Jan 26 min read

The 2024 Darzi Report | A Summary for Primary Care Network Leaders

Updated: 3 days ago

As always, I write blogs for new primary care network managers, administrators, clinical directors, and those interested in PCNs. This blog focuses on the 2024 Darzi report, emphasizing the increasingly complex health and social care support patients require.

This is an important document, as it sets the direction for future policy and a vision for a more integrated primary care.

In this blog, we cover:

The context and purpose of the document
A General Practice Lense looking at the business model and patient implications
A wider view of the workforce
Touch upon integrated neighbourhood teams
Health Conditions and Insights

Let's jump in.

The 2024 Darzi Report | Context and Purpose

In September 2024, An Independent Investigation of the National Health Service in England, led by The Rt Hon. Professor Lord Darzi, was published, who also authored the 2008 report, "High Quality Care for All."

The report was commissioned by the Labour government after the party's election victory in July 2024 to assess the current state of the NHS, examining patient access, quality of care, and overall health system performance and highlights seven major themes for NHS transformation:

1. Re-engage staff and re-empower patients

2. Lock in the shift of care closer to home through financial flows

3. Simplify and innovate care delivery for a neighbourhood NHS

4. Drive productivity in hospitals

5. Tilt towards technology

6. Contribute to the nation's prosperity

7. Reform to make the structure deliver

The investigation was initiated against declining public satisfaction with the NHS, growing waiting lists, and increasing pressure on services. The report aimed to establish whether the NHS is fulfilling its promises to the people and, if not, to understand why.

Banner promoting "Pure Unity Health" with text about primary care services. Includes a clickable link and a note on partnership with THC.

A General Practice Lense

The stats presented in this report are nothing new.

The findings indicate that while GPs are seeing more patients than ever before
The UK has 15.8% fewer GPs per 1,000 population than the OECD average
Primary care's share of NHS funding has declined from 24% in 2009 to 18% in 2021 despite increasing demand and complexity of care needs
Striking variation in GP coverage - from 1,467 patients per GP in Devon to 2,261 in North West London

The General Practice Business Model

Significant infrastructure challenges, with 20% of GP estates predating NHS founding
Problematic schemes limiting practice control over premises
Funding formulas failing to account adequately for deprivation
Need for fundamental reform of resource allocation

Patient Impact

33% of patients waiting over a week for appointments (2024)
Growing complexity of patient needs
Digital access remains underutilised despite high registration
Patient satisfaction at historic lows

Wider Workforce Challenges

Staffing Numbers and Distribution

44.1% decline in learning disability nurses since 2010-11
Community nursing numbers have fallen by 5% since 2009
Health visitor numbers dropped by nearly 20% between 2019-2023
Declining manager-to-staff ratios
Loss of experienced managers and institutional memory following 2012 reforms
Need for better development of clinical leaders
The challenge of balancing clinical and managerial responsibilities

Staff Wellbeing and Engagement:

The equivalent of one working month (22 days) lost per nurse and midwife annually to sickness
High levels of stress and burnout, particularly post-pandemic
Reduction in discretionary effort across all staff groups
Anxiety, stress, and depression are the most common reasons for sickness and absence
Record numbers of healthcare professionals seeking support

Integrated Neighbourhood Teams

Not much was written about integrated neighbourhood teams, which is interesting from a primary care network point of view as this is seen as the next step for PCNs.

However, the report emphasises that "the best way to work as a team is to work in a team," representing a model that brings together primary care, community services, and mental health services at a local level.

This approach aims to:

Deliver more coordinated care closer to home
Better manage complex conditions
Improve preventive care
Reduce hospital admissions
Enhance patient experience

Health Conditions and Insights

1. Long-term Conditions and Rising Prevalence

The report identifies significant increases in chronic conditions that are placing growing pressure on primary care services.

Diabetes has increased by 47% over 14 years (5.1% to 7.5%, 2008-2022)
Hypertension has risen by 27% over 18 years (11.3% to 14.4%, 2004-2022)
The complexity of care has increased with multiple long-term conditions becoming more common, rising at 6.1% annually between 2017-2022.

Age-Related Impact:

Age 65-74: Most patients have at least one chronic condition
Age 75-84: 60% have two or more conditions
Age 85+: 90% have at least one condition

2. Mental Health

Mental health presents a growing challenge.

Mental Health Referrals - Annual Increases:

Adults: 3.3% increase each year
Children and young people: 11.7% increase each year
Perinatal mental health: 23% increase each year (since 2016)

Depression:

More than doubled in 10 years:

2012: 5.8% prevalence
2022: 13.2% prevalence

Specialist Services:

ADHD assessments: Up to 8-year waiting times for adults
Eating disorders: 82% increase in hospital admissions (2019-2024)
Growing demand for autism assessments

3. Cardiovascular Disease and Cancer

Cardiovascular disease trends show concerning patterns, with mortality rates rising after previous improvements.
Treatment times for high-risk heart attacks have increased by 28%, and there are significant variations in stroke care access across the country.
Cancer cases rose at 1.7% annually (2001-2021), though early diagnosis rates improved to 58% in 2023 after stagnating between 2013 and 2021.

4. Children's Health

Children from deprived areas are 2.1 times more likely to be obese, with nearly one-third of children in the poorest communities being obese by year 6.
Life-limiting conditions have increased by 250% between 2001-2018, and the number of children with eight or more chronic conditions has nearly doubled from 7.6% (2012-13) to 14.0% (2018-19).
The number of children requiring long-term ventilation has more than doubled between 2013-2020.

5. Mental Health and Suicide

While UK rates remain below many other countries, there are concerning increases among young people, with annual rises of 6.9% for young women and girls and 3.2% for young men and boys (2015-2019).

However, there has been success in reducing suicides among mental health inpatients, falling from 100 in 2009 to fewer than 60 annually since 2017.

6. Learning Disabilities

People with learning disabilities:

Face significant health inequalities, with only 40% living to age 65.
Are twice as likely to die from preventable causes and four times more likely to die from treatable causes.

There has also been a 44.1% decline in learning disability nurses since 2010-11, impacting care quality and access.

7. Preventable Health Issues and Social Impact

The report notes rising cases of measles (the highest this century in 2024), growing concerns about antimicrobial resistance, and ongoing impacts of COVID-19.
Long-term sickness has led to 2.8 million people being economically inactive, an increase of 800,000 from pre-pandemic levels.
Mental health conditions are a significant factor, particularly among 16- to 34-year-olds, who have seen a 57.1% increase between 2019 and 2023.

These health trends have significant implications for primary care service design and delivery, requiring:

Enhanced capacity for managing complex, multiple conditions
Better integration of mental health services
Improved preventive care strategies
Stronger focus on health inequalities
Development of integrated care pathways
Investment in specialist nursing roles
Enhanced support for children and young people's services

Conclusion

The challenge now is to translate these insights into practical changes that benefit patients, support healthcare professionals, and create sustainable primary care services.

Success will require sustained investment, structural reform, and a commitment to supporting primary care as the foundation of the NHS.

This will require engagement at all levels, from national policy to local implementation, with a particular focus on enabling primary care networks to support the leadership and transformation in their communities.