GP Services

Sarah Newton Excerpts

Thursday 5th February 2015 Commons Chamber

[Sarah Newton (Truro and Falmouth) (Con)]

I am very proud to be part of a governing team that has spent more money on the NHS. We faced some incredibly difficult choices when the coalition was formed and protecting the NHS was at the top of our list. I have seen for myself some of the benefits of the reforms. Many more decisions about NHS services are now taken in Cornwall, led by clinicians and local people. That is very welcome.

I very much welcome the “Five Year Forward View” that NHS England has put together to cope with the considerable increase in demand on the NHS that is anticipated. Whoever is in government will face the challenge of how we can deliver the first-class services that everyone in this House wants for every constituent in every part of the country.

In the short time that I have, I will share with the House four observations that I have made from talking to staff in the NHS in Cornwall and to patient groups in my constituency, and we could usefully take them forward to help us to tackle some of the challenges we will face in the future.

The first is the role that women can play in addressing some of the work force challenges faced by the NHS as a whole and, in particular, by general practice. The second is how we can expand the services provided by GPs’ surgeries. The third is the role that GPs can play in A and E departments, and fourthly I wish to share some of the learning we have had from our great fortune in Cornwall in being part of the integration pioneer.

[Mr John Redwood (Wokingham) (Con)]

Does my hon. Friend agree that our party’s excellent policy of extending GP opening times and days is crucial, but it will require more GPs to work more flexible hours on an agreed basis?

[Sarah Newton]

My right hon. Friend makes a good point. The plan that NHS England has put forward is about shifting resources from the acute emergency care sector into primary care sectors, especially GP practices. The point that he makes about flexible working fits well with my point about enabling more women to stay in the NHS or to return to it. Many walks of life are addressing the issue of enabling women to combine their caring responsibilities with their desire to play a full part in society, whether that is in public service as a GP, as a Member of Parliament or in business. Much more work needs to be done by the NHS to look at ways to enable women to combine caring for children or elderly parents with being a GP or fulfilling other roles in the NHS.

Women often take a break to look after their families—it is something that I did myself—and it can be difficult for women in their late 30s or 40s to find the ladder back into their previous careers and occupations. I note that many former GPs could make excellent GPs again if they were given the opportunities to retrain and reskill. They could contribute enormously, through working flexibly, to enable GP practices to open more hours.

[Dr Poulter]

My hon. Friend makes an important point. I hope that she will welcome the opportunity we may have to revisit the issue of the annual performers list. At the moment that means that if a GP is out of practice for a year, it is very difficult to return. That is something that we need to address, and I hope that she will be supportive of the Government’s efforts to address it with NHS England.

[Sarah Newton]

I welcome the Minister’s intervention. That sounds like an excellent initiative and I am sure that more will follow, because we need to use the talents of everyone in our nation to address the challenges that we face. Women can play an enormously important role in the NHS, as they can in all other walks of life.

[Michael Fabricant]

I was very interested in the intervention from the Minister, who is of course also a GP. I was also impressed by some of the points made by the hon. Member for Walthamstow (Stella Creasy) about sole GP practices. If we are to have flexibility, so that people can go and see doctors quickly and to enable women and others to go back to work as GPs, it surely requires multi-GP practices, not sole practices. Otherwise, it is just not practical.

[Sarah Newton]

That is a good point. We have to look at how general practices are set up these days. Not all general practitioners want to be part of the old partnership model, which is a sort of small business. Many now would like to be salaried and work particular hours in particular settings. I would not want to prescribe a particular model: we need to look flexibly at different models of provision that meet patients’ needs, taking into consideration what the work force need to enable them to play their full part.

GP practices in my area are expanding the range of services that they are able to provide to the community. As hon. Members will know, I represent a large, remote, sparsely populated part of the country, and such expansion is especially important for rural areas. One example is the Probus surgery of GPs, which serves many villages in its rural community. It is expanding into many areas, including minor surgery. I have yet to come across anyone who has anything other than praise for the Probus surgery, which provides the normal services one would expect from a surgery, but also works closely with its primary care partners and district nurses. It also links up with care managers for people with chronic conditions and elderly people living at home.

By comparison, a very different group of GPs work at Penryn surgery. They serve a large campus that is home to Exeter university, Falmouth university and parts of Plymouth university. There is a growing student population and the surgery has been able to expand its services to provide mental health services, prescribing services and on-campus surgeries. In attracting additional funding for services to meet the needs of the young people—we welcome them into the constituency to study there—they have additional resources from which the whole community can benefit.

Those are two very different examples of how GPs are working positively and constructively with local commissioners to expand services, bring in additional resources and improve patient outcomes for the local community.

[Roger Williams (Brecon and Radnorshire) (LD)]

My hon. Friend represents a very rural constituency, as I do. We do not have any single GP practices, but many of our practices have fewer than five GPs. Our experience is that when one leaves and the practice has difficulty recruiting, it really puts the practice under pressure. Can anything be done to make rural GP practice more attractive to young doctors?

[Sarah Newton]

That is a very good point, and I was just about to make the point that although I have given two good examples of larger GP practices that are doing very well, I also have similar issues to my hon. Friend in more sparsely populated areas of my constituency, such as the Roseland peninsula. It has an older population and it is difficult for GP practices to innovate and bring in additional services to make their future sustainable. I am in regular correspondence with NHS England, which has taken away some of the specific funding that used to be available to support remote rural GPs, in the expectation that they will be able to attract additional funding for providing additional services. That is really not possible or viable. In order to maintain access for people living in sparsely populated areas, where the population is unlikely to grow rapidly, NHS England needs to look again at funding for GP practices in such areas. I hope that my hon. Friend will make common cause with me in writing to NHS England to ask it to reconsider that point as part of its five-year plan.

The third point I wish to make is the positive work I see at the accident and emergency department at Treliske. The Royal Cornwall hospital is the only acute hospital in Cornwall and I am proud to have it in my constituency. The head of the A and E department at Treliske has worked innovatively with his primary care partners to introduce GPs into that setting. As people arrive at the hospital, a triage system is in place so that if people would be better served by seeing a GP, they can do so, which takes pressure off the A and E department.

Finally, I wish to share some of the learning from the integration pioneer work that is happening in Cornwall. The Government designated 14 areas of the country as pioneer areas to look at how we can better integrate care services with the NHS. GPs in Cornwall have provided an essential foundation for that work. Our pioneer bid is led by Volunteer Cornwall and Age UK Cornwall—I think it is the only voluntary sector pioneer bid in the country, and it is very much supported by the NHS right across Cornwall, and by Cornwall council.

By working carefully with GPs to identify frail, elderly and vulnerable groups of people with chronic conditions who tend to use the NHS a great deal—GP services, care services or the acute sector—the pioneer discovered that having a trained volunteer attached to a GP surgery to work alongside families, linking up all available support and enabling them to reintegrate into the community around them, leads to a huge reduction in the use of acute and GP services, and, most importantly, significant increases in self-reported well-being.

There are a lot of lessons that can be learnt from the reforms we have put in place. I am confident that if NHS England’s five-year programme learns the lessons from the pilots and the past five years and puts proper resources into primary care, we can see the improved health outcomes I know we all want.

[Several hon. Members]

rose—

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[Dr Poulter]

The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.

One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.

[Sarah Newton]

Does my hon. Friend agree that the university of Exeter medical school at the Royal Cornwall hospital is an important medical school because it enables people to see general practice in remote rural communities? We know from previous contributions to the debate that that is important in attracting people into remote rural areas.

[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.