Recently, GP practices have seen increasing demand as a result of the rising cost-of-living. Higher energy and food prices combined with stagnant financial growth have precipitated what has also been referred to as a ‘public health crisis’. More people are seeking support for both physical and mental health issues.
In primary care, a recent poll by GP online found that 8 in 10 GPs said rising inflation had led to increased demand at their practice. While a survey from Pulse reported that around 22% of GP consultations are currently for mental or physical health problems caused or exacerbated by the cost-of-living. That same survey also found that 16% of GPs were in the process of implementing initiatives to support patients through the crisis.
In this article, we take a closer look at the impacts and how GP practices are responding.
The context
The devastating effect that economic and social pressures can have on the health of populations is nothing new. Both are well-known drivers of health inequalities and poorer health outcomes.
Between 2018-20, those inequalities meant if you were a person living in the least deprived 10% of areas of England, you would be more likely to live longer according to research. By gender, that’s up to 8 years longer for women and 10 years longer for men when compared with someone living in the 10% most deprived areas.
However, we have arguably not witnessed a socio-economic threat to public health on this scale in some time. Deemed by some as “a public health emergency potentially on a par with COVID-19”, the cost of not being able to afford life’s essentials could be just as high to the health of those less fortunate.
“Poverty causes ill health, drives inequality in health outcomes and increases use of health services.” - Kings Fund, Poverty and the Health and Care System: The Role of Data and Partnership in Bringing Change
The impact on general practice
For GP practices that were already stretched and grappling with pent-up demand in the wake of Covid-19, the timing couldn’t be worse. General practice provided 340 million appointments last year alone, almost 9% more than in 2019. Managing increasingly complex caseloads, the cost-of-living crisis has poured further pressure on teams and posed additional challenges.
Those challenges include supporting patients living with the effects of cold, mould and damp as a result of being unable to heat their homes, as well as the impacts to families and individuals having to make cheaper food choices and resulting poorer diets. In worst case scenarios, the dilemma has become one of ‘heat or eat’.
“The increased cost of living, coming so soon after the impact of the COVID-19 pandemic, poses a significant risk to the population’s health.” - NHS Confederation, Can Mental Health Services Afford the Cost-of-living Crisis?
The Confederation has outlined in detail the risks posed to the nation’s health including a rise in heart attack, stroke, falls and respiratory illness, to name just a few. For the elderly, vulnerable and those living chronic long-term conditions, the risks are even greater. For example, some practices have reported increasing HbA1c levels in type 2 diabetic patients, as a result of intake of cheaper carbohydrate-based foods.
While the constant worry, stress and anxiety of having to make ends meet on some individuals has contributed to GPs seeing a rise in patients experiencing new or exacerbated mental health issues.
At the same time, the crisis has posed a financial threat to GP surgeries themselves. In a survey, 9 in 10 GP partners reported that it had undermined the financial sustainability of their practice. Soaring energy bills were also said to have led some practices to close earlier or reduce sessions. And almost 40% of GP partners reported having to reduce energy use.
How practices are responding to increased demand
Just as in the Covid-19 pandemic, general practice, as the bedrock of the NHS, is working tirelessly to respond to the many challenges posed by the crisis.
Whether it’s proactively reaching out to the vulnerable with support, or acts of kindness such as the story of a GP organising a boiler for a family unable to afford one. Teams are going above and beyond to serve the needs of patients every day.
There has been an increase in social prescribing, with GPs signposting to other areas of the system where appropriate, and helping to refer patients to foodbanks. Some practices have also rolled out additional services. For example, the ‘warm home prescription scheme’ has seen GPs and other healthcare professionals prescribe ‘warmth’ to hard-to-reach homes, supporting vulnerable people with cold-sensitive health conditions.
The scheme provides payment support for energy bills to help those unable to afford heating to keep warm and well at home, in effort to prevent avoidable hospital admissions.
Other practices have repurposed physical spaces at their surgeries transforming meeting rooms as drop-in ‘safe areas’ for people to come in and get warm.
The need for greater support
But with all the immense efforts of GP practices, the cost-of-living crisis will not be solved by general practice alone. There is a need for more support for a primary care system working at its limit to cope with the rising tide of demand. In an article for the BMA, Dr. David Strain, Chair of the BMA board of science remarked:
“There’s a limit to our prescription pad. I can talk about the importance of good nutrition to manage diabetes or recover after a stroke, but it’s of little use if my patient can’t afford to eat. Ultimately, the cost-of-living crisis is a health crisis, but not one doctors can cure alone.”
Indeed, at a wider health system level, the King’s Fund has outlined how more could be done to tackle poverty through data and analytics, citing the potential for collaboration within integrated care systems. This includes the utilisation of linked data to inform more anticipatory models of care and the adoption of neighbourhood teams recommended in the Fuller stocktake.
They note, “As a consequence, ICSs need to deploy more anticipatory care models at neighbourhood level, and the Fuller stocktake into the future of primary care recommended the formation of neighbourhood level teams with this in mind. This will require innovative funding across organisational boundaries and greater risk-taking.”
Elsewhere, the Royal Society of Public Health has recommended adequate financial support from government for families and services as well as greater policy innovation, and monitoring of data on the long-term impact of the cost-of-living. This is in addition to a dedicated plan to grow the public health workforce.
While the Royal College of GPs (RCGP) has similarly called for more support from government to protect those below the poverty line, the elderly and vulnerable and urgent action to expand the GP workforce. In regards to the latter, an RCGP poll of GPs and practice staff reported that more than a quarter believed their practice was at risk of closure, with unmanageable workloads cited as the top contributing factor.
How Livi is supporting general practice
With primary care seeing record levels of demand, Livi is working with practice partners and PCNs across the UK to provide an increased number of appointments.
Livi Practice has been specifically designed to support GP surgeries with immediate digital primary care capacity, and can help with surge demand, extra cover for GP core hours and year-round resilience. We also provide assistance to ICBs and GP federations to support practice at risk of closure.
Livi serves more patients from economic areas of deprivation in each of the 12 regions in the UK* and help patients with a range of health issues, from long-term condition through to minor infections.
To find out more, contact partnerships-uk@livi.co.uk.
*(In terms of median disposable income, based on ONS gross disposable household income)
Article sources
GP Online. GPs lift lid on how cost-of-living crisis is driving up workload. Available online: www.gponline.com/gps-lift-lid-cost-of-living-crisis-driving-workload/article/1808478#.
Pulse. More than one in five GP consultations caused or exacerbated by cost-of-living crisis. Available online:www.pulsetoday.co.uk/news/clinical-areas/respiratory/more-than-one-in-five-gp-consultations-caused-or-exacerbated-by-cost-of-living-crisis/.
Kings Fund. What is happening to life expectancy in England. Available online: www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england.
London School of Economics. The cost-of-living crisis is a public health issue. Available online: https://blogs.lse.ac.uk/politicsandpolicy/the-cost-of-living-crisis-is-a-public-health-issue.
RCGP. GP practice closures in deprived communities will have a stark impact, says College Chair. Available online: www.rcgp.org.uk/News/GP-practice-closures.
NHS Confederation. Could the energy crisis cause a public health emergency? Available online: https://www.nhsconfed.org/long-reads/could-energy-crisis-cause-public-health-emergency.
GP Online. Nine in 10 GPs say cost-of-living crisis has destabilised practice finances. Available online: https://www.gponline.com/nine-10-gps-say-cost-of-living-crisis-destabilised-practice-finances/article/1808166#.
Pulse. How the cost-of-living crisis is affecting general practice. Available online: https://www.pulsetoday.co.uk/analysis/politics/how-the-cost-of-living-crisis-is-affecting-general-practice.
BMA. The cost-of-living crisis is a health crisis: why we are supporting JRF and Big Future. Available online:www.bma.org.uk/news-and-opinion/the-cost-of-living-crisis-is-a-health-crisis-why-we-are-supporting-jrf-and-big-future.
Kings Fund. Poverty and the health and care system: The role of data and partnership in bringing change. Available online: www.kingsfund.org.uk/publications/poverty-health-care-system-data-partnership.
RSPH. Our health: the price we will pay for the cost-of-living crisis. Available online: www.rsph.org.uk/our-work/campaigns/our-health-the-price-we-will-pay-for-the-cost-of-living-crisis.html.
Pulse. Quarter of GP practices at risk of closing, according to RCGP survey. Available online: www.pulsetoday.co.uk/news/workforce/quarter-of-gp-practices-at-risk-of-closing-according-to-rcgp-survey/.
NHS Confederation. Can mental health services afford the cost-of-living crisis?. Available online: https://www.nhsconfed.org/long-reads/can-mental-health-services-afford-cost-living-crisis.
Pulse. GP practice to repurpose meeting room for cold and hungry locals. Available online: https://www.pulsetoday.co.uk/news/practice-life/gp-practice-to-repurpose-meeting-room-for-cold-and-hungry-locals/.
