Primary Care Services (Report)

1st reading
Wednesday 12th July 2023 Commons Chamber

Motion for leave to bring in a Bill (Standing Order No. 23)

12:39

[Daisy Cooper (St Albans) (LD)]

I beg to move,

That leave be given to bring in a Bill to require the Secretary of State to appoint an independent reviewer to prepare a quarterly report containing an assessment of primary care services; to require the Secretary of State to lay before Parliament each report prepared by the independent reviewer; to require such reports to include the independent reviewer’s assessment of any measures taken to improve general practice services, dental services, community pharmacy services, optometry services, and mental health services; and for connected purposes.

Primary care services across the country are in crisis. People cannot get a GP appointment when they need one, some pharmacies are closing, people are resorting to DIY dentistry, and waiting lists for mental health appointments are sky high. The Government point to their recent long-term workforce plan as evidence that they are taking action, but that plan is only partially funded and will do nothing to increase staff levels now. Perhaps if the Government had not spent a year whipping their MPs to vote against any attempts to put a workforce plan into law, they might have made some progress, but we are where we are and it is legitimate for the British public to expect a Government who can plan for the long term while taking more immediate measures.

To be blunt, it is clear to me that MPs on both sides of the House are losing patience and are worried about the lack of urgency and action from the Government in fixing the front door to our NHS. The Bill seeks to force the Government to come clean about the challenges facing primary care health services specifically, such as GPs and dentists, by appointing an independent reviewer to report on the state and condition of primary care services every three months so that we can hold the Government’s feet to the fire on progress.

The Bill cannot come soon enough for patients. Let me start by detailing some of the urgent problems in GP services using a story that I have received from Gareth in Wimbledon. One morning recently, Gareth developed sudden loss of vision in the entire left field in both eyes, rendering him partially blind. Gareth tried to get an appointment with his GP, but due to a lack of appointments that day and a non-existent online booking system, he was instructed to call at 8 am the following morning. It was not until the next day that he managed to get an urgent referral for a brain MRI scan, which confirmed that Gareth had suffered a small stroke. With all strokes, the first 72 hours are critical to reduce the chance of subsequent strokes. His GP was undoubtedly dealing with hundreds of other urgent cases that day, but for Gareth, losing 24 hours due to a lack of capacity at his local GP could have been catastrophic. That is the real-world impact of the Government’s failure to recruit and retain GPs, and their failure to invest in IT infrastructure.

Let us remember that back in 2019 the Government promised to deliver 6,000 more GPs. Not only did they break that promise, but the number of fully qualified GPs has fallen by more than 900 since they made it. Those falling numbers have hit some areas harder than others. In places such as Somerset, the falling number of GPs is causing a shortage of appointments. Indeed, the number of GPs has fallen by 50 since 2016 in the area, and the number of patients per GP has increased by a massive 400. Shockingly, that is far higher than in the vast majority of England. In my county of Hertfordshire, there are now 2,203 patients per GP. I have heard from Denise, who spent the best part of the day on hold before giving up and trying the online booking system, which again turned out to be non-existent. While she was on hold for hours on the phone to her GP, by contrast it took just two minutes for Denise to book an online appointment at Specsavers. Everybody knows that the technology exists; it just has not been funded for our GP services.

All that is why the Liberal Democrats have pledged to ensure that we will have 8,000 more GPs working in the system within five years, with a campaign not only to train and recruit but to retain experienced practitioners. With that expanded workforce, everyone could see their GP within seven days for a first appointment.

However, it is not just the number of staff that is putting pressure on GP services. The Royal College of General Practitioners’ recent infrastructure report showed that 40% of general practice staff say their premises are not fit for purpose. Even when integrated care boards want to spend money on primary care infrastructure in city centres, for example, outdated Treasury rules do not allow them to—something that is happening in my St Albans constituency, and which I raised in this Chamber again just yesterday. Putting retention measures in place, accelerating improvements in IT infrastructure, fixing outdated treasury rules on investment in primary care infrastructure are just three of the challenges in general practice on which an independent reviewer could report progress to this House every three months until they are fixed.

In dentistry, too, we see Government incompetence at work. Last year, there was a £400 million underspend on the NHS dentistry budget, despite millions of people needing an appointment and thousands of dentists wanting to provide NHS care. It is absurd. Why are we in this position? Because the contract that the Government offers NHS dentists is so badly designed that dentists will not take it on, as they lose money on NHS dental treatment.

The Liberal Democrats have been calling for reform of the NHS dental contract so that it encourages and incentivises dentists to take on NHS patients, meets patient need and demand rather than arbitrary targets and finally puts an end to dental deserts. Just yesterday, the hon. Member for Winchester (Steve Brine) forewarned the Government that the Health and Social Care Committee, which he chairs, would be publishing its findings on NHS dentistry, and said that they would make for “uncomfortable reading”.

Again, locally, in places such Somerset, the real-world impact is that there is now only one dentist delivering NHS dental service for every 1,773 people. Somerset is among the 10 areas of England that have seen the biggest rise in patients per dentist since 2015, with each dentist now seeing more than 200 additional people.

However, what is truly an outrage is that tooth decay remains the most common reason for hospital admission among young children. It is a question not just of getting children the care they need, but of good use of public funds. The cost of treating a child for tooth decay in hospital far exceeds that of regular check-ups. Supervised tooth brushing training for children and removing the value added tax on children’s toothbrushes and toothpaste, as the Liberal Democrats have called for, would make a huge difference and cost next to nothing in comparison with dental surgery. Those are things the Government could be getting on with right now.

Of course, we know that community pharmacies are in crisis too, and we can see the impact that is having. For example, Peter from Winchester used to go to the pharmacy in Sainsbury’s until this year, when it was closed. The location was perfect, with plenty of space to park, and was easily accessible for disabled people. Now it is closed, Peter must take a special hour-long round trip to the next pharmacy, along heavily congested roads to a car park on a hill with only one disabled parking bay. As someone who is mobility impaired, his access to pharmacy services has been severely limited and his independence curtailed as a direct result of the pharmacy closures now taking place across the country.

This situation is completely unsustainable. The Government cannot just do a Dorothy; they cannot just click their heels together, say “Deliver, deliver, deliver”, and expect that GP and dental services will magically improve. They need to do things, they need to make decisions and they urgently need to improve primary care for patients right around the country. This Bill would in effect be a forcing mechanism, which would enable MPs every three months to hold the Government’s feet to the fire on their actions—or their inaction—on fixing the front door to our NHS. Given the crisis facing our primary care services, it cannot come soon enough.

Question put and agreed to.

Ordered,

That Daisy Cooper, Wera Hobhouse, Tim Farron, Richard Foord and Munira Wilson present the Bill.

Daisy Cooper accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 24 November, and to be printed (Bill 352).