Government should engage with primary-care providers

AS the group that represents Jersey’s GPs, the Primary Care Body welcomes Ann Esterson’s letter (JEP 17 May) raising concerns about the funding of healthcare. We hope that it stimulates debate with regards to the funding of GP and wider community healthcare. Ms Esterson is uniquely placed to draw attention to the subject, as she speaks with the considerable experience that comes from her time as the chief officer at Social Security.

The ‘rebate’ is the proportion of the GP consultation fee which is paid by the States to reduce the cost to the patient. It is paid from the Health Insurance Fund to which the majority of Islanders contribute or have contributed through social-security payments. She is quite right that the government contribution has not risen since 2012 and patients are, therefore, expected to pay proportionately more for their GP appointments. Over a number of years, the PCB has requested that the rebate be increased to lessen the impact of increasing costs on patients.

We recognise that the funding of healthcare is complex and likely to become more so with the adoption of the Jersey Care Model, which allows the Health Insurance Fund to contribute to the Health budget. This has already happened with annual payments nearing £1 million towards Health’s laboratory costs being made for a number of years. This year an additional sum of £11 million has been allocated to Health to address IT infrastructure. This is considerably more than the £8.6 million which was paid to support general practice in 2019.

As pointed out by the Social Security Minister, some services are contracted to general practice and community pharmacies to allow the provision of essential public health services in the community (childhood immunisations, flu vaccinations and cervical smears for example). The Health Access Scheme was also recently introduced to protect a proportion of the Island’s most vulnerable. This, again, allows the appropriate obligations of the States to be met through general practice. However, the above do not fund routine GP care.

The funding of day-to-day care is part-funded by the States via the rebates payable for GP appointments and a mechanism based on meeting agreed markers of good practice called the Jersey Quality Improvement Framework.

Figures provided by the States show that the amount spent per capita per annum on general-practice care has decreased from £86.48 in 2015 to £79.87 in 2019. This represents a fall of 16.5% in real terms over this period alone. The right to affordable healthcare for all is well established and it is sad that one of Jersey’s universal benefits has been eroded.

General practice retains a crucial role in the provision of healthcare. This appears to be much valued by our patients, but our place in the healthcare economy does not always seem to have been well understood by government. We have long pressed for increased funding to ensure the best value for patients and sustainability of GP practices with the ability to recruit and retain committed GPs, practice nurses, healthcare assistants and the administrative staff necessary to achieve this, while improving our premises and infrastructure. We continue to provide high-quality, safe and accessible healthcare. We are, therefore, well placed to support the Jersey Care Model and the possible changes in community care that the associated new hospital project and transition of services is likely to bring.

While using the fund to resource the broad range of health services in the community reflects the evolution of healthcare, the current calls on the fund do not seem to reflect the need to establish and promote community services as a priority. Indeed, the funding of general-practice services under the Jersey Care Model has been pushed back for a likely period of three years. Without the immediate support of the government, the necessary community resources will not be in place in a timely manner, putting the implementation of the Jersey Care Model at risk.

The Primary Care Body actively continues to try to engage with the government in order to enhance funding of general practice to cover the current needs of the population. We proposed an interim-funding model which was rejected in August 2020 and subsequently submitted an evidenced argument for an increase in the rebate for GP consultations, along with financial support for consultations with practice nurses. Sadly, these suggestions were dismissed in March of this year.

It is widely recognised that ‘health inflation’ exceeds the usual markers of inflation. GPs have tried to protect patients from the impact of increasing costs, but the current political stance to the funding of general practice will sadly likely be reflected in increased patient fees.

We call upon the government to engage with primary-care providers to support the needs of all Islanders.