Meanwhile, the RCP has been served a slice of humble pie by The King’s Fund review over its handling of the PA scandal.
The litany of horrors that is the NHS can be saved with an injection of funding into general practice, according to the independent review from Professor Lord Ara Darzi.
It comes as the UK’s Royal College of Physicians was dealt some “learnings” by The King’s Fund over the fallout from its Extraordinary General Meeting on the physician associate debacle.
Today cancer surgeon Lord Darzi – who was tasked with investigating the NHS to help shape the government’s upcoming 10-year reform plan – released his final report.
In what will most likely be a surprise to no one, the report found that the UK’s public health system was in “critical condition” and had been “chronically weakened” by a lack of capital investment to the order of £37 billion.
“These missing billions are what would have been invested if the NHS had matched peer countries’ levels of capital investment in the 2010s,” the report read.
“That sum could have prevented the backlog maintenance, modernised technology and equipment, and paid for the 40 new hospitals that were promised but which have yet to materialise.
“It could have rebuilt or refurbished every GP practice in the country.”
Lord Darzi said GPs were under-resourced and lacked the authority to manage the “increasingly complex care” expected from them.
Between 2009 and 2021, NHS expenditure towards primary care fell from 24% of the total expenditure to 18%.
“We have underinvested in the [GP] community,” Lord Darzi added.
“We have almost 16% fewer fully qualified GPs than other high-income countries relative to our population.”
He added that, as the most common front door to the health system, primary care should be the focus of reform.
“Indeed, research by the NHS Confederation has demonstrated that spending in primary and community settings had a superior return on investment when compared with acute hospital services,” said the report.
“It therefore makes sense that this should be the fundamental strategic shift that the NHS aspires to make.”
Lord Darzi said his review revealed “significant irritation” among GPs who were fielding “never-ending” requests for follow ups and felt that “more and more tasks [were] being shifted from secondary care back to primary care”.
The report said that the government must “irreversibly” adopt financial flows that bolster mental health, community services and general practice.
Despite the system being in “critical condition”, its vitals “remain strong”, suggesting there was still hope.
Lord Darzi said the system had “turned things around before”, laying out a plan of attack and championing the system’s committed workforce.
Former president of the RACGP Adjunct Professor Karen Price said that funding general practice as the salve for system failure had been “known for eons”.
“The willful theft of general practice resources is ignorant, malicious and commercially motivated,” she wrote on X (formerly twitter).
Increased GP funding should be 'fundamental strategic shift', finds Darzi review – Pulse Today
— Adj Prof Karen Price, 20-22 RACGP Past Prez (@brookmanknight) September 11, 2024
Really this has been known for eons
The wilful theft of General Practice resources is ignorant malicious and commercially motivated. https://t.co/DN0IkMQVK4
In other British medical news, The King’s Fund has released its review of the RCP’s handling of the physician associate’s debacle, outlining a “range of collective failures in leadership across the college”.
“There was a clear lack of accountability and due process,” reads the report.
As reported by The Medical Republic in July, the college was very publicly criticised by high-profile clinicians after its “in many ways fraudulent” presentation of data on members’ experiences with PAs at its EGM.
The EGM was called by members, following accusations of an all-too-welcoming attitude and a slow response from the college to the expansion of scope of PAs.
The ongoing ire from members prompted the college to commission The King’s Fund to examine the incident.
The review focused on events surrounding the EGM and “was not directly concerned with the policy and implementation issues in relation to the rollout of physician associates”.
The report attempted to avoid finger pointing and offer constructive criticism.
“Although undoubtedly individuals took actions that, with hindsight, they recognised to be inappropriate or unhelpful in relation to the outcome of the EGM, this was in the context of significant organisational dysfunction that was described to us during the course of this review,” it read.
“This review does not seek to point the finger of blame at any individual, but rather to identify the underlying issues that the college needs to address in order to rebuild relationships internally, with the wider college membership and with external stakeholders – and through doing so, to deliver effectively its mission of educating, improving and influencing for better health and care.”
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The report found that the college may have been slow to organise the EGM, but it did follow its bylaws.
There remained, however, a “pervasive” lack of trust in the college’s governance and a poor culture.
“We also found poor behaviours across the organisation and in particular surrounding council meetings and other interactions with and between council members,” the report said.
“These included shouting and the use of intimidatory language on both open and closed social media.”
In relation specifically to the survey carried out by the RCP which was presented at the meeting, the report found that there was a “lack of due process”, “ineffective use of expertise” and “organisational bias”.
The EGM presentation stated that 66% of doctors who worked with PAs were neutral or positive about PAs, but the raw data revealed that only 30% had responded positively, 27% were neutral and 42% were negative.
Despite the brewing concerns, proposals to expand the use of PAs in emergency departments have popped up in Australia.
