Primary care in England: coping with financial austerity

Abstract

General practices in England are currently facing possibly their most challenging financial circumstances since the NHS was founded in 1948.1 GPs and their primary care teams have traditionally been patients’ point of first contact with the NHS. Primary care teams are responsible for providing access to health services for all residents of England and dealing with most of the acute medical problems patients present with, as well as providing long-term care for people with chronic diseases. They also provide a wide range of systematic and opportunistic preventive and health promotion activities, such as smoking cessation services, NHS Health Checks, and screening for alcohol misuse. A strong primary care sector has allowed the NHS to make efficient use of resources, through the gatekeeping role that GPs have in controlling access to specialist services, and through the wide range of medical, social, and psychological problems that GPs and their teams manage through a mix of person-based and population-centred care. In the past decade, GPs have benefited from increased health spending on the NHS, leading to improved access and shorter waiting times for specialist services; and access to a wider range of services within primary care that are closer to patients’ homes. General practices also benefited from the implementation of a new contract and the introduction of the Quality and Outcomes Framework (QOF) in 2004 that led to an increase in the resources that the NHS allocated to primary care, and a greater focus on health targets. Additional flexibility in the provision of primary care services came from the introduction of personal medical services (PMS) contracts and local enhanced …