The primary care workforce in England is facing ‘unsustainable’ pressures, while community health services are up against increasing waiting lists and insufficient beds, the Care Quality Commission (CQC) has warned.
The CQC’s annual State of health care and adult social care in England 2023/24 report found that across settings timely access to good care is an ongoing ‘struggle for many’ and that inequalities in care persist.
Specifically, it identified the growing pressures across general practice and community services and highlighted the impact of rising demands for mental health and older people’s services.
Pressures on primary care
According to the report, which draws on inspection activity, research and insight from stakeholders, pressures on GP practices are being partly driven by workload being passed over from hospitals.
This includes ‘unsuccessful referrals’ to secondary care which is leaving people needing to be cared for longer by their GP while they wait for hospital treatment to go ahead.
‘This increased need for GP services is putting unsustainable pressure on the workforce,’ the CQC warned.
Workload dump is part of the reason GPs are currently taking collective action to protest against contractual terms and funding. Without a fair deal, more practices are likely to close, the British Medical Association (BMA) has warned previously.
Targeted assessments of GP practices over the past year had clearly shown that access to GP services continues to be an ‘area of concern for the public’, the CQC said, but it acknowledged the efforts of staff in increasing the number of appointments.
The report found that rural areas had been hit particularly hard. The 10 ICBs with the highest proportions of patients waiting over two weeks to be seen were in comparatively rural areas, and half of them in the south west.
Across the NHS, issues with access to services are often exacerbated by deprivation, the report noted.
This was reinforced by figures from 2023/24 which showed attendance rates for urgent and emergency care for people living in the most deprived areas of England were nearly double those for people in the least deprived areas, the CQC added.
This year’s report also strongly highlighted the impact of delayed care for children and young people within the wider NHS.
In some cases, it can mean an opportunity to intervene can be missed if the wait for a diagnosis is too long, the CQC warned.
And it flagged serious concerns around low numbers of qualified staff – specifically children’s nurses – and ‘gaps’ in staff training.
The School and Public Health Nurses Association (SAPHNA) is currently leading a campaign for a ‘school nurse in every school’ and recently released a report showing the staggering decline in school nurse numbers, amid a rise in pupils presenting with significant mental and physical health issues.
Access to community health services
The report flagged how access to community health services had also suffered – partly shown by a rise in waiting lists.
For adults needing to access community health services, the waiting list had increased by 22% from January 2023 to April 2024 – from 648,000 to 795,270.
Waiting lists increased more for children and young people in the same period, with a 32% rise in waiting lists – from 214,220 to 282,240. Although this is partly because additional services were added to this list in February 2024, the report explained.
In addition, the report said the declining number of health visitors – which has fallen by 45% in England over the last nine years – was an area of ‘specific concern’ within community based services.
Waiting times for care home beds
A rise in waiting times for care home beds was also flagged by the CQC.
It warned that insufficient beds delayed hospital discharges and prevented patients from returning to the community.
‘In April 2024, waits for care home beds and home-based care accounted for 45% of delays in discharging people who had been in an acute hospital for 14 days or more, with nearly 4,000 people delayed on an average day,’ the report said.
The CQC also found regional variation in discharge delays and for much of 2023/24, the North East and Yorkshire region had the highest rate of delayed acute hospital discharges due to waiting for home-based care.
The North East region also had the fewest homecare services per 100,000 population of older people.
In the same period, London had the most delayed discharges from acute hospitals due to waiting for a bed in a care home, with the fewest residential care home beds per 100,000 population of older people.
Responding to the CQC’s findings, Royal College of Nursing (RCN) general secretary and chief executive, Professor Nicola Ranger, said an ‘understaffed nursing workforce’ was central to many of the concerns raised in the report’.
‘This broad and damning report supports the view of ministers that the NHS is broken,’ she added.
‘Taking responsibility for fixing it will be tough but cannot start soon enough.’
Professor Ranger stressed that the government’s upcoming autumn budget was ‘the opportunity for ministers to show serious action is planned’.
Earlier this month, a government-commissioned review into the CQC found ‘significant failings’ that have led to ‘a substantial loss of credibility’ within the health and social care sector.
