A report released by thinktank the King’s Fund has called for a “radical and wholesale” refocusing of the health and care system towards primary and community services, prompting support from the Society of Radiographers.
Community-based healthcare can help reduce waiting times and improve patient care, the report, entitled 'Making care closer to home a reality: refocusing the system to primary and community care' says.
‘Effective and sustainable’
The vast majority of interactions with the NHS are through primary and community services – such as general practice (GPs), community pharmacy and district nursing. On average there are more than 876,164 GP appointments in the NHS every day, an increase of 34,219 appointments a day since 2018/19.
Despite this rise in demand, and despite repeated pledges to boost out-of-hospital care, the proportion of Department of Health and Social Care (DHSC) spending on primary care has actually fallen (8.9% in 2015/16 to 8.1% in 2021/22). In 2021/22 the largest proportion of DHSC spending, £83.1 billion, went to acute hospitals, compared to £14.9 billion spent on primary care.
Patients struggling to get appointments with their GP are at risk of their condition deteriorating and having to seek urgent help from already over-stretched acute hospitals, the authors say.
The report proposes incentivising more staff to work in primary and community services through increased pay and status and focus on career progression if it is to be effective and sustainable.
‘Community care can only alleviate the strain’
The King’s Fund report does not refer to the current rollout of Community Diagnostic Centres (CDCs). However Dean Rogers, executive director of industrial strategy and members relations for the SoR, said they could have used it as a “cautionary tale”.
The government has said staffing CDCs will require an additional 4,000 radiographers, as well as 2,000 radiologists and 500 advanced practitioners. The average vacancy rate for radiography has risen to 13.4 per cent, and this year the majority of university courses for diagnostic radiography had to enter clearing, because of a lack of students to fill their places.
“It is right to flag up the fact that lack of investment in primary-care services means that patients’ conditions worsen and they end up having to seek urgent care in A&E,” Mr Rogers said. “This further stretches our already overburdened hospitals.
“The SoR cannot emphasise enough how vital this step is. Community care can only alleviate the strain on hospitals with proper investment in healthcare professionals.”
‘A clear vision for community care’
The government has not allocated any additional funding for recruiting and retaining radiographers for the CDC programme. The SoR therefore fears that CDCs will drain hospital acute departments of staff, leaving critically ill patients waiting even longer for diagnosis and treatment.
The King’s Fund emphasises that “we cannot treat community care as a cheap, quick-fix solution”.
M Rogers added that the UK needs a “clear vision for how community care should work – with proper workforce funding to match”.
The report authors argue that the failure to grow and invest in primary and community health and care services, despite successive governments stating a commitment to this agenda, is one of the most significant and long-running policy failures of the past 30 years.
‘Keeping people healthy at home’
Instead, the report calls for future funding to be directed into a comprehensive plan to refocus the health and care system towards primary and community care. They warn that a piecemeal approach of cherry-picking policies ‘will not miraculously unlock change’.
This plan includes:
1. A clear vision for bolstering services
2.Growth in health and care funding targeted at primary and community services
3. Improved pay, status, and career progression incentives
4. Investment in care buildings and equipment
5.Greater flexibility for health and care leaders to meet local needs
Beccy Baird, senior fellow at The King’s Fund and lead author of the report, said: “Like other countries, England needs to bend the curve on the predicted rise in demand for high-cost, reactive and hospital-based care. That means supporting people to take care of their health and wellbeing, intervening early and keeping people healthy at home for as long as possible, which can only be achieved by bolstering primary and community services.
“While these changes may not unlock the quick-fix savings many mistakenly expect, the alternative is to build more expensive hospitals to manage acute needs that could have been prevented or better managed in the community.”
(Image: Dean Rogers, by the SoR)