I'm not at all surprised that Ipsos Mori's recent poll of vote-deciding issues put health at the top of voter concerns.
I too am concerned about the stance taken by politicians on what needs to be done to improve patient care.
When the system looks at demand management it always looks too far up the line, at demand on hospitals, on A&E, as if that is the point where all the activity happens. Yet it is a fact that 90% of all NHS activity takes place in General Practice with less than 10% of the overall funding. Moreover, an absolute pressure cooker effect has been building every day in GPs' surgeries. In London, we have seen massively increased demand at the doors of all our General Practices as community , social and mental health services which used to support GPs have been dramatically reduced, and as we try to handle all the multiple conditions that accompany our diverse, often deprived, highly mobile and ageing society.
Quite simply, demand outstrips supply not just in hospitals, but also in general practice. And with A&E and hospitals full, patients are increasingly returned to general practices that are handling more and more complex consultations with fewer resources.
We're regularly told by the Daily Mail and others that the 2003 GP contract enabled GPs to work less for more cash. This is a total fallacy. The contract renegotiation was recognition of the challenge of providing round the clock service in the community with a dwindling workforce, and exhausted GPs. Airline pilots would never have been permitted to have worked such hours. That was 10 years ago, and for the last seven years finance has at best been at a standstill while morale has progressively decreased as GPs find themselves working over 60 hours a week at maximum concentration in order to comply with the excessive bureaucracy and risk-averse regulation regimes that make Ofsted look like a picnic.
The most recent NHS structural changes had the potential to put GPs in the driving seat and help them commission and shape services better. Sadly, a lack of strategic direction and a stream of inexperienced expensive management consultants telling everyone how to do their job better has proven a recipe for talking down General Practice. We used to find 80 trainees applying for one GP vacancy: now we are likely to get one between two practices, with many practices carrying vacancies they struggle to fill.
Me and my GP colleagues want a system where patients receive the care they need closest to their homes. To do this we need our politicians to recognise that it is primary care GP, nursing and community services that need investing in, rather than large super-specialised institutions. A 10% shift in their commissioning approach would lead to a doubling of resources into primary and secondary services.
The NHS England Chief Executive Simon Stevens has recently changed the direction of travel of funding to enable these changes over the next five-year electoral cycle and that is a potentially positive move.
But whilst we wait for that to take effect the biggest challenge at the moment for GPs and their teams in London is morale. Morale, recruitment, retention, and the absolute frustration of GP teams to do the job that they believe they are trained to do - helping people to get better, to self-care, and to prevent illness.
Let's start supporting them instead of knocking them. Let's get our medical schools to encourage more doctors to take up general practice as a career, and let's start encouraging more GPs and nurses to work in our capital.