Nearly half of recently qualified GPs are experiencing rising levels of stress, while over a quarter say they don’t have time to deliver the care patients need.

Of 368 GPs surveyed by the BMA who qualified in 2006 (from a cohort of 435), 40% said their morale had deteriorated in the last 12 months.

The respondents identified the current NHS structural reforms – claimed by the Government to be ‘empowering’ GPs – as a major reason for this decline in the professional experience of primary care.

However, 92% said that interactions with patients improved their morale – showing that patients being more unwell or more demanding was not a major issue.

The 2012 survey found that 44% of respondents said their stress levels had worsened over 2012, 20% reported ‘unacceptable’ levels of stress at work, and 28% said they did not have time to deliver the care that patients needed.

In addition, more than half (54%) identified understaffing as a major problem in their practices, while more than three quarters (79%) said work-related administration duties negatively affected their time outside work.

The BMA said the survey's evidence of declining patient access to NHS primary care of adequate quality was “troubling”.

The NHS is limiting patient care by reducing access to medicines in order to achieve short-term cost control targets, the ABPI has said.

At its annual conference, the industry association emphasised that France, Spain and Germany spend three times as much per patient on new medicines as the UK.

While it focused on medicines, the ABPI statement echoed comments from the NHS Confederation on the way that ‘salami slicing’ of healthcare is being used as a short-term financial solution.

Both organisations are calling for service redesign to shift healthcare from the hospital to the community, rather than further cutbacks to existing services.

In particular, the ABPI noted, denying patients access to new medicines on grounds of cost is holding back the treatment of long-term conditions within the community, while giving hospitals more work.

Spending on new medicines is set to rise by only 1.3% by 2015 – half the projected increase in total NHS spend, and far below the rate of inflation.

The UK spends 74p per person per day on medicines, compared to over £1 in Spain, Germany and France. It spends only 7p per person per day on new medicines, compared to over 20p per day in those countries.

Stephen Whitehead, Chief Executive of the ABPI, said: “Our healthcare system needs to focus much more on caring for patients in their own homes and much less on treatment in expensive hospitals. Investing in new, innovative medicines will be absolutely key to this.

“By 2015, the new medicines which are being launched now will make up just 2.5% of the entire medicines budget, and yet it is these treatments which are able to transform the way many diseases are treated.”

The importance of NHS-industry partnership for medicines optimisation has been underlined by experts on pharmacy management.

Speakers at the Pharmacy Management National Seminar on 17 April argued that the growing prevalence of long-term conditions (LTC) made it vital for pharma and the NHS to work together in improving sub-optimal medication regimes.

The growing role of community pharmacists in guiding patient decisions on medication was also discussed at an event that brought together pharmacists and the pharma industry.

Keynote speaker Dr Charles Alessi (pictured), Chairman of the National Association of Primary Care, said that GPs were not meeting the clinically and economically vital challenge of medicines optimisation.

“We are in an age of personalisation, of trying to understand value and of dealing with mixtures of clinical conditions,” he said.

But poor follow-up of patient outcomes was resulting in 50% of people with LTC ceasing to take any medication within a year, while “we glibly go on thinking that’s all right”.

Joint working was an important way forward, he argued, with pharma companies helping doctors to address issues such as medicines interaction and compliance.

Dr Alessi also noted that community pharmacists were emerging as the “best placed” healthcare professionals to help people with LTC manage their medication.

Peter Rowe, former national QIPP lead for medicines use and procurement, warned that continuing austerity would mean no additional funding to deal with the “demographic time bomb” of the ageing population.

Medicines optimisation was essential, he said – and the changes had to be fundamental, not incremental. That meant “the NHS must work with pharma to better monitor patient outcomes”.

Other speakers discussed the common interest of industry and the NHS in patient compliance with treatment; and conversely, the need for doctors to help patients move on from unsuccessful treatments.

The NHS cost-cutting policy known as the ‘Nicholson challenge’ will be extended indefinitely beyond 2015, according to NHS England.

The Government does not expect any improvement in the economy beyond 2015, so has put in place plans to extend the QIPP agenda on a long-term basis.

The statement by NHS England’s Policy Director, Bill McCarthy, refutes Government claims that the NHS budget is ‘ring-fenced’.

However, McCarthy emphasised that the incremental cost-cutting measures that have so far been used to achieve QIPP savings will not be either adequate to the challenge or possible to keep repeating.

Instead, NHS England – through its Local Area Teams – would look at “ambitious and radical” service changes.

The LATs will need to ensure that the decisions of individual CCGs do not conflict with this national service redesign agenda, he said – further qualifying the supposed ‘autonomy’ of CCGs.

Instead of closely monitoring QIPP savings at the local level, as the DH had done before, NHS England will rate the savings plan of each CCG as ‘red’, ‘amber’ or ‘green’ based on whether it can be and is being realised.

NHS England recently published a business plan indicating that it was drawing up a framework for “major service reconfiguration”.

Malcolm Grant, Chairman of NHS England, stated recently that the next government would consider the option of charging for NHS services.

The combined statements by Grant and McCarthy suggest that a radical reduction in the availability of free NHS services is planned beyond 2005.

Like a patient in acute care, public satisfaction with the NHS is now in a stable condition after a severe fall.

According to a King’s Fund report based on the annual British Social Attitudes survey, 61% of the public are ‘satisfied’ with NHS services, compared with 58% in 2011.

These figures are statistically equivalent, but follow a steep fall from 70% in 2010 – though 58% represents only a return to the 2008 level.

Satisfaction with social services in 2012 was at a much lower level (30%) than satisfaction with the NHS, suggesting that social care is the ‘poor relation’ in the family of integrated care.

The figures are based on interviews with over 1,000 randomly selected adults, with the data being weighted to match the overall adult population.

Public satisfaction with the NHS rose consistently from 40% in 2003 to 70% in 2010, but dropped by 12% in the first year of ‘austerity’ measures.

The 2012 figures show a 5% improvement in satisfaction with A&E services relative to 2011, and no significant changes in satisfaction with GP, inpatient or outpatient care.

John Appleby, Chief Economist at The King’s Fund, commented: “With no real change in satisfaction with the NHS in 2012, this suggests the record fall in 2011 was not a blip and that the ground lost may take some time to recover.”

However, the King’s Fund report also notes that the 2011 figures may reflect anxiety about NHS reform, while the 2012 may reflect a better experience of consistency in NHS services than many people had feared.

In support of this conclusion, the think tank notes that “key measures of performance likely to have been noticed by the public”, including waiting times and hospital infection levels, did not change between 2011 and 2012.

The Government should impose a public spending freeze, including the NHS, in order to fund major tax cuts, according to Tory backbencher Dr Liam Fox.

Speaking to the Institute of Economic Affairs, Fox called for an end to protection of the NHS budget and a “systematic dismantling of universal benefits”.

While PM David Cameron immediately dismissed the possibility of cuts in NHS funding (apart from the existing ‘Nicholson challenge’), the speech has been taken as a sign that the public are being prepared for changes in health policy.

Fox, who resigned his cabinet role in 2010 over corruption allegations, said he may stand for the Conservative Party leadership after the 2015 General Election.

His speech proposed a public spending freeze of three to five years, overriding the current policy of ring-fencing health, education and overseas aid budgets.

He also called for universal benefits, such as winter fuel payments and free bus passes for pensioners, to be scrapped, and for housing benefit to be available to people aged under 25 only in exceptional cases.

The capital freed by these cuts, he argued, should be used to fund a temporary abandonment of capital gains tax and to end taxation on savings.

Admitting that the recession will last many more years, Fox stated: “We must ask whether ring-fencing departmental budgets makes sense in a period of prolonged austerity.”

Cameron insisted that he “would not listen” to advice that meant abandoning the promised annual [0.1%] increase in the NHS budget.

However, under his leadership, over £5bn per year cut from NHS spending via the ‘Nicholson challenge’ has been passed on to the Treasury instead of being reinvested in services.

It is possible, therefore, that Fox’s proposals and Cameron’s policies merely occupy different points along a scale of changing NHS policy.

Health Secretary Jeremy Hunt has published strategy documents on tackling premature mortality and cardiovascular disease (CVD).

The DH strategy on premature mortality calls for improvements in the prevention, diagnosis and treatment of cancer, heart disease, stroke, respiratory disorders and liver disease.

The CVD strategy emphasises treating CVD as a single family of diseases with integrated NHS treatment, and making wider use of NHS Health Checks.

Hunt pointed to a current report in the Lancet, according to which the level of premature deaths in the UK has fallen in the last decade but remains higher than in most of Europe.

He claimed that the measures outlined in the two strategy documents could save 30,000 lives by 2020.

Key actions outlined in the CVD strategy include:

• Providing integrated and co-ordinated care by treating CVD as a single family of diseases, and ending the pattern of ‘silo consulting’.

• Using NHS Health Checks to improve the prevention and management of CVD with targeted advice and support.

• Ending the postcode variation in treatment of CVD.

• Better detection and management of CVD risk factors such as atrial fibrillation.

Peter Hollins, Chief Executive of the British Heart Foundation, commented: “We welcome the Outcomes Strategy. It has all the ingredients to tackle the threat posed by cardiovascular diseases, which remain the major public health challenge of our time. We are particularly pleased to see the emphasis on an integrated approach to patients with multiple conditions.”

The strategy document on avoiding premature mortality argued that over half of premature deaths (under the age of 75) could be prevented through more effective public health.

It highlighted the need to address the increasing prevalence of multiple morbidities, where individuals suffer from two or more major conditions.

Alongside action on risk factors and lifestyles, the strategy called on the NHS Commissioning Board to facilitate early diagnosis and “access to the right treatment”, with consistency of outcomes between hospitals.

The document did not explain how, with hospitals that meet clinical targets but overspend facing closure, the emphasis on treatment quality would be funded.

Greek hospitals and pharmacies are running short of around 300 medicines because drug companies are refusing to supply them.

Hospitals failing to pay drug bills and parallel trading by wholesalers and pharmacists are the main reasons for supplies being withheld.

Major pharmaceutical companies that have admitted halting shipments of some products include Pfizer, Roche and Sanofi.

Medicines for arthritis, hepatitis C and hypertension, statins, antibiotics, anaesthetics, antipsychotics and antidepressants are all affected.

Dimitris Karageorgiou, Secretary General of the Panhellenic Pharmaceutical Association, said: “I would say supplies are down by 90%. The companies are ensuring that they come in dribs and drabs to avoid prosecution. Everyone is really frightened.

“The government is panic-stricken and the multinationals only think about themselves and the issue of parallel trade because wholesalers can legally sell them to other European nations at a higher price.”

According to the Greek government, more than 50 companies are holding back products or planning to do so. The Ministry of Health is intending to fine eight major drug companies, which have not been named.

There are reports of widespread panic and anger among patients who are going from one pharmacy to another with prescriptions. “We have reached a tragic point,” commented Karageorgiou.

With austerity tightening in Greece, the debts owed to pharma companies by hospitals and social insurance funds has reached €1.9bn (£1.6bn).

Pfizer has admitted withdrawing four medicines “because alternatives were available and because of the parallel trade situation”: leukaemia drugs Zavedos and Aracytin, the analgesic Neurontin and the epilepsy treatment Epanutin.

Roche said it was withholding supplies to Greek public hospitals, apart from “critical medicines” such as HIV drugs, but was still supplying pharmacies.

Sanofi claimed it was still supplying public hospitals with life-saving and unique products (for which no generic version or recommended alternative exists).

GSK, AstraZeneca, Novartis and Boehringer Ingelheim denied they had stopped supply of any products to Greece.

The pharmaceutical industry has urged the Greek government to set its drug prices in accordance with a eurozone standard. Greek drug prices are 20% lower than the next lowest in the EU, giving rise to widespread parallel trading.

Greek regulator the National Organisation for Medicines has banned the export of 60 medicines and is considering another 300. It will fine wholesalers and pharmacists who have broken the export ban.

The global market in statins, once the pharmaceutical industry’s lead blockbuster products, is predicted to decline by 40% in the next five years.

The forecast by GBI Research of a negative CAGR of 7.2% up to 2013 for the cholesterol-lowering drugs is based on prospects of generic erosion, weak pipelines and failing prescriber confidence.

The decline in the statins market shows that the shift of healthcare towards prevention and management of long-term conditions is not without pitfalls for the pharma industry.

Statins, which lower cholesterol levels by targeting an enzyme in the liver, have been hailed as ‘wonder drugs’ that could radically reduce the global incidence of cardiovascular events.

Routinely prescribed for ‘high-risk’ patients such as people with high blood pressure or diabetes, statins have also been linked to reduced risk of bowel cancer and reduced death rate from influenza.

However, their global market declined from $23.7 billion in 2004 to $20.5 billion in 2011 (a negative CAGR of 2.5%), due largely to patent expiry.

The report predicts a much steeper decline in the statins market over the next five years, for four reasons:

• Patent expiry – the generic share of the statins market is predicted to grow from 11% in 2011 to 34% in 2018.

• Austerity health budgets – spending on prevention is likely to be cut back.

• Weak product pipelines – the ‘me-too’ nature of most statins betrays a lack of potential for innovation.

• Increased use of alternative drugs.

Medical writer Ben Goldacre has argued that the marketing of statins in terms of relative risk reduction glossed over the low absolute risk reduction they offer, and left the products open to a backlash over side-effects.

Statins are associated with both symptomatic side-effects (including digestive disorders) and potential ones (including increased risk of type 2 diabetes).

As the overall statins market declines, the report says, individual products will struggle to gain or keep a place within it: “The global statins market has reached the competitive stage of its lifecycle, with many branded and generic drugs competing with each other on price.”

The Government’s reform of public health funding means that the deepest spending cuts are occurring in the most deprived areas.

Public health budgets for local authorities are now correlated with average age rather than poverty, so the funding for 2014–15 has shifted towards wealthy areas where life expectancy is higher.

As commentators have observed, this policy – developed by former Health Secretary Andrew Lansley – appears designed to improve the relative public health provision enjoyed by Conservative voters.

Two-thirds of local authorities have seen a drop in their public health budgets of up to 43% relative to the levels set by the outgoing PCTs.

Lansley argued that basing public health funding on levels of deprivation was relevant only to a minority of patients – those “on long-term benefit” – rather than communities in general.

His analysis was recently contradicted by Duncan Selbie, the new Chief Executive of Public Health England, who stated: “Where you’re born is still the biggest determinant of how long you live.”

One of the wealthiest local authorities, Richmond upon Thames, has seen its public health budget rise to £40 per head where the outgoing PCT had set a target of £33 per head.

By contrast, Waltham Forest had a budget target for public health of £67 per head, but has been allocated only £42 per head.

Nicola Close, Chief Executive of the Association of Directors of Public Health, commented: “There’s only one health budget, so the more that is pushed towards public health, the more that has to come out of the zero sum budget from the Treasury.”

A spokesman for the Local Government Association said the two-year settlement would enable councils to “cover their statutory services”, but perhaps not to deliver the full anticipated public health service.