The crisis in accident and emergency departments leads me to share the results of an analysis from East Devon. Two years ago we worked with hospital colleagues to identify the cause of the large increase in emergency admissions in our area. East Devon has a population structure equivalent to that projected for England and Wales in 2042; we found that people aged over 80 years formed the bulk of the increase in emergency admissions and, to a lesser extent, attendances at the emergency department of our main acute hospital. We worked in partnership with the acute hospital to address this problem.
It seemed inconceivable to us that consultations in primary care by this group wouldn’t also have risen dramatically. We analysed data from our practice computer system, comparing consultation statistics between 2004 and 2012. We found that in 2004 our GPs and nurses saw 63 377 patients in the surgery, made 2531 home visits, and had 4609 telephone consultations. In 2012 these figures were 78 597 (24% increase), 3241 (28% increase), and 18 810 (408% increase) respectively. Our practice population had grown by 10% over this time period. All components of our work had increased substantially but telephone consultations had shown an extraordinary rise.
We were not able to analyse these figures by age group, but data from the NHS Information Centre (provided from the QRisk® studies of Professor Julia Hippisley-Cox et al) from 1995–1996 onwards show that, whereas the average consultation rate per year for a registered patient rose from 3.9 to 5.5, there were much higher rises in the over 85s, for whom consultation rates approximately doubled, from 7 to 14 consultations per year.
Nationally, including the 2004 contract change, real terms primary care trust (PCT) spending on primary care rose by 22% (just under 3% a year) between 2003–2004 and 2011–2012. Almost all of this increase occurred between 2003 and 2005. In comparison, PCT spending on secondary care jumped 40.1% over the same period, increasing from £49.1 billion to £68.8 billion. This is equivalent to an average increase of over 5% a year. Between 2010–2011 and 2011–2012 there has been a real terms reduction in spending on primary care of 1.2%.1
It is a great privilege to provide primary care for older people and, as a profession, we need to campaign for resources that reflect their needs. This means investing in primary care as well as secondary, community, and social care. The legacy of the 2004 GP contract, with its sudden 14% increase in GP income, is a failure to consider workload, or workforce planning 9 years later. At present it seems that the NHS knows the cost of primary care, but not its value.
- © British Journal of General Practice 2013
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