Loading... Please wait...

​​​Does financial restraint and healthcare provision mean a conflict of interest in modelling STPs?

Posted by

What do you do if you expect a 72% increase in weekly patient contact hours by 2021? It might surprise you to hear that slashing the number of GPs available to see patients is deemed to be the answer. That's what the Sustainability and Transformation Plan (STP) for Somerset is proposing. The extra demand will be met by a 43% increase in the total primary care workforce. Fewer doctors, more pharmacists, more paramedics, more counsellors, more nurses, and more health coaches.

While the government plans for more GPs, STPs are prompting cuts

The government has promised to recruit more GPs. The RCGP says that 10,000 are needed as a third of GPs are expected to retire in the next five years. Yet the STPs demanded by NHS England are clearly driving primary care away from client consultations conducted by GPs and NHS doctors.

(Read our blog post about how the RCGP push for doctor recruitment may be missing the point.)

These STPs are supported by NHS England, NHS Improvement, the Care Quality Commission (CQC), Health Education England (HEE), Public Health England (PHE) and the National Institute for Health and Care Excellence (NICE).

What they do is admit to a growing need for primary care, while justifying cuts in GP numbers by a more 'patient-centric' approach. Patients should be educated to take more control over their own health needs. It looks as though GPs will be expected to help their patients develop their care plan, selecting the healthcare professional that is most appropriate to their needs.

In Somerset, a reduction in GP numbers from 310 to 254 is planned by 2021. This shouldn't be hard to achieve – a third of doctors in the area are expected to retire in the next three years, and 50% of vacancies will remain unfilled.

Can the objective of sustainability be met?

The Somerset STP seeks to tackle a deficit forecast at £600 million by 2021. Slashing the number of GPs might be expected to help reduce this deficit. However, the increase in other primary care staff is projected to cost an extra £8.3 million. In order to meet this extra cost, practices will need to consolidate and redesign their services to be more cost-effective.

Who will lead this? GP practices, of course. They will be responsible for employing the new employees needed to deliver a greater range of services. Practices will be expected to share or outsource administration functions. Staff will probably need to be shared between practices, or practices merge.

As we've discussed before in our blog "amalgamation of hospitals and GP practices could be the way forward for primary health in the UK", patients may benefit from a new model of care. But that model of care should surely be devised to produce the care that is needed.

Somerset STP leader, GP Dr Matthew Dolman has quite rightly said, "Doing nothing is neither desirable nor sustainable, and that's the case across the country." He also said, "It is essential that health and social care are financially sustainable. If we continue spending beyond our means we will struggle to maintain good, safe services."

He's right that spending beyond means is a road to no service provision. However, I'm not convinced that patients, carers, and the wider public will see the proposals for the slashing of GP numbers as the future of healthcare they are expecting. And this is the possibly unavoidable conflict of interest facing all STPs.

eSupplies Medical is a trading name of Williams Medical Supplies Ltd, a DCC business