NHS England payment structures should be looked at closely to ensure they financially reward local health ‘systems’, including GP practices, that prioritise patients in most need of help, a group of influential MPs has recommended.
MPs from the public accounts committee (PAC), which scrutinises the value for money of Government projects and service delivery, also said that NHS funding processes should be reviewed so they align with the ambition to shift care out of hospital and into the community.
In its report on NHS financial sustainability published yesterday, the committee outlined nine recommendations aimed at managing the ‘complacency’ it said both the Department of Health and Social Care and NHS England have with regards to NHS finances.
A key proposal centred on payment mechanisms that can ‘mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients,’ with the report using payments given to GP surgeries for child vaccinations as an example.
‘This vaccination funding mechanism favours areas where parents are more willing to inoculate their children,’ the report said, ‘while areas with higher levels of vaccine hesitancy, which may be more deprived areas, receive less funding and therefore have fewer resources to carry out much-needed
activities such as outreach and education, potentially leading to even fewer patients being vaccinated in those areas.’
It called on NHS England to ‘review current payment systems and processes’ to ensure that incentives are in place for ‘local systems to work with those in most need of help’.
MPs also recommended that NHS England should ensure that, year on year, a ‘greater proportion’ of its funding is spent in the community, including general practice, ‘in line with its own long-held ambition’ of moving more care from hospitals to the community, which, it added ‘has stalled’.
The report said: ‘NHSE’s long-held ambition to move more care from hospitals to the community has stalled. There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023/24 had NHS England not redirected funding to prop up the day-to-day spending of local NHS systems.
‘Despite carrying out 15% more elective activity compared to before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.’
The committee goes on to question whether the DHSC and NHS England can successfully bring about the changes set out in the Government’s 10-year plan, due to be published in the spring.
It said the three reforms in the plan – moving from hospital to community-based care; switching from
analogue to digital; and focusing on prevention of illness – are ‘essential to the NHS’s recovery and future sustainability’.
However, MPs stated that they are ‘concerned about the lack of fresh thinking and decisive action’ at NHS England and the DHSC.
‘The scale of government’s ambitions is great, but senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital’ the report warned.
Committee chair Sir Geoffrey Clifton-Brown said that ‘truly fresh ideas’ and ‘radical energy’ are needed to turn the situation around.
He said: ‘The current Government has told the public that the NHS is broken. This will not come as news to NHS patients, nor to its hard-working staff across the country.
‘Nor indeed does it to this committee, which has long warned of the systemic issues plaguing the NHS, issues which the Government has transformative ambitions to address.
‘We therefore have a simple message for those senior officials responsible for delivery. Truly fresh ideas and radical energy must be generated to meet the scale of what is required – on community healthcare, on prevention, on digital transformation.’
NHS England said that the report contains ‘basic factual inaccuracies’ and showed a ‘flawed’ understanding of financial processes. It also said that NHS allocations for primary care are adjusted to reflect their deprivation, so areas with more deprived groups get additional funding to support outreach. It added that NHS investment in primary medical care and community services increased faster than overall integrated care board (ICB) spend in 2023/24.
An NHS England spokesperson said: ‘Lord Darzi’s report was clear many of the solutions can be found in parts of the NHS today, and we are working closely with the government to drive this innovation forward as we develop the ambitious 10 Year Health Plan to build an NHS which is fit for the future.’
A Department of Health and Social Care spokesperson said: ‘We have been consistently clear that fixing the broken NHS and ensuring it is fit for the future requires urgent and radical reform.
‘This will be a challenge, but health leaders in the NHS have said they will meet this task, and we will work with them to deliver it as part of our Plan for Change– as we shift healthcare from hospital into the community, from sickness to prevention and from analogue to digital.’
The BMA said that the report’s recommendations around allocating more funding to services in the community, including general practice, and improving NHS financial planning, make ‘absolute sense’.
BMA council chair Professor Phil Banfield said: ‘Allocating more funding to the community and giving local systems greater control over how that’s spent, for example, is something the BMA has long called for to help prevent ill health and avoidable, often expensive hospital treatments.
‘Continuity of care in general practice reduces hospital admission, morbidity and mortality. When it comes to increasing the amount spent on prevention, including specifically public health services, the report fails to identify additional central funding that would be needed to achieve this, while there is an imperative to maintain elective and emergency services in parallel in a period of transformation.
‘This report highlights the importance of holding the Government and NHS England to account, and making sure every penny is well-spent, both in the NHS and on wider population health initiatives.
GP practice staff have been urged to share ideas for how to ‘fix’ general practice in order to shape the 10-year plan.
A version of this article was first published by our sister publication Pulse
