GP Services

Jamie Reed Excerpts

Thursday 5th February 2015 Commons Chamber

[Natascha Engel (North East Derbyshire) (Lab)]

It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow) who, in his previous role as Minister responsible in this area, gained a wealth of knowledge of primary care, mental health and social care, something I want to pick up on in terms of GP services.

I do not want to repeat everything that has been said before, but without a doubt GP services are facing a real crisis. Everybody has mentioned how many people use their GPs. Most people have a GP. Over 90% of all contacts made in the NHS are made through GP services. GPs and GP practices are the absolute bedrock on which the NHS is founded, so we must get this right. At the moment something is going very, very wrong.

I want to put this in context. The hon. Member for Clacton (Douglas Carswell) said earlier that this was about patients, not doctors. Unless we get right the framework in which the doctors are working, it is the patients who suffer. We also need to understand that, over the last 20 years, the number of GP consultations has risen by 25%. There are many more appointments, without the system having changed that much to accommodate that. The average person now sees a GP six times a year, which is double what it was a decade ago, but the word “average” hides something. I represent a constituency with quite high levels of deprivation, but there are a couple of perfectly well-to-do areas where the GP services are not in crisis and are absolutely fine. The problems are in those areas of greatest deprivation. Arguably those are the areas that most need GP services to be running as well as they can. It is also where GPs are under such a lot of strain; some are retiring early and others are not going into GP practice in the first place. I want to emphasise that if a person is deprived, they will use their GP services as much more of a lifeline than others who go to see their GP.

My hon. Friend the Member for Walthamstow (Stella Creasy) spoke passionately on behalf of her constituents. We found in one of our practices where services were starting to crumble that problems compounded each other. Once things start to go wrong, there is a terrible domino effect. A high number of patients are signed up to my practice and one of the partners retired. That one retirement caused the GP practice to go into crisis. We can all sometimes make the situation worse by highlighting an individual practice, in order to try to help as much as possible, and saying that it is in crisis. That means that GPs will not then apply to work there, when actually the issue is not about that one practice; it is one piece of an entire jigsaw. Patients then leave that practice and sign up at a neighbouring practice, causing that practice to go into crisis. We need to look at this not from the perspective of North East Derbyshire or Walthamstow, but as a national problem.

[Mr Jamie Reed (Copeland) (Lab)]

Does my hon. Friend share my concern that unless we as a country address these problems quickly, holistically and in a detailed way, we run the risk of creating a two-tier NHS service, in which those who, as she rightly points out, most need care are less able to access it?

[Natascha Engel]

Absolutely. I am deeply concerned about that, and about where the pots of money are that people are accessing. I will come to that in a moment. One thing I hear a lot locally is, “The problem is that we are all living longer.” Of course it is not a problem that we are living longer; it is fantastic, but we need to change the way we look after people as they get older. The problem is not just dementia, cancer or heart disease; diabetes, as we have heard, is an absolute killer. We need to invest much earlier to make sure that people can manage their illnesses or, hopefully, avoid them altogether. GPs have a fundamental role in that.

What I really wanted to talk about was the interconnection locally. We have had enormous cuts to the budgets of local authorities. Derbyshire county council, which is responsible for social care, has had its budget slashed to a point where it is difficult to provide the levels of care that were provided before. I have a sheltered housing facility called Mallard Court, where 50 people are living independently because they have a warden service. That warden service and the care line allow people to live active, social and healthy lives with a minimum level of support. Cuts to local authority funding mean that that social care can no longer be provided. We are looking at finding other ways to provide it, but taking that warden away means that those people will, in a matter of weeks or months, go into crisis, whereas now they are living independent lives. In looking at GP services, we need to look at that issue as well, as it is the local GP practices who will feel all the pressure of those 50 individuals.

That goes back to my point about pots of money and the ring-fencing of them. We can have social services, GP services and acute care in different places, which sucks up all the money in the NHS. Unless we start to look at all of this, as my hon. Friend the Member for Copeland (Mr Reed) said, as one big picture, the solutions will not be found.

Younger generations are much more demanding, and people have access to the internet. It is good that people are more demanding. That gives a rocket boost to the NHS by making people develop and keeping them on their toes, but we really need to make sure that people are realistic in their demands. The group of practice managers that I meet regularly—they have joined us here today—would say that it is a question of people being realistic in the demands they make on GP services. As MPs, we need to promote that.

I want to talk about normal GP practices. Most of my practices have multiple members. At the moment, there is immense stress and strain on GPs who are partners and own the building that the practice is in. Those employed just as GPs in the practices do not have the same pressure, financial uncertainty and risk that a partner does.

What often happens is that partners retire young and sell their shares in the ownership of the practice. People are not taking on that risk, but are instead working, often in the same practice, as locums. As locums, they can earn around £100 an hour, and that is before they start charging for additional things on top. Rather than having all that stress and strain, and never really having the time to take a step back and look at the bigger picture of where the GP practice is going, partners are standing down and working as a locum, doing the work that they want to do and getting highly paid for it; that is, so far as I can see, a no-brainer.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing this incredibly important debate. We have had a series of genuinely good speeches from right across the House. I thank the following for their contributions: the hon. Member for Henley (John Howell), my hon. Friend the Member for Walthamstow (Stella Creasy), the hon. Member for Truro and Falmouth (Sarah Newton), the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for North East Derbyshire (Natascha Engel), the hon. Member for Newton Abbot (Anne Marie Morris), who made a brilliant contribution, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and the hon. Member for Rochester and Strood (Mark Reckless), who told us about his constituents who have to wait up to six weeks for an appointment, which is clearly not acceptable,

Finally, I thank my hon. Friend the Member for Easington (Grahame M. Morris), who made some incredibly important points. He mentioned that 1 million people today will visit a GP in England, and that 1.6 million will visit a pharmacist. Some of the answers to the questions he raised lie in making better use of the interfaces that patients have with medical professionals, whether it be GPs, nurse practitioners, district nurses or pharmacists. We need to look at the capacity that we have across the system to do more. He said that 30% of training places for GPs in the north-east remain unfilled, and I am with him on that. It is a real issue affecting my community in Cumbria. I hope he forgives me for calling him telepathic, but I think that we need to produce our own doctors to serve our communities.

We should approach the Royal College of General Practitioners, higher education institutions and further education institutions about identifying people at a young age and encouraging them to go into medical careers and to stay in their communities to practise. I am trying to do that in my own community with the university of Central Lancashire. If that idea is to take wings, it will need significant support from the centre—the Department. Hopefully, we will reach a cross-party consensus on that. My hon. Friend hit the nail on the head with his practical solutions to the problems that so many communities face, particularly in the north-east, north-west and the midlands.

I also extend my thanks to the Backbench Business Committee for ensuring that this debate took place. The sustainability of our GP services is crucial to the health of the nation and to the overall performance of the national health service.

There are 372 million GP consultations each year and that number is rising. As my hon. Friend the Member for North East Derbyshire pointed out, around 90% of all patient contacts with the NHS are through a local GP. No one can dispute that GPs provide a vital service, but increasing pressures on this service are having a major impact on the NHS as a whole. The service does not exist in isolation, and so a holistic approach to our national health service must be taken if we are to have a system that is fit for the challenges of the 21st century.

I wish to touch on three key tenets to our GP services: the issues surrounding the work force and the impact that they have on the profession; the concerns regarding access; and the wider impact that all these pressures are having on the NHS as a whole. Before I address those issues, I wish to pay tribute to the Royal College of General Practitioners and its chair, Dr Maureen Baker, for its Put Patients First campaign, which has put the problems facing general practice to the top of the political agenda. Like other MPs, I thank GPs around the country for their work under such extreme pressures. They really do perform superbly in difficult circumstances.

The latest GP patient survey was a timely reminder of the problems facing both medical practitioners and patients. It found that one in four people is waiting a week or more for a GP appointment, or not getting one at all. If such a trend continues over the course of this Parliament, we will find that by 2020-21, the number will have risen to more than 22.5 million people. A Patients Association survey revealed that four in 10 people are concerned about the impact that the wait for a GP is having on their health. We may disagree over the causes of those concerns, but there can be no doubt that the Government have overseen a deterioration in the patient experience. Colleagues across the House will have repeatedly heard that from their constituents. Hopefully, the one thing we can all agree on is that there are not enough GPs.

In March 2014, the Government’s taskforce report, “Securing the Future GP Workforce” was published. It said:

“The taskforce has concluded that there is a GP workforce crisis which must be addressed immediately even to sustain the present role of General Practice in the NHS.”

The Government’s own report paints a damning picture. It says that GP recruitment has remained “stubbornly below” the Government’s target, and that

“this cumulative recruitment shortfall is being compounded by increasing numbers of trained GPs leaving the workforce, most significantly GPs approaching retirement, but perhaps more worryingly women in their 30s.”

We have heard that concern from Members across the House.

The report goes on to say:

“Disturbingly, evidence is also emerging from the NHS Information Centre that the GP workforce is now shrinking rather than growing.”

It also shows that the number of GPs per head has fallen below levels seen in 2009. At a time when demand is rising, such a reduction is having a profound impact on the service that GPs can provide. We know from personal experience and from our constituents that the vast majority of GPs work tirelessly in extremely trying conditions to provide the best care possible for their patients, but under this Government that is becoming harder and harder for patient and practitioner alike.

I speak to GPs from all around the country, including in my constituency, who are on the verge of burning out. GPs are concerned that they are so overworked that they are at risk of harming a patient. I have written to the Secretary of State with regard to comments made to me by a local GP, who said that unless something changes, unless recruitment improves and unless service pressures ease, “we are going to kill someone”. Clearly, that is an untenable and unacceptable state of affairs.

The increase in demand and workload is having a detrimental impact on the morale of GPs. A BMA survey in March last year revealed that more than half of GPs reported that their morale was either “ low” or “very low”. This is a matter not of professional whinging, but of patient safety. The chair of the BMA GP committee said at the time of that report:

“It is clear that General Practice is facing a workload disaster that is threatening its long-term future.”

The Government’s inaction is only making things worse. The work force issues that I have outlined now mean that more GPs are considering early retirement, thus potentially exacerbating an already unsustainable situation. The BMA survey showed that more than a quarter of GPs were considering leaving the profession, six out of 10 were considering early retirement, and a third were already planning for that decision. Instead of delaying, I hope that, in the days remaining before the election, the Government will back Labour’s time to care fund, which, with a budget of £2.5 billion a year, would recruit 8,000 more doctors, 5,000 more care workers and tens of thousands of other new staff by 2020. We would do that by taxing mansions, clamping down on tax avoidance, and raising a levy on tobacco companies. We can fund new medical professionals to ease the work force pressures and to give GPs the support that they need to provide a service on which we all rely.

In response to Labour’s announcement on the time to care fund, particularly on our pledge to produce 8,000 more doctors, the chair of the Royal College of General Practitioners, Dr Maureen Baker said:

“It is good to see that the Labour Party have recognised the resource and workforce pressures facing General Practice and their pledge of 8,000 more GPs by 2020—something the RCGP has long called for—is very welcome.”

In contrast, the Government have missed their own recruitment target, which is having a profound impact on the overall service. I hope that they will back our plans to ease the work force crisis that they have, in part, helped to create.

Moving on to access, despite the best efforts of GPs and other professionals, work force pressures are having adverse effects on patient experience. More than one in four people do not get a GP appointment within a week. The GP patient survey shows a deterioration in access to GP services. When Labour left office, the vast majority of patients could get an appointment within 48 hours, but one of the first acts of this Government— something I am sure that they now regret—was to scrap Labour’s guarantee. As a result, it is now getting harder and harder for patients to see their GPs. That is not surprising, given the worsening work force pressures that the Government have presided over.

The Government have failed not just on overall access, but on the continuity of care. They talk of the continuity of care and access to a named GP, yet the GP patient survey shows that one in five people are unable to see their preferred GPs regularly. This, too, is unacceptable. The overall picture of GP access is one of deterioration, not improvement. The Government have heaped pressure on primary care, and now, as we all know from our constituency surgeries, patients are feeling the effects.

By cutting competition and rolling back the market that the Government have imposed on the NHS, Labour has committed to investing an extra £100 million to deliver new options for GP access. The Government should back Labour’s plans to give patients three options for accessing their GP: first, a same-day consultation at their GP surgery; secondly, a GP appointment at their surgery within 48 hours; and thirdly, the ability to book ahead to see the GP of their choice. All Members who have spoken today have raised precisely such issues, and only the Labour party has produced the solutions to those issues, which so many constituents are taking to colleagues. Where possible, some GP surgeries already provide those options, and with Labour’s extra funding and new doctors, we want to give all practices the ability to deliver them.

Timely access to GP services is essential for the whole NHS. The GP patient survey has shown that almost 1 million people have gone to A and E because they were unable to get a convenient GP appointment. That is creating unprecedented demand on our A and E departments, manifesting itself in the number of patients now waiting for more than four hours—something that we all see—and causing reverberations throughout the whole system. The Government’s cuts to social care have also increased pressure on primary care services, and that, in turn, is also increasing pressures on A and E

The constituent services of the NHS do not exist in isolation, and the Government’s failings in easing work force pressures for GPs have had profound effects throughout the system. Instead of addressing these issues, most of which were predictable, the Government blew precious time and more than £3 billion on a reorganisation that was deliberately hidden from the public before the last general election. Only by backing Labour’s plans for thousands of new doctors, funding to improve GP access, and moving towards the greater integration of health and social care, can we really ensure that all parts of the NHS, including GP services, are sustainable for the future.

We have heard about profound difficulties in Walthamstow and other communities. I am one of those fathers who hang on the phone for 30 minutes or longer, trying to get an appointment for a sick child. I do not blame GPs; they are under huge pressures and we have heard about recruitment problems all over the country. I have written to the Secretary of State for Health about recruitment problems in Cumbria, but sadly, I have yet to receive a reply. Will the Minister, if nothing else today, commit to write to every Member who has expressed concerns in the debate to illustrate in detail what the Government will now do to help those communities to assist with GP recruitment and sustainability? Universal services require universal standards and the ability of patients to access these services universally.

--- Later in debate ---

[Dr Poulter]

My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.

I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.

In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.

In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.

A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.

Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.

[Mr Reed]

In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:

“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?

[Dr Poulter]

It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.

Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.