Opinion: Winter access: Not just for winter?

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Declan Mullaney, Livi Head of Policy and Public Affairs, explores why ongoing demand challenges point to a need for long-term support for primary care in winter and beyond.

In recent years we have grown accustomed to expect a winter season worse than the last in health and care. “This winter will be a winter like no other,” goes the frequent cry.

As we look back on a summer period that has seen levels of demand in line with winter months, it is understandable that many are worried at present. We have witnessed trusts declaring black alerts and red alerts in general practice also. There have been demand spikes across the health system, at a time when the NHS usually gathers its breath over the summer months.

Covid has not gone away. The very title of the recent joint HSJ and BMJ editorial, ‘The NHS is not living with Covid, it’s dying from it’ paints a stark picture and the statistics do not lie. It reports that in the first six and half months of this year, those who tested positive for Covid-19 averaged at over 9,000 compared with just under 6,000 in 2021 and 7,000 in 2020.

New COVID waves and successive heatwaves have made for the perfect storm. As we head into the autumn, elective waiting lists stand at 6.8 million patients. An estimated 26 million appointments were delivered in general practice in July of this year alone. And that age-old adage of a system creaking at the seams (ambulances queuing outside A&E etc), has come to fruition.

A system issue

With demand overwhelmingly up in primary care, it is inevitably spilling into other parts of the urgent care system. What I think this reflects is two things. First, that access and capacity have, and always will remain, system issues. If one part of the system cannot cope, it invariably affects the other. And this is very much what we’re seeing.

Similarly, acute capacity restraints are no longer confined to winter. It is no longer cyclical, it is becoming a year-round event. The continued pressures we have seen throughout the summer will likely impact efforts to reduce backlogs through the autumn and winter.

In preparation, NHS England’s recently announced package of winter support for general practice, PCNs and teams includes additional funding to purchase additional workforce and increase clinical capacity to support additional appointments and access for patients. This comes alongside an ICB framework to identify where to allocate support, as well as changes to the Network Contract DES that introduce “further flexibility” into ARRS and other roles to support practice capacity.

The need for flexibility

I think flexibility is the key word here. Last year’s Winter Access Fund provided welcome respite, helping teams increase capacity to same-day urgent care at both a general practice and PCN level. Indeed, we have heard from some of our partners that without it, they would not have been able to stay open.

We have also heard that the ability to spread support throughout the year and plan this out over a longer period would be most welcome. After all, while winter will be hard, the rest of the year isn't much easier. In anticipating a winter season many believe will be the most challenging on record, there is a need for greater flexibility and certainty over what support will be available and how it can be used.

This summer has taught us winter pressures will not abate by March. Pressure on practice teams and physicians continues to increase. This is impacting the wellbeing of those on the frontline and compounding a workforce crisis where GPs are leaving the profession.

Capacity-boosting funding streams like winter access are desperately needed throughout the year to give providers the best chance of catching up. Long-term planning at a system level based on assessment of capabilities and capacity available on the ground are required. And to realise appointment timeframe targets, we must look at ways we can deliver more support to those tasked with providing them. After that, we may be able to face the prospect of better winters to come.

The above article is an extract for our recent winter pressures report titles "Success through winter access". To read the full report, click here.