Provision of primary health care is always in the headlines and is a priority for all the political parties. Of particular concern is the number of GPs and nurses in practice, and patients’ real and perceived access to them. Expansion of primary and community health as an alternative to A&E is hotly debated as resources are carefully allocated. An ageing population coupled with high expectations of the general public mean that timely and appropriate primary health care provision is a major issue for any potential government.
All the five main parties pledge improved NHS health care personnel provision in their manifestos. Whilst there is mixed evidence that the number of GPs in practice influences A&E attendance, we do know that care from the same GP (continuity of care) does help reduce it. However, there is a very clear association of lower socio-economic status and lower educational attainment with greater emergency care use within a primary care practice population. So if the Liberal Democrats do have the opportunity to follow through with their aim of encouraging more GPs into deprived areas this is likely to improve patients’ satisfaction and potentially reduce use of emergency care.
However, most detail in the manifestos is focused on access to primary health care ranging from opening hours to patients’ electronic records. Most of the parties specify support for increased physical access to primary health care in terms of opening hours, and ability to make timely appointments in line with the content of the current GP contract. Research to date suggests that opening hours does reduce emergency care demand and patient satisfaction.Electronic patient records and who can access them has been more controversial. The GP2GP system enables patients’ electronic health records to be transferred directly and securely between GP practices.A YouGov poll found that 85% of the population wanted any medical professional directly responsible for their treatment to have secure electronic access to relevant data from their GP record. Only 3% of GPs in England offered online record access at the end of 2014 with the aim of all practices providing access by April 2015. Patient access is highlighted in the Conservative party manifesto however there are concerns about patients suddenly being able access their records without any controls in place.
The Labour manifesto pledges to support both the public’s awareness of symptoms of cancer and increased support and training for GPs in recognising them. This is in line with a NHS England document published in early 2014 outlining a five year strategy for cancer care including training for GPs. The Liberal Democrats promise to increase blood tests and screening within primary care. This approach is supported by evidence suggesting this takes the pressure off emergency care. The Lib Dems also outline their support for GP presence within A&E. Whilst this appears to benefit the health care process, the verdict is out as to whether this is a cost effective approach.There is limited detail on the promises from across the parties on integration between both primary and secondary care and health and social care.
So overall what does this mean for primary health care? More personnel is good with a targeted approach needed in both where and how they are used. All the opposition parties with the exception of UKIP call for the repeal of the 2012 Health and Social care bill. We know that there is no reason to expect an outright win by one party and we are likely to be heading towards another coalition government of unknown composition. This makes it difficult to predict exactly what will be on the cards for primary health care in the next parliament.