Derek Twigg
The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.
I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.
As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.
This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to
“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”
How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.
The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.
Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.
The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:
“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”
Those words are not mine but those of a GP: NHS 111 has caused some real concerns.
The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.
My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a time to care fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.
In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.
One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The hon. Gentleman is making some important points, but does he recognise the fact that it takes a number of years to train any medical specialist, including a GP? While he is talking about the previous Government’s investment in the NHS, would he like to explain why that forward work force planning was not done and how such planning may have helped with some of the issues that he is raising today?
Derek Twigg
The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.
Derek Twigg
Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.
Dr Poulter
On long-term work force planning, the hon. Gentleman suggests that there is suddenly a crisis in GP recruitment—which I do not think is necessarily correct—but if the previous Government were serious about investing in general practice, they should have trained a lot more GPs than they did.
Derek Twigg
I know the Minister’s background, but he should read the figures on the number of GPs recruited by Labour when we were in power. Between 2000 and 2009, there were thousands of extra GPs, compared with the additional recruitment since this Government came to power. He should compare the two records.
I will not take any more interventions, Mr Speaker, because other Members want to speak.
Many local initiatives are trying to deal with the crisis in general practice and gaining access to GPs, or certainly to mitigate the effect. Clinical commissioning groups, such as Halton CCG, are working closely with partners to develop a strategy within the financial constraints. Halton CCG has told me:
“Delivery may be across the whole CCG on a Halton-wide footprint; by bringing more than one GP practice together to service distinct communities through a ‘hub’ based approach; by sustaining individual practices wherever appropriate and by giving local people and communities more opportunities to self-care and create resilience”.
It is working with partners to try to improve the situation, despite the financial constraints and the shortage of GPs, but we must attract more GPs.
The Royal College of GPs has told me that, in its view, it is vital that we increase the share of the NHS budget spent on general practice in England from 8.3% to 11%. That is one of the key parts of its campaign. That increase would help to reduce pressure on other parts of the NHS by supporting the delivery of more patient care in the community and keeping people out of hospital wherever possible.
The fact is that general practice cannot go on in this state. We need a sustainable, funded plan to ensure we have enough GPs to meet the population’s needs and to provide better care outside hospital. Clearly, patients should not have to wait days and sometimes weeks to see a GP or be constantly denied the opportunity to see the GP of their choice. We need to relieve the pressure on hard-pressed GPs, by ensuring that general practice is where more young doctors want a career, and in doing so we would have much better integrated care. We need better buildings to make general practice a more attractive place. We must of course constantly challenge the medical profession on how they can work better and deliver better services to patients within available resources. In the end, both politicians and clinicians must put the interests of patients first, while getting the best value for the taxpayer.
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.
Caroline Lucas (Brighton, Pavilion) (Green)
I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing the debate. I am very pleased to have worked with him to have this opportunity today to discuss the vital issue of building sustainable GP services.
Proper funding for our GP services is vital for good patient care, easing pressure on hospitals and ongoing sustainability. The question we need to ask is this: why have Ministers allowed a trend of consistently falling GP funding? The Royal College of General Practitioners made its own concern clear back in June 2013 with an urgent call for an increase in GPs’ share of the NHS budget, so that 10,000 more GPs could be hired. However, recent figures reveal funding to be at an all-time low of 8.3%, something which shows a worrying complacency. In response, more than 300,000 people, including many in my constituency, have signed the RCGP’s petition, “Put patients first: back general practice”. The petition calls for more money to be allocated to GP services. Alongside the campaign, the BMA has conducted clear analysis of the serious work load pressure facing GPs, an issue so many hon. Members have raised today.
As the Minister well knows, the drop in share of the NHS budget for our doctors’ surgeries comes at a time when GPs are under increasing pressure and are having to see more and more patients. A situation in which they are seeing 40 to 60 patients a day is simply unsustainable for both patients and doctors. It is horrifying that 80% of GPs say that they do not have sufficient resources to provide high-quality patient care.
GPs in my constituency are telling me that good patient care is being destroyed because of what they see as impossible demands, including as a result of privatisation and a lack of funding for primary care services. For example, in a joint letter to me, seven local GPs said:
“There is no doubt that general practice is really suffering from the lack of investment, impossible demands and never ending re-organisations. If we could stop having administrative battles and spend our precious hours on patient care we would all be much happier, and the service would be better and significantly cheaper to run.”
Dr Poulter
I commend the hon. Lady for making points on behalf of her local GPs. She talked about privatisation. Would she not accept that the funding model for GPs as small businesses in their own right has existed since 1948, when Nye Bevan created the NHS?
Caroline Lucas
I accept that, of course. When I talk about privatisation, I guess what I am referring to is constant fragmentation: the way in which NHS England, CCGs and others are still struggling to get a streamlined process, which makes it more difficult for patients to be seen when they need to be seen and by the person who needs to see them.
Paul Burstow (Sutton and Cheam) (LD)
I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.
I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.
About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.
According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.
Dr Poulter
I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?
Paul Burstow
Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.
In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently their lives are cut short.
GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.
I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank the hon. Members for Halton (Derek Twigg) and for Brighton, Pavilion (Caroline Lucas) for securing this debate today. I commend them for raising important issues about the resourcing of general practice, access to GP services and the future shape of general practice and how it will continue to deliver high-quality care to patients. In particular, I should like to praise the many GPs who work exceptionally hard every day for our NHS and deliver high-quality care to patients.
The hon. Member for Halton made some other important points about mental health training for GPs. Historically, GPs have not always received training in mental health. That must change. The Royal College of General Practitioners and the Royal College of Psychiatrists support that change, and that is why we have stipulated in Health Education England’s mandate that GPs should receive compulsory training in mental health in future. Health Education England is now working with the royal colleges to put that in place. That important step forward will benefit many patients throughout the country.
I will ask my right hon. and noble Friend Lord Howe to look into the issues raised by the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and to get back to them in due course. Although the hon. Member for Halton raised some important issues, some of which were echoed by the shadow Minister, the hon. Member for Copeland (Mr Reed), it is frankly not good enough to complain now about a GP work force crisis when they were in power for 13 years. It takes three years from the end of foundation training to train a GP, and training a part-time GP takes longer. If there is a work force crisis in general practice, it is because the previous Labour Government did not have the foresight to train enough GPs when they were in power.
Dr Poulter
I will give way in a moment.
Under this Government, 1,000 more GPs are working in the NHS or training. That is a move in the right direction. We have put in place long-term work force plans to ensure that there are 5,000 more by 2020. We have recognised the pressure that GPs are under, and we have trained and are training more. I hope that the hon. Gentleman will do better than he did in his speech and at least acknowledge the point I have made.
Derek Twigg
With respect to the Minister, I am not suggesting that everything that the Labour Government did was perfect or that we met every demand on us. I tried to make it clear, although he does not want to recognise this, that there were massive improvements in the number of GPs. The Library’s figures for 2003 to 2009 show an extra 5,000 GPs. Many of the GPs now coming into place were trained under the Labour Government.
Dr Poulter
Indeed, there was an increase in the number of GPs, as there has been under this Government, but it is not good enough to lay the blame for a lack of GPs at this Government’s door, as the hon. Gentleman and the shadow Minister tried to do, when it takes a long time to train more GPs. What may have been a better decision for the previous Government in the advanced work force planning would have been to follow this Government’s example, by saying that 50% of medical graduates should become GPs. Currently, the rate is 40%. That needs to rise to 50%, and we need to encourage more people to become GPs. If we had more equality in where medical graduates end up practising medicine, that would be a big step in the right direction in training the extra GPs needed. If that had been done 10 years ago, we might not have some of the problems that the hon. Gentleman outlined. Indeed, he said that only 27% of GPs were under the age of 40. That reinforces my point about medical graduates.
Duncan Hames
I agree with the Minister that there is no substitute for persuading more medical graduates to train as GPs, but will he look at what can be done to attract women who were GPs back into general practice after they have started a family if that was the reason why they left? Will he also look at the working practices that we require of GPs to find out how that can be a more reliable way to make the most of the GP training that we have committed to?
Dr Poulter
Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.
Dr Poulter
I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.
General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.
On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.
Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.
Grahame M. Morris
Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?
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.
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.
Mr John Baron (Basildon and Billericay) (Con)
Will my hon. Friend give way?
Dr Poulter
I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.
As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.
Dr Poulter
I will give way one last time, but then I will have to conclude.
Stella Creasy
In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?
Dr Poulter
I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.
Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.
In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.
Sir Gerald Howarth
I am extremely grateful to my hon. Friend and to the House, because I have been following this important debate not only occasionally in the Chamber, but on the screens. In the area around Aldershot and Camberley, GPs have got together to provide out-of-hours services run by them, and it works, so there are good practices providing accessible out-of-hours services, where GPs have come together to provide that cover for their patients, not for other surgeries’ patients.
Dr Poulter
My hon. Friend makes an important point. We talked earlier about the GP contract changes in 2004. Many local GPs have recognised the barriers that can be put in the way of delivering high-quality, local patient care and have worked together to provide local solutions. My right hon. Friend the Prime Minister has provided £100 million to support the return to seven-days-a-week services, and I think that rural practices will increasingly want to bid for that fund. Initial funding has predominantly gone to urban areas, but areas such as Suffolk are now looking to bid, because local GPs recognise that it is in the best interests of patients to provide locally run, seven-days-a-week services. I commend my hon. Friend’s local GPs for what they are doing to deliver that care in Aldershot.
Under this Government, more money is going to general practice. We have returned to having a dedicated GP for every patient. There are over 1,000 more GPs, and we plan to train 5,000 more. If we have a Conservative-led Government after May, we will return to seven-days-a-week GP care for all by 2020. This Government are backing GPs and delivering the care that patients deserve.