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Claudia Martinez is the Research Manager of Reform

Politicians are like magpies, they covet shiny things. That’s why high-speed rail trumps fixing local roads. It’s also why billions are promised for brand new hospitals, while almost a third of GP surgeries can be found in portacabins, former office units, and converted terrace houses. But not all that glitters is gold. If the Prime Minister is serious about transforming people’s lives, he should focus on fixing the basics.

Boris Johnson has a particular fascination with grand-scale infrastructure projects, born of his time as the Mayor of London. None of us were surprised when, from day one of the General Election campaign, he made it clear that “levelling up” would require a UK “infrastructure revolution”. The words “building” and “infrastructure” appear a combined total of 46 times in the Conservative election manifesto, and £80 billion has been pledged for infrastructure investment in new roads, rail schemes, and schools.

The NHS is receiving the same treatment. One of the Prime Minister’s big pre-election giveaways was a £1.8 billion capital injection for the NHS. Some of that money was meant to support staff to do their jobs better and invest in technical medical equipment, but the lion’s share was focused on upgrading hospital buildings. And hot on the heels of that announcement came the much-touted promise to build 40 brand new hospitals over the next decade (in fact the money has only been allocated for six).

If we’re to have a modern health service then this investment is essential. But while this new cash is long overdue, the Prime Minister’s grand NHS infrastructure plan has a fatal flaw: it has almost entirely bypassed primary care. Shockingly, a mere six per cent of the total capital investment committed for the NHS estate has been earmarked for the part of the health service that should be reducing our reliance on the acute end. Much of the primary care estate hasn’t been upgraded for 35 years, and half of GP surgeries are considered to be unfit for purpose and unable to cope with demand.

It may not provide the ribbon-cutting photo-op, but the truth is that fixing primary care would do far more to serve patients than sinking yet more cash into hospitals. Take A&E, for example. The NHS has long been grappling with the challenge of rising A&E attendances, unacceptably long waiting times, and a shortage of hospital beds forcing patients to wait on trolleys in corridors. Not only has the number of people presenting to A&E skyrocketed, but one in six patients are now waiting more than four hours to be seen by a professional or to get admitted to hospital.

Yet instead of focusing on how to reduce demand, with each monthly release of damning A&E statistics we wring our hands and insist that more money is needed to meet that demand. This is bonkers. Consider just one fact: over a third of patients who attend A&E do so for non-urgent, minor injuries.

What that means is that one in three people do not, in fact, need the sort of care that A&E should provide, but would be better treated in their communities, for instance via their GP. And as well as freeing up much needed A&E capacity for serious cases, caring for someone in a primary care setting costs a fraction of what it costs in hospital.

The problem is that patients end up flocking to A&E because they see no alternative. Their GP surgery is closed and there are no out-of-hours services in their local area; or they simply can’t get a doctor’s appointment; or their local surgery lacks basic diagnostic equipment, such as X-rays.

This is why the Prime Minister’s failure to commit serious investment into primary care is so short-sighted. Investing in upgrading primary and community care services would make an outsize difference. In 2019, just ten per cent of people thought they could get a GP appointment on a Saturday, two per cent thought they could on a Sunday.

Equipping primary care to undertake basic diagnostic and surgical procedures would also drastically reduce pressure on our hospitals, allowing doctors in A&E to actually focus on those who require long-term and specialist care.

But that means investment in the boring basics – you can’t co-locate services in a portacabin, or perform basic surgery in a space the size of a terrace house. Nor can you expect an efficient, modern health service without fixing primary care’s ‘digital plumbing’ – GPs currently spend 17 minutes every morning just logging into a computer. And many can’t share key patient information with other professionals because systems simply don’t talk to each other.

It may not be headline-grabbing, but over 90 per cent of patient interactions take place within primary care and one of the biggest NHS gripes is people’s inability to get a GP appointment. Greater investment into these services would go a long way in ‘levelling up’ everyone’s experience of the NHS. That’s not just the right thing to do, it’s also politically expedient.

Read our briefing paper, A primary care estate fit for the future, here.

17 comments for: Claudia Martinez: Politicians like to boast about new hospitals but primary care should be the priority

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