We could save £700million in primary care in 2032 by taking decisive action on obesity and diabetes

– Closing the GP Workforce gap (part 2)

Last week we provided an overview of our analysis of the GP workforce gap and the steps that can be taken, starting today, to prepare primary care for 2032. In this post, we highlight the potential benefits – both on workforce and more – that can be gained from addressing demand drivers.

Closing the 2032 GP workforce gap, aiming for 8.5 % vacancy
Number of GPs expressed as Full Time Equivalent (FTE)

Recent trends in care utilisation, ageing and the rise in chronic health conditions are projected to place an unprecedented demand on healthcare. Not all demand will be avoidable, but opportunities to address what is possible should be sought. This is because, despite representing a relatively small margin of intervention compared to supply issues, the cost-benefit of targeted strategies is highly advantageous, and in addition to benefiting workforce numbers it has far-reaching consequences for the wider nation’s health.

We have developed a machine learning model to predict future appointment numbers that accounts for past trends, the effects of ageing as well as rising prevalence of diabetes and obesity. Our model projects that in 2032 GPs in England will have to carry out 382million appointments (nearly 100million more than the current 285million figure), growing at an average of 2.7% a year.

If we expect our workforce to grow by the same extent, we will need an extra 9,450 fully qualified GPs* compared to 2022 (27,500 GPs) to meet demand alone, in addition to the 2,300 needed to halve the current vacancy rate (reported at 17%).

With primary care appointments per patient suffering from obesity or diabetes reported at 2.96 annually and 2.68 per quarter respectively, we can expect an extra 31million appointments in 2032 when taking into account the projected prevalences of diabetes and obesity (9.6% – Public Health England – and 36.7% – Cancer Research UK– respectively).

If we made use of targeted strategies to slow down the rise of obesity and diabetes, and we considered the effects that interventions for obesity and diabetes could have on other conditions such as hypertension, atherosclerosis, chronic kidney disease which exert a large primary care burden, it would not be unreasonable to suggest that we could save at least 18million appointments in 2032.

This equates to freeing up 2,000 GPs as well as savings of up to £700million in direct costs for 2032 and up to 3.8billion over the 10 years (with appointments priced at £39 each), the equivalent of £300 for each of the estimated 13 million patients who are either obese or diabetic. This, however, is only a reflection of appointment costs in primary care and does not account for even greater expenses such as prescriptions, secondary care costs, wider economic consequences and loss of QUALYs associated with a raised BMI (adding up, as a whole, to £58billion).

The new ICBs are placed in a prime position to take action, as the roof under which NHS organisations, primary care and local authorities now work together to improve health. Although the most cost-effective interventions are top-down and national-level, such as reducing mass-media advertising and implementing taxes on sugary and fatty foods (NICE, ACE-Obesity), we should exploit the new ICBs to attempt something that has never successfully been done before – provide a consistent message and pathways across healthcare, schools and local communities that reinforces healthy eating and physical activity, inspired by the NIHR multi-system plan to target obesity.

Tackling underlying demand drivers will play a key part in the long-term strategy for the health of our nation, but it addresses a relatively small amount of the projected primary care demand at just over 5%. Planning on delivering an adequate supply of workforce will be the game changing factor to guarantee a dependable, resilient primary care in 2032, as we will explore next week on our upcoming post on training.