No one ever wants to pay over the odds and in many aspects of life we look for value for money, often opting for the bargain especially if it means we aren’t skimping on quality.
When it comes to healthcare our society quite rightly expects it to be good quality, timely and free at the point of need but the gap between expectation and reality here is growing and its impact perpetuating the problem. Nowhere is that starker in Northern Ireland then with general practice.
The challenges are well rehearsed. An increasing population that is living longer with multiple long–term conditions and complex needs, insufficient transformation, crumbling infrastructure and inadequate workforce planning are merely the supporting acts to the headliner of more than a decade of underfunding. This has left general practice now receiving just 5.4% of the total healthcare budget and some of the worst waiting lists in Europe. Put simply, much more need, fewer GPs and patients getting sicker as a result of a system that is ultimately supposed to be making them healthier.
Bearing in mind that primary care delivers more than 95% of all healthcare contacts across a person’s lifetime, and is the part of our health care system than can deliver the greatest economic impact for our society, one must ask the question what is stopping the investment in general practice and what does our society stand to lose as a result?
The current expectation around the slice of the healthcare funding pie is that general practice needs to deliver an all you can eat buffet to a population hungry for healthcare, but we are barely funded for a starter.
For every one pound invested in primary care we see a £14 return compared with a mere £4 for the whole of our system. So, whether you’re a betting person or a cautious investor wanting to increase your chances of a seeing a return or even just seeking value for money, there is no safer bet.
In a system where there is a greater focus on counting outcomes that you can see and measure more easily, it is far from surprising that counting the cost of not needing four medications for heart disease, not developing cancer, not being off work due to a mental health crisis, is a much greater task than those we currently rely on as a measure of productivity, or target reaching.
As generalists in whole person, whole of life, care, GPs are well placed to support not just diagnosis and management but more importantly proactive and preventive care. Care that saves lives, and importantly saves money. Even the very nature of a patient being able to see “their GP” when needed builds relationships and continuity of care. It also results in better health outcomes, when compared to the transactional care that is increasingly on offer due to lack of investment and funding.
Having to focus on firefighting, increasing urgent demand with a workforce that has contracted in the last decade, means that the very things we are good at, and we know improve the health of our patients, are being sidelined, in the quest to do what we can with the limited resource we have. As a result, GPs are as frustrated and disheartened as our patients. The relentless ask is to do more and more with less and less.
The result for patients is fairly obvious. Today’s problems not effectively managed and tomorrow’s problems not halted, not minimised, not prevented but waiting in the wings to make their appearance. When they appear tomorrow’s problems will need more input and more resource to be managed effectively. For GPs burnout and moral distress are as real and as challenging as the 8.30 am scramble for appointments, or the years–long waiting lists for hospital–based care. Too often this leads to GPs quietly quitting, retiring early, handing back a contract, moving abroad, leaving medicine. We cannot afford to ignore or minimise these outcomes any more than we can countenance the lack of access to services for our patients, for one has such a direct impact on the other.
Considering the current healthcare spend and of course the budgetary limitations, there are some stark decisions to be made. Within a transformative agenda the current trajectory of relative defunding of general practice will only lead to reduced access, poorer outcomes and risks widespread destabilisation and collapse. Our society simply cannot afford for that to happen. Budget allocation too will need a transformative approach if general practice is to survive.
A wise investor considers the short, medium and long–term options, spreads the risk and moves money around strategically to ensure the maximum gains. There is no doubt that an invest–to–save strategy in general practice is not just a safe bet, it would be a game changer for patients, for practices and for the NHS in Northern Ireland.
Unfortunately, the window of opportunity won’t be able to stay open for much longer.
Dr Ursula Mason, Chair of Royal College of General Practitioners Northern Ireland and GP Partner in Carryduff Surgery.
Dr Mason’s clinical interests including women’s health and prescribing, she is a member of the NI Prescribing Guidance Editorial Board and a former clinical lead for gynaecology in the General Practice Elective Care Service.
