The NHS must change in order to survive, writes Anne Connolly

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Happy ending? Our beloved NHS is old and in intensive care – we must look after it.

The NHS is the envy of the world, but is creaking under severe and mounting pressures. It must make changes in order to survive.

While spending by local authorities has been slashed, an increasingly complex aging population – with multiple co-morbidities – requires expensive medications and procedures. Furthermore, the rising demand for access to healthcare professionals makes the existing provision of healthcare unsustainable.

The pressure is on all sectors of the system. GPs are struggling to provide sufficient access, resulting in an unbearable strain on out-of-hours providers and emergency departments. Meanwhile, reduced in-patient bed capacity and delayed discharges means the system is hopelessly grid-locked.

The government is also demanding seven-day services, with minimal evidence that providing extra cover would improve quality or efficiency.

These concerns – alongside ‘Brexit uncertainty’ – have been the catalyst for our young workforce disappearing to ‘greener pastures’, and a dramatic reduction in clinicians who want work in the NHS.

There are opportunities, however, to make the unwieldy system more effective, but this requires a clear plan, without the threat of competition. Integrating service delivery across the system and delivering health and social care, in the right place, at the right time, by the right person, can make efficiencies.

No amount of restructuring will deliver the savings without a change in public expectation. The UK population is becoming more physically unhealthy, with high rates of smoking, alcohol use and obesity, while more are becoming psychologically unwell due to financial concerns, unemployment and social isolation.

Ultimately, responsibility for health does lie with the individual, but empowerment and support is required to make positive change. Self-help schemes require the development of online resources, use of social media and improved access to social prescribing. Understanding the risks of poor diet, lack of exercise and other life choices is an essential piece of that jigsaw.

The NHS must survive – it is our national treasure and many of us are proud to work for it – but it cannot continue in its current state.  


Step change: How the NHS can save itself

  • Implementation of jointly commissioned care pathways, between local authorities and CCGs, to reduce duplication from fragmented commissioning responsibilities. 
  • The establishment of Accountable Care Organisations to deliver new care models that integrate services previously provided separately. This would allow the sharing of expertise in multi-disciplinary team working, delivering a holistic, life-course approach to care with appropriate payment mechanisms. 
  • A federation of GP practices to reduce management costs and allow the development of primary care enhanced services, with contracts tendered for services such as dermatology and musculo-skeletal medicine.
  • CCG Quality, Innovation, Productivity and Prevention plans (QIPP) for tough decisions about medicine optimisation, stopping procedures of limited clinical value and restricting procedures because of risk factors, including high BMI or smoking.


Dr Anne Connolly is a GP in Bradford and Chair of the Primary Care Women’s Health Forum.