February 2024 CEO Briefing

Some of our PCN Clinical Directors may have joined the webinar held by NHSE and Wes Streeting today (30 January) in which he set out some of the main themes of Dept. of Health and NHSE forward view for the NHS. LMC colleagues on the webinar were not enthusiastic about his messages and the impact his stated thinking would have on the current GPC England contract negotiations with NHSE.

It is clear to us that the NHS must be put on a financially sustainable footing if it is to deal with the multiple challenges it currently faces. These include an ageing population, increasing delays for ambulances and emergency treatment, and growing waiting lists for operations, all of which have led to public satisfaction levels with the NHS reaching all-time lows. Lord Darzi in his recent wide-ranging review of the NHS concluding that it was in serious trouble. But the NHS’s financial position continues to worsen, with local NHS systems overspending by some £1.4 billion in 2023–24, more than double the previous year, due to rising demand, failure to invest in the estate, inflation, and workforce issues.

Given the extent of these challenges, both the Dept of Health and Social Care (DHSC) and NHS England (NHSE) seem complacent regarding the NHS’s finances and the state of general practice. NHSE is relying on the extremely optimistic assumption that it will achieve unprecedented productivity improvements of 2% each year by 2028–29, as part of the NHS’s recovery. Yet it continues to fail to address the core funding issues of the GMS contract which (in real terms) is some 54% down on the contract value in 2004.

Both DHSC and NHSE tend to blame the NHS’s poor financial position on exceptional external factors, such as the Covid pandemic, inflation and industrial action. While these undoubtedly have played their part, there are also well-known issues that are within officials’ control. For example, DHSC and NHSE have repeatedly failed to provide information about budgets in good time to local NHS systems and indeed in some cases not until months after the start of the financial year. This disregard for basic principles of sound financial planning is hampering NHS systems’ ability to deliver services for their local areas and negotiate local agreements (e.g. LES funding).

The new government sees health as one of its key missions and will present a 10-year plan for the NHS early 2025. It has set out three big shifts that it wants to see: from hospital to community-based care; from analogue to digital; and from treating ill health to its prevention. These transformations are essential to the NHS’s recovery and future sustainability but saying them is not the same as achieving them.

In relation to the first of these the elephant in the room is GMS core funding. We are concerned about the lack of fresh thinking and decisive action we heard from DHSC and NHSE. This has been echoed by a recent Parliamentary Committee. The scale of government’s ambitions is great, but the weakness continues to be a lack of will to invest in general practice.

At our January LMC we used your feedback to debate advising practices to withdraw from all unfunded or commissioned work. We will return to this subject at our next meeting following the special LMC conference on 19th March and provide more advice to you after that.

William Greenwood

LMC Chief Executive