The NHS is often portrayed as a single, coherent entity.  For patients and staff, it can feel somewhat different.  The organisations and teams that make up the NHS system don’t always seem to be pulling in the same direction, and there are some regular points of friction.  Relations between our primary (GP) and secondary (hospital) systems appear to be particularly strained at the moment.

Staff working in emergency departments (EDs) point out that more and more of the patients they see could and should have been treated by their GP.  This is impacting on care for people with more serious conditions and injuries, and is increasing pressure on already over-stretched ED staff.

Meanwhile, as waiting lists for planned hospital care grows, GPs point out that they are spending more time managing patients whilst they are waiting.  The extra work required to support these patients is heaped on top of their bulging appointment books and waiting rooms.

We provide some sense of the scale of these issues in our recent report. 

Taking a step back, we might see these complaints as two sides of the same coin (a coin that cannot fund enough services to cope with demand).  Hospital demand arising from GPs not seeing patients, is eating into the resources that they would use to manage down the elective backlog.  In turn, this is creating more demand for GPs. 

It’s a vicious circle of failure demand. Neither GPs or hospitals are responsible; and neither can resolve it.  Left to play out, we should expect failure demand to represent an increasing proportion of activity in both primary and secondary care.  This is bad news for patients, GPs and EDs alike.