The Primer: Autumn is coming

Autumn is coming

Readers seeking the comfort of familiarity might be pleased to hear the traditional rumbles of the autumn/winter policy season approaching.

Namely, sparks flying over NHS spending settlements, and worries about the severity of coming winter pressures.

On the first, the Times reckons the Treasury may be gearing up for an NHS spending announcement as soon as next week. Although the full spending review won’t be till later in the year, the health service still needs a budget for the second half of 2021-22  so the decisions could be bundled into one, even taking in a long overdue move on social care, the paper suggests.

We’ll believe it when we see it. And — you will not be shocked to learn — the mood music (courtesy of NHS Providers and the Telegraph) suggests the money on offer will be insufficient, potentially leaving the service with real cuts to make improvement ambitions much curbed in the wake of covid. The Nuffield Trust’s Sally Gainsbury, formerly of this parish, wrote a piece carefully estimating the size of the funding hole at £5bn annually earlier this month.

Autumn is coming 2

One contributor to the ‘summer crisis’ of demand urgent care services has been experiencing — perhaps a major contributor — is a surge in respiratory illness and other infections, which are on the rampage out of season after being kept locked down by lockdown. It may also be linked to the heightened mortality rates we are also seeing this summer.  

HSJ revealed concerns about RSV in children back in the spring, and the virus has as forecast been causing problems for paediatric emergency and intensive care services.

The Times brings us the latest update with concerns about how the situation may escalate in coming weeks and months, with schools returning, in the face of covid and other pressures.

A further autumn challenge this year — and one less familiar from past years — will be whatever covid vaccination tasks are handed to the service. Scientific and clinical guidance has not come as quickly as was hoped on vaccinating children and booster shots. This leaves accusations of chaotic policy and delivery, while the health service tries to ready itself for a quick start without knowing the details. In recent days the government has been turning up the volume on appearing poised and keen, with a news story in the Telegraph and column by Sajid Javid in the Times.

On the subject of vaccination, esteemed feminist author Caroline Criado-Perez has written about how pregnant women have been overlooked in the development of covid vaccines, and should not themselves be blamed for poor uptake.

General practice under fire

The difficulty getting a GP appointment is a familiar old sore which has been aggravated by the pandemic. It’s long been a hot ‘doorstep’ issue for politicians, giving rise to a string of initiatives and targets to do something about it: normally they are flawed and soon falter.

The situation has now been aggravated — for some — by the arrival of the GP phone call as an extra obstruction to being seen in person.

They are well represented on the Telegraph letters pages. The paper has been banging the drum for more face-to-face GP access since the spring unlocking, and capped it off on Saturday with a leading article from its tried and tested ‘the NHS needs radical reform or privatisation’ lineage. At the other end of the telescope, there are fresh reports this week of the abuse GPs are suffering in this climate.

In another sign something is going wrong (or is it just good old Wild West GP-land?) the Times reports on a practice whose partners have been crowd funding in their community to pay for their blinds — something that, NHS England delicately points out in the comment, is meant to be purchased by its partners as business expenses.

James Kirkup, also in the Times, thinks the underlying problem is how money is directed, failing to get enough GPs into the deprived areas where they’re more needed for early intervention, referring to research published last week.

If primary care is the foundation of a preventative health service it needs to be strong in the areas of most chronic illness and least ‘health opportunity’. Yet the workforce often flows away from those places, and reforming the GP Carr-Hill funding formula has been firmly in the ‘too difficult’ box for decades.

Instead, NHS England encourages reform around the edges, and last week it published details of the next phase of its ‘long term plan’ GP contract. NHSE is shovelling praise and thanks on the sector recognising it is under pressure and under staffed, on the back-foot, and more sensitive than ever.

Yet while the latest contract update pushes back promised ‘enhanced service’ requirements, it does press on with the introduction of a range of metrics which, if met, will reward primary care networks with meaningful funds. The indicators and requirements include some edgy stuff, especially reducing unplanned hospital admissions, and a new ‘live’ measure of patient-reported access. The current GP patient survey says satisfaction is mostly good and, strangely, went up in 2020 after a trend of decline. It is a very robust survey but annual and slow.

Amid an intense climate over GP appointment access concerns, this new measure is an intervention worth watching. GP mag Pulse’s Copperfield columnist last week gave a flavour of what may be to come, responding to the prospect of these new delivery measures with some archetypal GP fury.