The lack of primary and community care investment is ‘one of the most significant policy failures of the past 30 years’, one of the country’s most influential health think-tanks has said.

The NHS in England ‘must be radically refocused’ to put primary care at its core, according to a new report by the King’s Fund.

NHS England and the Department of Health and Social Care (DHSC) should consider changes to the current national contract approaches for primary care, ‘creating more flexibility for local commissioners to drive change based on local need’, the report said.

The financing model for primary care – general practice and community pharmacy through mainly national contracts – ‘does not allow easy flexibility or change’, or larger-scale local investment, the authors said. They pointed out that the proportion of DHSC spending on primary care had fallen from 8.9% in 2015/16 to 8.1% in 2021/22.

They also raised the need for more pharmacy engagement, and emphasised the role the sector could play in a needed focus on prevention and longer-term outcomes.

However, they highlighted that pharmacists had ‘limited headspace to do so while dealing with short-term demands’ and limited incentive to take risks where the impact may be uncertain or the rewards longer term.

The report said: ‘The failure to grow and invest in primary and community health and care services despite the often-avowed intention to do so must rank as one of the most significant and long-running failures of policy and implementation in the NHS and social care over the past 30 years.

‘Future growth in funding and staffing needs to be directed proportionately more to primary and community health and care services rather than to acute hospitals.

‘The Department of Health and Social Care and NHS England need to prioritise capital and revenue investment in technology and estates for primary and community health and care services.’

King’s Fund chief executive Sarah Woolnough said: ‘Many people across the country will have personal experience of struggling to get a GP appointment, trying to contact other services, and when all avenues have been exhausted, reluctantly going to A&E. It feels like all roads lead to the hospital, but our hospitals are already full.

‘To achieve an effective and sustainable health and care system, politicians and national leaders need to embark on a radical and wholesale refocusing of the health and care system towards primary and community services.

‘Doing so will free up hospitals to treat the patients they are best placed to treat, thanks to many more people being diagnosed and cared for in the community.’

Alastair Buxton, director of NHS Services at Community Pharmacy England, said: ‘Today’s report from The King’s Fund highlights one of the central issues that must be addressed for the future of the health and care system, and I was pleased to feed into the research process.

‘MPs across all parties have recently been talking about a shift in focus onto primary care and prevention, but we agree that these words need to turn into action.’

Chief executive Association of Independent Multiple Pharmacies Dr Leyla Hannbeck added: ‘Today’s announcement by the King’s Fund is what we have been arguing for some time now, that community pharmacies are ideally placed to meet the health and preventative needs of the communities they serve.’

Meanwhile, director of corporate Affairs at the National Pharmacy Association, Gareth Jones, said: ‘The common sense case for investment in community-based services is normally summed up as prevention is better than cure. This new report confirms that the flow of funding within the NHS often doesn’t follow this plain logic.

‘Community pharmacies have great potential to help people stay well and live independent lives for longer, yet in funding terms they are very much a poor relation to secondary care.’

Royal Pharmaceutical Society director for England James Davies said: ‘I agree on the need for a wholesale shift in the focus towards primary and community health and care and, as shown throughout Covid-19, pharmacy teams are key to making this happen.’

A DHSC spokesperson said: ‘This government wants to end short-term thinking and we are taking the long-term decisions that will mean everyone can access high-quality care that enables choice, control and independence.

‘We commissioned the first ever NHS Long Term Workforce Plan to train, retain and reform the workforce, and put primary and community care on a sustainable footing.

‘Backed by more than £2.4 billion, the plan will increase the number of GP training places by 50% by 2031.

‘We have also delivered our commitment to provide 50 million more GP appointments per year, rolled out the Pharmacy First service to reduce pressure on GPs, and made up to £8.6 billion available over this financial year and next to support the adult social care workforce and help people leave hospital on time.’

A version of this article was first published by our sister title Pulse