What health and care need from the next government: #3 – General practice and dentistry

The NHS and social care in England are struggling. A combination of the sudden shocks from the Covid-19 pandemic and high inflation, and the longer-term pressures of poor workforce planning, morale problems, failure to deliver promised efficiency savings, and decades of delay to social care reform are all taking their toll. Strain and dysfunction are deeply rooted and will not immediately improve, and the public sees this clearly: satisfaction with both services is at historic lows. Credible long-term plans to improve this situation are vital for any political leader who wants to gain the support of the British people.

Our series of general election briefings, produced with funding from the Nuffield Foundation, looks at a set of key issues where we believe a government taking or returning to office in the next year must act in order to meaningfully improve health and care. The third in that series looks at general practice and dentistry.

General practice

The NHS was designed to have general practice as the point of connection between people and almost all the care they might need – from basic checkups to lifesaving operations. However, this critical point is under immense pressure. The number of full-time equivalent GPs per person has declined, increasing workloads and causing difficulties for patients to access care. Despite easy access to general practice being the public's top priority for the health service, GP funding has risen far slower than other areas of the service. Addressing this issue requires more than just increasing appointment availability; it involves providing appropriate appointments in suitable timeframes to meet diverse patient needs and reduce unnecessary NHS referrals.

Test 1: The next government must commit to an increase in people having access to their own doctor – the GP they prefer – as measured by the patient survey

This should start with groups with complex or changing health problems, or with multiple illnesses. The evidence shows that seeing the same professional over time has benefits including reduced mortality and lower A&E admissions. Practices should be incentivised to deliver continuity, and there should be a benchmark they have to meet.

Test 2: Clinicians must be able to take a decision as to who needs an urgent appointment, as well as who needs face-to-face care or could more quickly get what they need online

There should not be a blanket target for GPs to offer all appointments within a certain number of days or hours. This is not relevant to many groups of patients, and distorts how available capacity is used, leading to frustrating restrictions on patients such as the 8am rush for slots. Instead, general practice should be judged on how happy patients are overall with their access to care, as measured by the Patient Survey.

Test 3: General practice must get its share of the £3.4bn technology funding planned from next year, as well as more support for training staff in the use of digital tools

Better data and digital technology is crucial to support clinicians in making sure patients get the appointments they need, and monitoring those with ongoing conditions.

Test 4: The steady decline in GP numbers must be urgently addressed

Measures must both improve retention, and better support experienced GPs, through policies that also address wide regional disparities in the numbers of GPs.

Test 5: Measures to safely manage the expansion of additional roles in general practice – such as social prescribers, pharmacists and more – without disrupting patient care and further driving down satisfaction

GPs and GP nurses need time carved out to support and supervise their new colleagues; staff should be appropriately regulated; and the public should be better informed about the varied professionals they may expect to see in general practice.

Test 6: Government must resist the temptation to forcibly restructure the operating model of general practice in order to deal with the many problems of the existing partnership model

Instead, the government should clearly set out the core functions that general practice should deliver but allow flexibility in the exact form that GP services take, and incentivise the emergence of innovative models in pursuit of those core functions, holding them to account appropriately.

Dentistry

NHS dentistry is also supposed to serve as a universal front door to dental care yet most of the adult population is going without the NHS check-ups recommended for good oral health and public satisfaction is at an all-time low. The next government must take bold actions and tough decisions given how far NHS dentistry is from being able to meet everybody’s needs:

Test 1: The government must urgently embark upon a programme of dental contract reform to move away from an outdated inflexible approach that rewards activity over outcomes and disincentivises undertaking more complex care

A new approach should be developed whereby dentists are reimbursed for work carried out for a particular list of patients, weighted according to need.

Test 2: Deal with the immediate workforce shortage 

Unless clinically indicated otherwise, the time between routine checkups should be extended in line with official guidance to free up staff time. Careers must be made more attractive for dental nurses, hygienists, therapists and other professions who can take on more extensive roles.

Test 3: Introduce a means-tested NHS dental offer that prioritises the allocation of scarce resources for those that need them most

Prioristing children, pregnant women, older people and those who cannot afford private care should be considered unless there is a credible plan to fully fund and restore universal NHS dentistry.