The minister, the GP surgery and the signal of change

In an unremarkable setting, the new Secretary of State for Health and Social Care did something remarkable this week.

Wes Streeting made his first official visit to an NHS service, but instead of touring a shiny new hospital wing, he travelled to the less glamorous, but just as important, location of a GP surgery.

The sparse waiting room and child’s drawing Blu-Tacked to the wall might make for a less exciting photo backdrop, but the signal to NHS leaders and the public was clear. The new government plans to prioritise general practice, community pharmacy, and other community-based health services.

The images from Wes Streeting’s visit chime with the NHS most of us experience. There are roughly 967,000 appointments in primary care every day, a sharp increase in recent years, but still not enough to keep up with patients’ needs.

Despite the scale of general practice in this country, it is far more common to see images of ambulances queueing outside A&E departments or emergency wards full to bursting on our screens.

The seemingly contradictory truth is that the answer to these overcrowded hospitals is not more hospitals. Instead, the solution lies in bolstering out-of-hospital services, so that people are better supported to manage their health, and hospitals are freed up to focus on the highly specialist care they are best placed to provide.

The fundamental NHS operating model needs to shift. In 1948, the health service was established with the model that people get sick, get treated and go home cured. In 2024, with people living far longer but not necessarily in better health, many people get sick, stay sick, and need the NHS and other services to help them manage. A 20th-century health service model that offers short episodes of treatment is not able to support the 21st-century patient who needs ongoing care and support.

For more than 30 years it has been the stated aim of successive governments to move more care into the community, yet the opposite has happened.

Step forward the new Labour government and its goal to reform the NHS. The party has said it wants a ‘neighbourhood health service’, with far better support for people in the community so that they can stay well without the need for expensive hospital treatment.

The tricky part is that this ‘care closer to home’ policy agenda isn’t new. For more than 30 years it has been the stated aim of successive governments to move more care into the community, yet the opposite has happened. In fact, the proportion of NHS spending on primary care has decreased in recent years, and while the number of NHS consultants grew by 18% between 2016/17 and 2021/22, there was just a 4% increase in the number of GPs over the same period.

In the recent past, the pressure to throw funding at the immediate problem of hospitals under strain has repeatedly scuppered the noble ambition to prioritise primary and community care. It must count as one of the most significant policy and practice failings of the past three decades.

With his visit to the Abbey Medical Centre, Wes Streeting is signalling that he wants to avoid the mistakes of the past. During his visit, he also pledged to ‘divert billions of pounds from hospitals to GPs’. That is a potentially unpopular statement, but increasing the proportion of NHS cash going to primary and community care is undoubtedly part of the solution.

But beyond the optics and the money, making care closer to home a reality will take sustained, often quite technocratic, reform to change the hospital-centric NHS we have today.

Ministers need to set out a clear vision for the change and stick to it. They should avoid the trap of thinking that these reforms will bring short-term savings. They won’t. But they will bring long-term sustainability. Government and national bodies should also give local health and care leaders more flexibility to meet local needs, holding them to account for improving overall patient care rather than just waiting lists.

And of course, the vision of a neighbourhood health service can’t be fully realised without addressing the oft-promised, but not delivered, reform of adult social care, which for too long has languished in the ‘too-difficult’ pile.

Incentives need to be put in place to attract more staff into primary and community jobs. That includes looking afresh at how clinicians and managers are given significant experience in primary and community services as part of their training. Buildings and kit in primary and community care are desperately in need of attention. Red tape should be cut to allow organisations to better pool their physical space so that services can make best use of the buildings available.

And of course, the vision of a neighbourhood health service can’t be fully realised without addressing the oft-promised, but not delivered, reform of adult social care, which for too long has languished in the ‘too-difficult’ pile. In opposition, the government promised to develop a social care plan. Many people are watching this particular space with interest.

Earlier this year, in our report Making care closer to home a reality, The King’s Fund called for political energy to bring about these reforms. By choosing to start his first full week in the job with a visit to a GP practice in North London, Wes Streeting has sent a strong signal of this intent. Now we wait for the promised NHS 10-year reform plan to see if this government can truly succeed where others have failed and shift the focus from hospital to community.