The Week, 12 November 2021
Integration has long been the watchword in healthcare policy, and Sajid Javid is no different in his ambition to further integrate health and social care. If his speech to the NHS Confederation on Wednesday is anything to go by, then he is serious about leading on health disparities, which will require a joined up approach. The creation of the Office for Health Improvements and Disparities (OHID), a body designed to target support where it is most needed, is a welcome first step.
A key area in which these disparities is felt is, of course, general practice. As our friends at the Social Market Foundation have this week argued, part of the reason is a mismatch between where GPs are incentivised to practice, and the areas that have the most complex health needs. However as demand for GP consultations skyrockets, and family doctors are expected to provide a wider range of services than ever, Javid should consider more radical change. Consider, for example, that the average list of patients per GP in Liverpool is only 1,614 — far below the national average of 2,289 — and yet it ranks nearly last for health outcomes in England.
Examples like this point to a basic truth about primary care: good health begins in the community and not the GP practice room. When conditions are defined as medical, they are met with medical interventions. In the case of stress, anxiety or depression, though, it is often more effective to target the drivers of conditions rather than simply their symptoms. As Andy Bell of the Centre for Mental Health said this week, “Mental health inequalities are social and economic inequalities”. A GP cannot give someone a fulfilling job, or a close group of friends to socialise with.
Elsewhere in the world of healthcare wonkery, a report by the Health Foundation this week found that whilst the UK performs well for access to hip surgery, the all-cause mortality rate for hip fractures was the worst of the 11 OECD countries it compared. This is partly because, in the UK, hip fracture patients spend more time on inpatient wards after surgery: an environment that limits independence and carries a higher risk of mortality. Look to Canada or the Netherlands, where community care is integral to patient rehabilitation, and mortality rates are suddenly much lower.
All of this is not to say that the UK lacks success stories. The Financial Times this week reported on Ollie Hart, a Sheffield-based GP, who started a community coaching company to help diabetic patients manage their own health. We at Reform have recommended community diagnostic hubs, to meet the diagnostic backlog beyond hospitals. But with more than 90 per cent of patient contacts with the NHS occurring through primary care, more can and should be done to reduce demand on GPs.
Research & Events Assistant