This article is from the source 'bbc' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.bbc.co.uk/news/uk-england-london-40045316

The article has changed 2 times. There is an RSS feed of changes available.

Version 0 Version 1
General election 2017: Tough choices for London's NHS General election 2017: Tough choices for London's NHS
(about 3 hours later)
The simple statistics for the NHS in London make stark reading and tell you why trying to sort it out and protect it for the future is both incredibly important and extremely challenging.The simple statistics for the NHS in London make stark reading and tell you why trying to sort it out and protect it for the future is both incredibly important and extremely challenging.
Every year in the capital:Every year in the capital:
They are big numbers that require big solutions, along with a big dose of political support. But change of that scale could be hard to deliver.They are big numbers that require big solutions, along with a big dose of political support. But change of that scale could be hard to deliver.
Ten years ago there was a plan to change the way the NHS worked in London, with greater focus put on primary care rather than hospitals.Ten years ago there was a plan to change the way the NHS worked in London, with greater focus put on primary care rather than hospitals.
Sound familiar?Sound familiar?
Called "A Framework for Action", it was a plan that delivered some big changes in London with particular success in the new major trauma units and the new specialist stroke centres.Called "A Framework for Action", it was a plan that delivered some big changes in London with particular success in the new major trauma units and the new specialist stroke centres.
It also promised 100 new so called "polyclinics" to offer a range of services from new buildings.It also promised 100 new so called "polyclinics" to offer a range of services from new buildings.
But the strategy was ditched when the coalition government came to power in 2010.But the strategy was ditched when the coalition government came to power in 2010.
David Cameron's government had its own plan, which promised a boost for local GP services and a move to more care out of hospital.David Cameron's government had its own plan, which promised a boost for local GP services and a move to more care out of hospital.
Today the arguments remain pretty much the same.Today the arguments remain pretty much the same.
There is wide agreement more care needs to be delivered closer to home and more resources need to be funnelled to primary care and GPs.There is wide agreement more care needs to be delivered closer to home and more resources need to be funnelled to primary care and GPs.
Experts say a shift is needed to a proper National Health Service that keeps people well and away from a national illness service, that picks up the pieces when they become unwell.Experts say a shift is needed to a proper National Health Service that keeps people well and away from a national illness service, that picks up the pieces when they become unwell.
But how do you get there? Change in the NHS is expensive and also politically difficult.But how do you get there? Change in the NHS is expensive and also politically difficult.
Moving or cutting services at hospitals for example is often deeply unpopular.Moving or cutting services at hospitals for example is often deeply unpopular.
Promises made at elections can make you look opportunistic some years later.Promises made at elections can make you look opportunistic some years later.
Campaigners at Chase Farm Hospital in Enfield, north London, will remember David Cameron promising to keep their A&E open before the 2010 election. It is now closed.Campaigners at Chase Farm Hospital in Enfield, north London, will remember David Cameron promising to keep their A&E open before the 2010 election. It is now closed.
Services across the capital are currently being reviewed under a process known as Sustainability and Transformation Plans, which assess how the NHS will look over the next five years.Services across the capital are currently being reviewed under a process known as Sustainability and Transformation Plans, which assess how the NHS will look over the next five years.
There are five of these and all involve moving services around, while some involve the closure or downgrading of A&Es.There are five of these and all involve moving services around, while some involve the closure or downgrading of A&Es.
All involve plans to save millions in the way services are delivered while also spending millions on new buildings and different services.All involve plans to save millions in the way services are delivered while also spending millions on new buildings and different services.
All say that doing nothing is not an option. If the NHS continues to spend in the way it is and deliver services in the way it does now, it will face a funding shortfall of more than £4bn in London alone.All say that doing nothing is not an option. If the NHS continues to spend in the way it is and deliver services in the way it does now, it will face a funding shortfall of more than £4bn in London alone.
If re-arranging hospital services is a challenge, the one facing primary care is just as hard. Shifting the focus to getting patients treated by GPs means finding doctors to deliver that service.If re-arranging hospital services is a challenge, the one facing primary care is just as hard. Shifting the focus to getting patients treated by GPs means finding doctors to deliver that service.
A recent survey by the London-wide Local Medical Committees, showed 42% of practices had a GP or practice nurse vacancy, while 45% of practices had a GP who was planning to retire in the next three years. A recent survey by the Londonwide Local Medical Committees, showed 42% of practices had a GP or practice nurse vacancy, while 45% of practices had a GP who was planning to retire in the next three years.
In fact, NHS statistics show the city has the highest number of GPs over the age of 55.In fact, NHS statistics show the city has the highest number of GPs over the age of 55.
"The situation is worse than I've ever seen it""The situation is worse than I've ever seen it"
Willesden GP Dr Adrian Richardson knows the pressures only too well.Willesden GP Dr Adrian Richardson knows the pressures only too well.
His practice nearly closed last year, as three of its partners left, either retiring or choosing to get out of general practice.His practice nearly closed last year, as three of its partners left, either retiring or choosing to get out of general practice.
"It's sad the situation in this practice was that people felt that options were better outside the practice than in," he said."It's sad the situation in this practice was that people felt that options were better outside the practice than in," he said.
"I stayed because I didn't feel it was right to leave 15,000 patients without a proper practice.""I stayed because I didn't feel it was right to leave 15,000 patients without a proper practice."
He blames increasing workloads and paperwork for the extra pressures.He blames increasing workloads and paperwork for the extra pressures.
"The situation is worse than I've ever seen it."The situation is worse than I've ever seen it.
"If you ask me about 2016 it will go down as the worst year of my clinical life.""If you ask me about 2016 it will go down as the worst year of my clinical life."
All the parties are committing to recruiting more GPs and nurses but doing it quickly is not possible, given the length of time it takes to train them.All the parties are committing to recruiting more GPs and nurses but doing it quickly is not possible, given the length of time it takes to train them.
All the parties are promising more money for the NHS and social care. There are promises too of more money for new buildings and pledges to rebuild an ageing estate.All the parties are promising more money for the NHS and social care. There are promises too of more money for new buildings and pledges to rebuild an ageing estate.
There are promises that may be viewed with some scepticism from those working in the NHS and certainly shared by the Nuffield Trust think tank which specialises in analysing health policy.There are promises that may be viewed with some scepticism from those working in the NHS and certainly shared by the Nuffield Trust think tank which specialises in analysing health policy.
It said: "Promises of billions extra for the health service can sound like big sums ... unpicking the pledges from each of the manifestos reveals that the NHS looks set to face a further five years of austerity, whoever forms the next government.It said: "Promises of billions extra for the health service can sound like big sums ... unpicking the pledges from each of the manifestos reveals that the NHS looks set to face a further five years of austerity, whoever forms the next government.
"Whichever party forms the next government will have to face some tough decisions about the future shape of the health service, and how it can continue to meet the needs and expectations of its patients and staff.""Whichever party forms the next government will have to face some tough decisions about the future shape of the health service, and how it can continue to meet the needs and expectations of its patients and staff."
Hard choices on the NHS lie ahead for whoever wins the election.Hard choices on the NHS lie ahead for whoever wins the election.
What's on offer from the party manifestos:What's on offer from the party manifestos:
Labour:Labour:
Conservative:Conservative:
Lib Dems:Lib Dems:
Greens:Greens:
UKIP:UKIP: