GPs and Primary Care (North East Bedfordshire)

(Limited Text - Ministerial Extracts only)

Tuesday 7th June 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for North East Bedfordshire (Richard Fuller) for securing the debate and raising important points about the good work that is happening, as well as the substantial issues facing his GPs and constituents. I will not stand here and pretend everything is rosy: I want to work with him to address a number of the issues that he raised.

I start by thanking GPs, general practices and primary care for all their work during the pandemic, and for the work they are doing now, increasing their workload, such as dealing with people on elective waiting lists who need care because they are not able to get procedures done as quickly as normal, or helping with the covid vaccination booster. They are dealing with almost a tsunami of patients who are now coming forward to seek help, after we advised them to stay away and protect the NHS during the covid pandemic. We are seeing almost 11,000 cancer referrals a day, for example, and each one comes through a GP. On average, there are 1.6 million appointments nationally per working day, which is an increase of 5.3% on April last year, and 62.5 million covid vaccinations have been delivered by general practices.

That gives the scale of the work that has gone on, but I do recognise some of the issues raised. To reassure my hon. Friend, GPs—whether they are salaried or partners—are generally not directly employed by the NHS. They are independent practitioners who have a business of their own and have a contract to deliver NHS care. Some of those historical arrangements limit the interventions we can make, and some GPs want more integration than others—we have to be flexible in the support that we give.

My hon. Friend the Member for North East Bedfordshire is quite right to identify the issue of telephone access. I know from my own constituents that getting through to the GP is half the battle; once they have got through they usually have a positive experience seeing the GP, or other healthcare professional in primary care. We tried to help with this in autumn last year with the winter access fund. Part of that help meant that practices could bid for funding to introduce cloud-based telephony systems, which can transform the way that appointments can be made. My hon. Friend highlighted systems where GPs can see how many people are waiting on the line and how long they have been waiting for, and can divert resources to get calls answered quicker, even doing so remotely, with receptionists not having to work directly in the surgery to answer the phone, book appointments or organise prescriptions.

Cloud-based telephony is really transforming access to GPs. Unfortunately, some GPs are already signed up to contracts with other telephone providers that they cannot get out of, and some have signed up with other cloud-based telephony systems that are not as good as others, as my hon. Friend pointed out. NHS Improvement is working with GPs to drive full adoption of cloud-based telephony across the system. We are working with surgeries and sharing best practice of what really works. He is quite right that when patients are frustrated about not being able to get through they take it out on staff and GPs. To deal with the telephone access issue and make it easier to get through will transform the lives of both patients and staff.

We must also bust the myth around the 48-hour appointment model, which was in place under previous Governments, where patients had to be given an appointment within 48 hours. Patients had to phone up every morning and could only get an appointment within that 48-hour window. There is no need for that, and we are trying to say to GP practices that that is a historical model—they do not need to stick to it. Very often, a patient will be happy with an appointment next week, rather than having to phone up on the Tuesday, the Wednesday and the Thursday but still not get an appointment. There is a lot of work around practice management, and the systems in individual practices, that we are happy to help GPs with.

We are also working on the pharmacy consultation service, which has been used very successfully during the pandemic. If a patient phones 111, or the GP practice, there is a range of minor ailments that a pharmacy can deal with face-to-face, quickly and expertly. Those ailments, which range from sprains to colds and flu—even those patients with long-term conditions and on long-term medications, such as some diabetics or those with high blood pressure—can be well managed by a pharmacist. We want to go further with that and introduce more services provided by community pharmacists. We are in negotiations with pharmacy teams to see if we can do that. Scotland and Wales have a pharmacy-first system that works extraordinarily well; we are keen that patients in England have access to similar support.

We are introducing changes to the GP contract this year—some of those are more popular than others. For patients, one of the key elements is about extending opening times to evenings and Saturday mornings, to make it easier for patients to be able to see their GP if they need to. That comes on top of the point that my hon. Friend made about other healthcare professionals working in primary care. Primary care is changing dramatically. We have already recruited over 18,000 additional primary care professionals, such as nurses, physios, pharmacists and paramedics, who are often better placed than the GP to provide the care and support a patient needs. My hon. Friend is quite right that there is sometimes a reluctance from patients—a feeling that they are being palmed off on someone else rather than seeing the GP. However, we are finding that once they have seen the paramedic or the physio, they are very pleased to see that professional the next time an appointment is offered. We are hoping that the take up of that will improve.

We have a commitment to recruit 26,000 more healthcare professionals by 2023-24 in addition to the GPs. We are on track to meet that, so that primary care becomes a multidisciplinary experience for patients, and it is not always the GP who they need to see first. However, as my hon. Friend says, we do need more GPs, and a record number of 4,000 doctors have taken up GP training posts this year, which is a real boost to the numbers, but I recognise that they will take several years to be trained and to come through.

Although my hon. Friend speaks well about the pressure on whole-time equivalents, his local clinical commissioning group allows GP registrars to see patients, which boosts patient appointments and capacity in the local area. He will be pleased to note on housing—again, my constituency in the south-east has similar problems, where housing developments are in their thousands rather than their hundreds and spring up overnight with no consultation with the local GP, who then has to take those patients on—that I am meeting the Housing Minister, my right hon. Friend the Member for Pudsey (Stuart Andrew), this month to discuss the very issues my hon. Friend raises about primary care being a key feature during planning and when things such as section 106 and community infrastructure levy money is being allocated. As he rightly says, the health centres need to be built first before the housing.

[Richard Fuller]

I am delighted that the Minister is taking such an active interest in the impact of development on access to services. In my speech, I requested that, ahead of my meeting with the Secretary of State, the Department look back at that history in my constituency as a test case to see what could have been done differently and what might be done now. Will she commit to that being done ahead of my meeting with the Secretary of State?

[Maria Caulfield]

I am not sure when my hon. Friend’s meeting is—I think it is fairly soon.

[Richard Fuller]

July.

[Maria Caulfield]

It is in July. We can certainly look at that, because we need to look at the lessons learned if we are to make progress going forward. The Housing Minister is keen to address this problem, so it is good to look at what has not happened in the past that should have, so we can take that forward. I cannot commit 100% to that being ready for my hon. Friend’s meeting, but we can certainly look at it.

The final point was on the GP partner model and support for GPs in their role and in some of the challenges they face, whether that is taking on premises or taking on liability. There is definitely a trend where partnership numbers are going down, but salaried GP numbers are going up. That is because younger GPs coming forward often do not want to take on the responsibility of being a partner and everything that entails, but partners feel that being bought into the practice gives them a huge amount of additional investment in terms of time and finance, as well as guidance, development and support for patients.

The Secretary of State has instigated the Fuller review—that is not my hon. Friend, obviously, but a GP—around the future models of GP practice, and whether that is partnership or salaried or whether there are different models available. We will take a good look at those recommendations because there may not be a one-size-fits-all solution. Some partners have a definite view of where they want to go; others are struggling and need support and help. I do not think it will be that one size fits all, but the Fuller review will certainly make some strong recommendations.

I hope in the short time we have had that I have been able to acknowledge the main challenges my hon. Friend’s constituents and GPs are facing and have outlined some of the measures we are taking to support primary care and enable patients to see their GPs more quickly and easily, whether that is virtually or face to face.

Question put and agreed to.