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The Minister for Community and Social Care (Alistair Burt)
It is a great pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for Tottenham (Mr Lammy) on securing the debate and thank him for his great courtesy in sending me and my officials a copy of his speech, which will enable me to address in my remarks some of his questions. I appreciate that.
I have some knowledge of the area. I was a member of Haringey Council between 1982 and 1984. I represented Archway ward at that time, and I was on the governing body of a school in Tottenham, so I have some feel for the area and I am grateful to it for giving me a start. I sat on benches opposite the right hon. Member for Islington North (Jeremy Corbyn). I think I am now the only Member of Parliament who served on the council with him, so we have a long-standing relationship and friendship. My time in Haringey taught me that it was an outer London borough with inner-London characteristics. I saw at that time colleagues on the Labour-run council wrestling with very difficult issues and problems and I have never forgotten that.
I will tackle some of the issues that the right hon. Member for Tottenham raised. I do not follow all his argument. Yes, there is some element of market principles in the NHS, but I think Mr Blair had something to do with that as well as us. If the right hon. Gentleman would really like to reorganise the national health service completely, I am keen to hear the proposals from those on the Labour Front Bench in relation to that. The structure that we have is one we will have for some time. It does not stop the work being done but enhances the localisation of making sure that the right things are done.
The right hon. Gentleman is right on poverty and inequality. The tragedy of the United Kingdom is that this is not a short-term issue. If we laid a map of poverty in Victorian Britain over a map of the United Kingdom today, we would find remarkable similarities between the two. The issue that all Governments wrestle with is that Government in, Government out, and socialism in or liberal capitalism in, we still have not cracked all the issues of inequality that we want to crack, and everyone has given it a lot of effort. We have to do better and we have to try different things. That is at the heart of some of the different things that the Government have been trying in health service reform. It is a process that will go on, but none of the issues that the right hon. Gentleman mentioned—length of life and inequality issues—has arisen in the past six years. They are long-standing issues that go back many years, which is why it is always essential to work at new initiatives and look for things that are different, to try to make a difference.
The right hon. Gentleman raised very straightforward and serious issues. All of us in the Chamber pay tribute to those who work in front-line services—the primary care staff. GPs are the first point of contact. Of course, it is not just GPs, but nurses, physiotherapists, occupational therapists, pharmacists and many other healthcare professionals who play a part in delivering high-quality care to patients in practices and in the community every day through the NHS.
In relation to the right hon. Gentleman’s constituency, he quoted extensively from the report by Healthwatch Haringey. Healthwatch nationally is actually funded and part-supported by Government. It is part of the monitoring process that the Government use. I understand that the report “GP Access in Tottenham Hale”, published in September 2014, highlighted a number of serious issues around accessing GP services in that part of his constituency. I thank Healthwatch and all associated with it for all the work that they do.
I am aware that access to GP services is a long-standing issue for local people. I am also aware that many local practices are single handed, and that some premises are not suited to the needs of primary care in 2015. Haringey clinical commissioning group has developed a primary care strategy to address just the sorts of issues that we have heard about this afternoon. That strategy focuses on encouraging practices to work together to run services more effectively, funding initiatives for practices to improve their appointment and triage systems, and encouraging a mix of professionals to work together as part of local networks: for example, welfare advisers, nurseries and healthcare assistants.
A number of practical steps to improve primary care locally have already been taken. In north-east Haringey, a shared call centre has been set up so that staff can respond to patients more quickly. In the south-east of the borough, GPs have worked together to provide telephone consultations for patients between 6.30 pm and 8 pm. In central and western areas of Haringey, Saturday clinics have been established. I understand that the CCG plans to have Saturday clinics and evening appointments available across the whole of Haringey in the new year. The CCG has funded two part-time practice managers to support practices that are struggling to meet access demands, and it is working to increase the number of practice nurses in Haringey through a recruitment programme to enable nurses from other settings to transfer into primary care.
On the important matter of GP premises, I am advised that the CCG and the local council have worked with NHS England to develop a strategic premises plan. The right hon. Gentleman is correct in saying that those have not been adequate, and he is right—as was Healthwatch—to draw attention to that. The premises plan was completed in July 2015. It highlights a shortfall in GP provision and in premises capacity in Haringey. The shortfall was particularly noted in Tottenham Hale and, to a lesser extent, in Northumberland Park. The plan makes a number of recommendations for short and medium-term action.
To date, NHS England London has appointed a local provider of temporary services for up to 6,000 patients in Tottenham Hale. It has also, together with Haringey CCG, sought national approval to use capital funding from NHS England’s primary care transformation fund to purchase the temporary premises. It has done so because capital funding is seen as representing best value and minimising annual revenue costs. As the right hon. Gentleman said, NHS England London and Haringey CCG hope to obtain approval for capital funding of the premises on 18 December, which is Friday of this week. However, I understand that, in the event of NHS England not agreeing to provide funds from the primary care transformation fund, the purchase of the premises will still be secured by means of revenue funding. NHS England will continue to work with Haringey CCG to find a permanent site for the practice in Tottenham Hale.
The new GP practice in Hale Village is due to open in the new year. It will start with a zero list and will have the capacity to register up to 7,000 new patients. That development has been welcomed by Healthwatch Haringey as representing a positive outcome for local residents. NHS England has also asked CCGs to set out an overarching estates strategy to ensure that estates resources are used across all of health and social care. As part of that work, Haringey CCG is looking closely at how else it can help to ensure that GP local premises are fit to meet current and future primary care needs, particularly in the light of the regeneration in Tottenham that the right hon. Gentleman mentioned and projected population growth in the area.
The right hon. Gentleman made clear his concerns about the levels of primary care funding in areas of relative deprivation. The national formula is currently under review, and the possibility of giving greater weight to deprivation is one factor being considered. I can reassure him about GPs’ salaries, however. GPs are not paid differential salaries in different areas. The capitation is different, because capitation covers things other than GPs’ salaries, but clearly it could not work if GPs in one area were deliberately paid less than those in another. That is not at the heart of the problem. When it comes to capitation and things that are considered in the national formula, deprivation is being considered as an issue to be looked at further.
Getting more people into primary care is really important. The Secretary of State set out in June details of a new deal for general practice, in line with the five-year forward view, recognising the pressures that GPs are under. We are training, and plan to train, more GPs. In the last Parliament, we increased the number of GPs working and training in the NHS by some 1,700, which is a 5% increase, but we still need more. That is why we have announced plans to increase the primary and community care workforce by at least 10,000 by 2020. That figure includes an estimated 5,000 more doctors working in general practice. That will be a 14% increase in the overall number of GPs working and training in the NHS.
We have established some work to try to reduce the level of workload. Having visited a number of practices in urban deprived areas and others, I can say that there is very much a sense in some practices that GPs are worn down, that they are on a treadmill and that they are worried about bringing new people in. In others, however, sometimes not very far away, GPs are trying something different. They are working with the Prime Minister’s challenge fund pilots or the vanguard sites on different ways of providing their services. Such work can often be the trigger for more doctors being interested in coming into work.
There is a different side to the pressures on GPs. I am clear that, in practices that are very much under pressure, by reducing bureaucracy and working with them to provide support, we can lift them up from their present difficulties. The transformation fund of £1 billion that will be used to improve premises over the next few years will also make a difference, and it will ensure that premises are fit for purpose when it comes to what we want from primary care in future.
If we are to address the health inequalities that the right hon. Gentleman rightly mentioned at the beginning of his speech, it will be essential for that work to be carried out in the most deprived parts of the country, as in any other. It has been interesting to visit those pilots and look at what has been done. The reorganisation of resources in primary care and the establishment of more contacts with those who provide allied health professional services—relieving some of the pressure on GPs—can have a marked impact, as can the closer integration between the NHS and local authority services in the same area.
We are all trying to lever up standards and deal with the inequalities, as the right hon. Gentleman has mentioned. There are plans, proposals, new initiatives and new ideas, and some of those are demonstrated in London. I hope some of the practices involved, particularly the new ones, will take those opportunities to do something different where they are and try to meet the challenges that they face.
To conclude, as well as the investment in primary care that I have detailed, a number of approaches are making a difference to access to GP services: longer opening hours, to increase the sense of access; better use of telecare and health apps, which are really working and beginning to have an impact on populations that are much more used than some others to using such things; and more innovative ways to access services by video call, email or telephone. Schemes are integrating services in order to offer a single point of contact to co-ordinate patient services across health and social care. Some 2,500 practices have taken part in the access fund schemes, covering more than 18 million patients, so a third of the country will have benefited from improved access to primary care by March 2016. We want to continue to roll out such initiatives to 2020, investing in primary care and making sure that investment is made in the areas where most work is needed. It is clear from what the right hon. Gentleman said that Haringey is right up there.
Alistair Burt
I will ask exactly that. I do not doubt that it is doing that already. Clearly, the right hon. Gentleman needs to be reassured, and we shall do so.
Sir Roger Gale (in the Chair)
Order.
Motion lapsed (Standing Order No. 10(6)).