have been closed to a level far below comparable countries, resulting in hospital bed occupancy being close to, or above, 100% in recent years. There is ample evidence that bed occupancy above 85%-90% causes hospitals to become much less efficient, with patients stuck in inappropriate parts of the system.
Saving money often results in administrative support to clinicians being reduced when efficiency should mean that highly trained staff are able to spend their time using their skills, not completing administrative tasks.
Phil Taylor
Retired GP, Kilmington, Devon
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