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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Beaconsfield (Joy Morrissey) for bringing forward the debate. As we have heard from MPs from across the political parties, their postbags show that this is a big issue from the perspective both of constituents, who are trying to access appointments, and of GPs, who are reaching out to their local MPs to highlight the pressures and difficulties that they have faced recently.
I want to start off by thanking general practice teams and GPs in particular. It is disappointing to hear what the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), had to say. There is no war on GPs. We are all in this together, including GPs, reception staff and nurses. On 14 October the Secretary of State announced a GP support package precisely to support GPs in supporting their patients. We have been listening long and hard to the difficulties faced in primary care. The range of measures I will talk about are there to help GPs as much as patients. If we do not support GPs, the patients will struggle.
I wish to put on the record my thanks to all in general practice during the pandemic. They have gone above and beyond—and often under the radar—by continuing to see patients during the crisis. They have also helped support and in many cases run vaccination programmes in their local areas, and have been a key factor in supporting community teams to help patients be discharged from hospital more quickly and to prevent readmission. That was key during the crisis. Without their hard work and dedication, much of that would not have happened.
There is, however, an issue. We all know that there are problems with accessing GP appointments, but there is also some good news. My hon. Friend the Member for Barrow and Furness (Simon Fell) described the situation perfectly when he called it a perfect storm. So many patients did not come forward during the pandemic, as advised in the main, and many issues, symptoms, conditions and worries are now coming to the fore. The pent-up demand is such that GPs are overwhelmed by the number of people who now need to be seen, often with symptoms and conditions that are far worse than if they had been able to come forward at an earlier stage.
The physical set-up of many GP practices—infection control measures had to be put in place to protect GPs and their staff and patients—means that they have struggled to see patients. My hon. Friend the Member for Bracknell (James Sunderland) asked about those measures. They have been relaxed: social distancing has been reduced from 2 metres to 1 metre. Face masks are still required, but it is now safer for GPs to open their doors and get more patients into their waiting and consulting rooms. Some infection control measures have been relaxed and we should see an improvement.
Appointment numbers are returning to pre-pandemic levels. In August the average number of general practice appointments per working day was 1.14 million, which represented a 2.2% increase on August 2019. As GPs will tell us, they are seeing more patients. The proportion of face-to-face appointments is also increasing. Since August, nearly 60% of appointments have been face to face. That shows that things are starting to return to pre-pandemic levels, but the sheer scale of people who now need to be seen means that it often does not feel like that for patients.
I will give my hon. Friend the Member for Beaconsfield some specific figures for Buckinghamshire. In August, practices arranged a total of more than 200,000 appointments with patients, which is an increase of more than 3,000 from August 2019. In addition, practices in Buckinghamshire helped deliver more than 786,000 vaccines. I take her point that there are specific issues with certain practices that are struggling. My advice to her—and I am happy to meet her and discuss this more fully—is to try to broker a meeting between the GPs and the clinical commissioning group, because often additional support can be given locally to those practices that are really struggling. Sometimes GPs are so overwhelmed that they do not have the space to ask for help and support, even though that is what they need.
Many colleagues, including my hon. Friends the Members for Bolton West (Chris Green), for Beaconsfield and for Barrow and Furness, have raised the issue of telephone access. Much of the problem that patients face is that they cannot get through in the first place, whether that is to make a face-to-face appointment, have a telephone consultation or make a virtual appointment. That is an issue. GPs have historically devised their own telephone systems. They may have gone in with primary care networks or the CCG, and many have their own set-up. Given the sheer scale of the numbers, there is a real issue in having two or three receptionists tackle 300 or 400 calls on a Monday morning, most of which will be complex calls rather than quick, five-minute calls to book an appointment.
That is why part of the GP support package that the Secretary of State announced on 14 October will provide telephone support through a cloud-based system, which will do a number of things. First, it will increase capacity so that patients can get through much quicker. Secondly, it will provide an automated queuing system. I know from my own constituency that patients can be 29th in the queue and have to wait for a long time, so providing that extra capacity will take the pressure off GPs. It will also provide an insight into how much admin support GPs actually need. That valuable data will allow us to provide them with support for the long term.
There are a number of other measures in the GP support package and we are working hard on this matter. There is a £250 million winter access package, aimed at helping GPs open up their surgeries for more face-to-face appointments because this is not an either/or situation. Many Members, including the hon. Member for Batley and Spen (Kim Leadbeater), pointed out that many patients like telephone consultations and the virtual appointments, and we are not going back to pre-pandemic face-to-face-only appointments. We need to embrace the changes that technology has brought. It is far more beneficial for busy people who are working or juggling childcare to be able to speak to a GP rather than have to trundle down to the surgery, but there is a place for face-to-face appointments as well.
The access package of £250 million can be used in a number of ways by GP practices. It can be used to take on locum staff if they are available, to take on other healthcare professionals to see patients, to extend opening times, or even to change the layout of a surgery so that it can accommodate more patients. It is for local commissioners and GPs to decide how they would like to use that fund.
There are also significant moves to reduce bureaucracy for GPs. They are often the only people who can sign fit notes or Driver and Vehicle Licensing Agency requests. As has been said, there are other healthcare professionals who are equally qualified to do that. Some of it may need legislative changes, which we are working at pace to introduce, but we want to take that bureaucratic burden off GPs so that they are free to see patients when they need to.
There are also a number of other measures in terms of increasing the general practice workforce. As the hon. Member for Barrow and Furness said, communications is a crucial point because it is not always the GP that patients will see in face-to-face appointments. They might see a nurse, a pharmacist or a physio. We need to get that message out at a general practice level, but also at a national level.
Chris Green
On compulsory vaccinations in the care sector, I have concerns about compulsory vaccination on the NHS sector. Would the Minister do what she can to ensure that there is an impact assessment before this is done on the NHS, if it is done in the future?
Maria Caulfield
My hon. Friend is certainly persistent in his questioning on that issue. It is a decision for the Secretary of State, who is looking at such factors. The vast majority of NHS staff have been vaccinated, for their own protection as much as anything else. I want to highlight that we are increasing the number of primary healthcare professionals across the board, aiming to replicate the model used in hospitals, where a consultant leads a team of multi-disciplinary professionals who will help see a patient and are, sometimes, more expert in dealing with certain clinical situation than GPs themselves.
Margaret Greenwood
I have had GPs talk to me, somewhat frustratedly, about not having sufficient GPs in their surgery and having physician associates who do not have the same level of training. There is a concern that this is a backing-away from the Government’s commitment of 6,000 extra GPs. Could the Minister confirm whether the Government are still committed to 6,000 extra fully qualified, trained GPs?
Maria Caulfield
We are committed to increasing GP numbers, as in our manifesto commitment. However, that does not stop us increasing the numbers of other healthcare professionals. We need to get the message out to patients that seeing a nurse, physio or paramedic at the GP surgery is not second best. These are highly qualified, experienced and educated professionals who often are better placed—though I do not want to upset the shadow Minister—to see a patient than a doctor. They can make a considerable difference, but very often patients feel they are being fobbed off or seeing the second best. We need to do a lot of work to reassure patients on that.
We have already recruited 10,000 of the additional 26,000 staff we stated in our manifesto would be working in general practice by the end of 2023-24. We are strengthening our plans to increase the number of doctors in general practice. To reassure Members, so far we have filled a record number of GP speciality training places this year, with the latest data showing that there are already 1,200 more full-time equivalent doctors in general practice than two years ago. It is a challenge; I am not going to say it is not, but we are making progress.
I feel particularly passionate about the use of community pharmacists. In many other countries, the pharmacist is the first port of call for minor ailments. They are highly qualified professionals with over five years of clinical training who are able to assist patients. Over 800 practices have already signed up to participate in the community pharmacist consultation service, which enables patients to see a pharmacist, on the same day in many cases, to deal with minor conditions. That will not only help patients, but it will free GPs up to see the patients that really need to see them for clinical conditions.
Rachael Maskell
Will the Minister also ensure that the funding goes into community pharmacies in the right way if they are to be utilised? Likewise, with the voluntary sector involved in providing support for people through different forms of wider health support, will she ensure that it too gets proper funding?
Maria Caulfield
I thank the hon. Lady. The spending review tomorrow may have further updates on that, so I will not comment on the funding for now. NHS England and the Department of Health and Social Care have asked the Royal College of General Practitioners to provide GPs with more guidance on how to blend face-to-face with virtual appointments. We do need a mix of both going forward, and the comms, as has been said so much this afternoon, will make a difference, so that patients know where to go, what is available and who they can see for their particular condition.
The issue of abuse has featured heavily this afternoon. The hon. Members for Batley and Spen and for Linlithgow and East Falkirk (Martyn Day), my hon. Friend the Member for Bracknell and for Waveney (Peter Aldous) and others have mentioned the impact of abuse. When patients have been waiting a long time to see a GP, cannot get through on the phone and are feeling unwell in very distressing situations, they often take it out on practice staff. It is unacceptable, and we all have a role in this place to say that we have zero tolerance for that.
We know as MPs what it is like to face a torrent of abuse. If it is not acceptable for us, it is certainly not acceptable for them. My message to general practice staff is that we are four-square behind them on this and will support them. As part of the winter support package, there is £5 million to facilitate extra security, be that CCTV, extra screens or door entry systems—whatever practices feel will make their staff more secure, that funding is available to them. That is not the only solution, and they should not face abuse in the first place, but we are taking it extremely seriously.
In the few minutes that I have left, I want to say that there are two main issues here. There is the short-term covid issue, which has seen a tsunami of patients whom we need to support as we come out of the covid period. There is the £250 million winter package, and there is support around opening up community pharmacies and enabling other healthcare professionals to see patients, which will take some of the bureaucracy away from GPs while we support them to get through the period. However, there are some longer-term solutions as well. General practice and primary care were creaking before covid, and we need to ensure that they are supported in the long term going forward.
I thank my hon. Friend the Member for Beaconsfield for securing this afternoon’s debate. She has raised some really important points. On Thursday, I am holding a cross-party call for MPs to raise some of their constituency GP issues. I urge them to feed back to me as the Minister where it is working well, because there are some brilliant examples out there. Where it is not working so well, it is not the fault of GPs. There are some fundamental solutions that we can help them with, but it is important that we hear about the problems so that we can support them. If Members have specific issues from their constituencies, they should join the call. We are hoping to hold such calls on a regular basis, if that is needed by colleagues, and I am keen to work with everyone across the House to support general practice, because that is the only way we will support patients in the end.