Department Of Health
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Id like to begin by saying a public thank you to you, Kamila, and, by extension, to your College. In Opposition, we engaged in good-natured, but robust debate on the things we disagreed on and, more often than not, found ourselves in violent agreement on the state of General Practice today and our responsibility to rebuild General Practice for a brighter tomorrow.
That relationship, based on mutual respect and a spirit of partnership, means I come here today feeling that I am not only among friends, but among teammates a theme Ill build upon in my speech this morning.
In that same spirit, can I also say a special thank you to Sunaina, Paula, Rumshia, and Andy for those outstanding presentations.
You are proof that, while the NHS may be in the midst of the worst crisis in its history, the biggest asset we have are the people who work in it. More than that, you provide hope to a country that is desperately looking for it, because you are showing us not only is reform possible, but it is already happening, and you are showing us what a reformed NHS could look like.
Im delighted to be the first Secretary of State personally addressing this conference in seven years. I cant imagine what the others were so worried about
I imagine some of you were quite happy to not have to hear from my 7 predecessors who held the job in that time. The good news is Im here this year, the bad news is whether you cheer or boo, Ill be back for more next year. For 2 reasons:
First, I always welcome challenge, and as you might have gathered by now, I love a good argument.
More seriously, I recognise that the health service is in a deep hole, and its only by working together that well get out of it.
Its my job to mobilise nearly 2 million people who work across the NHS to be the team that takes the NHS from the worst crisis in its history, gets it back on its feet, and makes it fit for the future.
I cant do it on my own. We can only do it as a team.
The team spirit we need to build together starts with honesty.
The NHS is broken. Thats what 2 in every 3 patients believe. I suspect a poll of NHS staff would find the same sort of result. Im yet to speak to a GP who tells me on many of the visits Ive done in the last few years everything going really well, my workload is entirely manageable, this is just what I signed up for.
And I want to be clear about something else too the NHS is broken, but GPs didnt break it.
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And thats not just my view thats effectively the conclusion of the Darzi investigation.
I know hes a surgeon. Sorry about that.
But I think that, if youve read his report, the analysis is so stark and so clear that you might even forgive him for polyclinics.
Lord Darzi found, GPs are expected to manage increasingly complex care, but do not have the resources, infrastructure and authority that this requires.
Hospital resources have shot up, while primary care has been neglected. There are 1,500 fewer fully-qualified GPs in the NHS today than 7 years ago.
While hospital productivity has fallen, the reverse is true in general practice. Despite there being fewer of you, youre delivering more appointments than ever before- squeezing the time you spend with each patient. And as RCGPs research this week revealed, its the poorest areas hit the hardest.
Cuts to capital investment mean that one in every 5 of you are working in buildings older than the NHS itself.
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In Lord Darzis words, GPs were to all intents and purposes set up to fail.
Were left with a status quo that isnt working for anyone. Not for patients, two in three of whom arent satisfied with the service they receive a record low.
Nor does the status quo work for staff- you are working harder than ever before, pushing you to burn out and in too many cases pack it in.
Patients are frustrated they cant see you. Youre frustrated you cant meet their demands. Its not sustainable.
The NHS is broken, but not beaten, and I think what unites all of us - staff, patients and, crucially, the evidence is the shared conviction that continuity of care, what most people would call the family doctor relationship really matters. Its what drives patient satisfaction, your job satisfaction and better outcomes for patients.
It will be at the heart of this governments plan to reimagine the NHS as much as a Neighbourhood Health Service as a National Health Service.
Well shortly be embarking on a wide-ranging and deep engagement exercise to build our 10-year plan.
That 10-year plan for the NHS will deliver three big shifts in the focus of healthcare:
- From hospital to community
- Analogue to digital
- And sickness to prevention
And general practice is fundamental to each one.
Just look at what the GPs who introduced me today are already doing.
Paula is using basic technology to meet demand for same day appointments, and giving patients a digital front door, leading the way on ending the 8am scramble.
Advances in big data are going to transform the NHSs ability to end the cruel postcode lottery of health inequality. Rumshia is already showing us how - by taking screening, checks, and care directly to the communities most in need- intervening early and preventing ill-health from worsening, what we can already do.
And as Andy and Sunaina have shown, if we bring GPs together with colleagues from mental health services, community pharmacy and social care, all working in lockstep as one team, more patients can be treated in the comfort of their own home where they want to be. Thats the Neighbourhood Health Service we want to build. Thats the future of the NHS.
And I think weve seen in the last 3 months weve started as we mean to go on.
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GPs were left qualifying into unemployment this summer. While patients cant get a GP appointment, GPs couldnt get a job.
You asked us to act, so we did.
In what might be the first example in history of someone signing a petition that actually led to action.
I received RCGPs petition, we cut red tape, found the funding, and were recruiting an extra 1,000 GPs this year, our first step to fixing the front door of the NHS.
In my first week as Health and Social Care Secretary, I pledged to increase the proportion of NHS resources going to primary care. And in our first month, the government made a downpayment on that pledge, providing practices with their biggest funding increase in years.
Ive never pretended that one measure on GP recruitment or indeed the funding that was announced was a panacea. But given the 22 billion blackhole we inherited, and the painful cuts weve had to make and are having to make elsewhere, be in no doubt how hard we had to fight to deliver that extra funding. It was a serious statement of intent. A proof point. An early decision to demonstrate that were serious about rebuilding General Practice.
Not everything is about more money. Its also about less waste.
When I spend time shadowing GPs, one of the things they are dying to show me, is the sheer amount of paperwork you are required to fill in, to refer a patient.
I was genuinely stunned to hear about one practice that has to complete more than 150 different forms to refer patients into secondary care services.
Practices spend as much as 20% of their time on admin and work created by poor communications with secondary care.
This is intolerable. That time should be spent with patients.
Thats why today I can announce that Amanda Pritchard and I will launch a Red Tape Challenge to bulldoze bureaucracy so GPs are freed up to deliver more appointments.
The challenge will be led by Claire Fuller and Stella Vig, primary and secondary care leaders who have their bulldozers at the ready. Tell them whats working well, but more importantly what needs to change. We will listen, act, and solve this problem together.
Amanda and I will receive the conclusion of this work in the New Year. And NHS England will hold ICBs and trusts to account if they fail to act.
The other frustration I hear from staff and patients alike are the pointless appointments youre forced to hold and patients are forced to attend. You didnt go through 5 years of medical school plus 5 years of training to tick boxes. So where there are appointments that can be cut out, with patients seen by specialists faster and GPs time freed up to do what only GPs can do, we will act.
Starting in November, 111 online, which is available through the NHS app, will pilot directly referring women with a worrying lump to a breast clinic.
That means faster diagnosis for cancer patients.
And more GP appointments freed up.
Better for patients and better for GPs.
I suspect there are other cases that come across your desks every week, where a patient has been passed to you by someone else in the NHS to refer them on to someone else in the NHS. It is a waste of everyones time, including yours, and where you give us examples of patient pathways that can be simplified through appropriate patient self-referral or direct referral by other NHS services to save your time, we will act.
Its not just that I value your time, I respect your profession and your expertise.
General Practice is a specialism.
Thats why I am committed to the creation of a single register of GPs and Speci