GP Recruitment and Retention

Julie Cooper Excerpts

Wednesday 28th March 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon, and I thank my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) for securing this important debate and for the strong case she made.

To set the debate in context, the NHS has the equivalent of 28,960 full-time GPs, which is 1,300 fewer than two years ago, despite the fact that the Government promised in the NHS Five Year Forward View to deliver an additional 5,000 GPs by 2020. The situation is getting worse as fewer medical students decide to enter general practice, while at the same time more GPs are opting for early retirement. The average age of retirement among GPs is 59, and given that 20% of all GPs are approaching that age, it is no exaggeration to say that there is a ticking retirement time bomb. The situation is set to get a whole lot worse as the number of GP vacancies continues to rise.

In 2011, the number of GP vacancies stood at 2.1%, but by the end of 2017 that had risen to a worrying 12.2%. NHS Digital data showed that, between 17 March and September 2017, the number of full-time equivalent GPs decreased by 166. Over the same period, the number of GP partners fell by 638. I spoke to one young GP and former practice partner who gave his reason for leaving. They said

“no one wants to be the last man or woman left standing.”

When GP recruitment was raised during Health questions in December, the Secretary of State said:

“One of the best things about the NHS is that people have a GP who knows them and their family.”—[Official Report, 19 December 2017; Vol. 633, c. 894.]

I agree, but increasingly that is not the experience for many people. For the elderly, the mentally ill and the chronically ill, that lack of continuity is troublesome. I have elderly constituents with complex needs who rarely see the same GP twice, and because no single GP really knows the whole person, they are constantly bounced back and forth between the surgery and A&E. Too often, that leads to hospital admissions that could have been avoided.

In many areas across the country, patients report that they have experienced difficulty getting to see any GP—that point has been made forcefully by a number of Members today. Indeed, it is not just patients who say that: 71% of doctors surveyed feel that patient access to services has decreased. I have spoken with GPs across the country—including some with 30 years’ experience or more—who declare that there is a crisis in general practice, the like of which they have never seen. The traditional service is struggling to cope with the ever-increasing demand from an ageing population, and GPs face unprecedented workloads. In addition, the harsh economic environment has negatively impacted on the wellbeing of many of the poorest people. Depression and stress-related illnesses have increased, further adding to the demand for GP services. Inadequate mental health resources mean that GPs are often unsupported, with patients in need of specialist support. Cuts in adult social care budgets have meant that many old people are left at home without the support they need and with no one to turn to except their local GP.

In the face of all those pressures, it is no wonder that doctors are choosing early retirement. The more who leave, the greater the pressure on those who have been left behind. The downward spiral of retention is particularly evident in the most deprived parts of the country, where the challenge of recruitment is reaching nightmare proportions. I spoke to one GP in such a community. He said that he had had only one week’s leave in three years because he had been unable to recruit either a partner or a salaried GP to help. Other GPs have told me that they feel like they have their finger in a hole in a dam holding back a tsunami of demand.

It is clear that this situation is unsustainable. The BMA says:

“With an insufficient workforce, a funding plan that is no longer sustainable, a growth in population and a sea-change in the level of complex cases being presented, urgent steps need to be taken to save general practice.”

It tells me that eight out of 10 GPs feel unable to deliver safe care. For the benefit of patients and the long-term future of the general practice that we all know and love—the service that was the envy of the world—the Government must heed these severe warnings from the professionals.

The Government have taken little action to date. When I raised this with the Secretary of State in December, he said that we must

“encourage more medical school graduates to go into general practice as a specialty”.—[Official Report, 19 December 2017; Vol. 633, c. 895.]

I agree, but progress is poor. The recently announced new medical schools are welcome, but they will not in themselves make the profession more attractive. If the Government are serious about delivering 5,000 additional GPs, they must demonstrate that they truly value the service. At a time when morale in the profession is low, the Government must stop adding to the pressures by demanding seven-day access, which is not a priority for patients.

The offer of an additional £2.4 billion is welcome but does not go far enough. The Government must increase the proportion of NHS funding that goes into general practice. They must put general practice at the heart of a primary workforce strategy. Instead of having ill-equipped private companies foisted on to surgeries, GPs should be offered comprehensive support with everything from surgery premises to professional indemnity. If the sector is properly resourced and supported, it will be a more attractive proposition for medical graduates. Such measures would not only attract new graduates into the profession, but help to retain existing practitioners. The current GP retention scheme for doctors who are approaching retirement and considering leaving the profession for personal reasons is helping, but reducing the daily workload would do more to stem the tide of retirement.

Finally, the service cannot be viewed in isolation. There is no doubt that properly funded adult social care, and public health and mental health services, would alleviate pressure. I also make the case for greater utilisation of community pharmacies, which are not to be confused with the welcome addition of pharmacies in GP practices. They would help in so many ways. A nationwide roll-out of minor ailment services would be a good first step that would help enormously, leaving GPs time to see patients with more serious medical needs.

GPs across the country, the excellent Royal College of General Practitioners and the BMA will be listening. I take this opportunity to pay tribute to our GPs for their exceptional dedication. I want GPs across the land to know that the Opposition appreciate the work they do, which so often goes above and beyond the call of duty. They want the Minister to go beyond warm words and wish lists and to outline a detailed, properly funded plan to save general practice. I hope the Minister will not let the professionals and our constituents—the patients—down.