In the UK, an annual ritual is unfolding. Several hospitals hit and policymakers toyed with the idea of banning A&E patients. There were proposals to use spare rooms in private homes for recuperating patients 鈥� dubbed 鈥� to free up hospital beds ahead of what might become the 鈥溾��. The government promised an extra 拢350 million, quickly .
The boring predictability of winter crises in the National 午夜福利1000集合 Service has complex roots, but a paradoxically simple solution: we need to shift the focus of our health system 鈥溾��. This term has its origins in the apocryphal experience of an A&E (accident and emergency) doctor who stopped to consider insatiable patient demand:
鈥淚 feel like I spend every day rescuing people who are drowning in a river. I save as many people as I can, but they just keep coming. It鈥檚 completely exhausting. Eventually you just want to get out, walk upstream and stop the bastard who keeps pushing them in.鈥�
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So what is pushing more and more patients into A&E? In one sense, the NHS is a victim of its own success: medical advances have vastly improved survival rates for childhood illness, heart attacks and cancers. This has created a growing, greying cohort with multiple chronic conditions. Their needs put , with these GPs now seeing relatively fewer snotty noses and relatively more older patients with complex needs. The issue has been exacerbated by a failure to keep and in step with rising demand.
This has led to a crisis in general practice. of GPs aged over 55 plan to retire in the next few years, and two practices in England close . This makes more work for those left behind. The ensuing vicious cycle deters potential recruits. General practice used to be one of the most popular options. Latest figures show that 18 per cent of GP training positions .
As 90 per cent of all NHS patient contact occurs in general practice, staff shortages cause major backups. Waiting times exceed in 40 per cent of practices, so it鈥檚 not surprising that many people head straight to A&E.
Little more than lifeguards
To his credit, health secretary Jeremy Hunt , and the knock-on effects for the wider NHS. He has focused on increasing capacity through an influx of , for new trainees and a 25 per cent increase in places. That is all laudable, however it is a bit like training more lifeguards for the river. We need to go much further to tackle this problem definitively.
Genuine upstream interventions would focus on keeping people well in the first place. In the UK, a of all deaths are preventable and 70 per cent are related to such as smoking, drinking alcohol, eating a poor diet and insufficient exercise. Despite lots of about prevention, nationally only 拢1 is spent on preventive activities for every 拢20 spent on treating disease.
The sustainability of the NHS depends on GPs leading a prevention revolution. They already offer lifestyle advice and medication, but could be if they spent time identifying and addressing local that shape behaviour and seed chronic conditions.
These may include a lack of , the availability of cheap , a dearth of 聽, derelict children鈥檚 , cheap alcohol, an and poor options. None of these fall into the traditional purview of 鈥渉ealth鈥�, yet they are the root causes of a lot of rising demand and cyclical crises, so why not empower GPs to act on them?
Researchers have been experimenting with 鈥� a way of understanding complex scenarios 鈥� to identify and address these kinds of local factors that push people into bad health, and there is appetite for more upstream work among . This is a radically different way of doing things and would require a major overhaul of training, funding, incentives and governance. It would also require significant upfront capital investment. But do we have a choice?
It is abundantly clear that business-as-usual isn鈥檛 working.
Read more:聽NHS reforms have failed to boost community-based care in England
