(3 days ago)
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Richard Tice (Boston and Skegness) (Reform)
It is a pleasure to hold this Adjournment debate on face-to-face appointments with GPs. I ask hon. Members listening and watching to go back to October 2023 and imagine that they have abdominal pain and some blood loss. They seek a GP appointment and they are given a telephone appointment. They are given a diagnosis of endometriosis and prescribed some painkillers. This diagnosis, sadly, turns out to be incorrect.
They then move forward, still in pain, to mid-December 2023. They receive a letter with a gynaecological appointment for the end of January 2024. But they are still in deep pain. The pain intensifies. Their husband rushes them to the urgent treatment centre at Pilgrim hospital, where a doctor sees them and reaffirms the diagnosis of endometriosis. The doctor says, “As you are being looked after by a GP, there’s nothing more I should do.”
Over the next two weeks, the pain intensifies, to the point where at the end of December 2023, they are rushed to A&E. It is just before new year. They are told to come back for tests on 2 January 2024. Those tests reveal some problems and some lesions around the liver. They are put on a two-week cancer pathway with more tests, CT scans, MRI scans and an endoscopy. On 2 February, they are given the results of those tests. Sadly, the cancer has spread to such a degree that nothing more can be done. Just three days later, they pass away.
It is impossible to imagine or to understand this, but it is the tragic story of Laura Barlow, aged just 33, the mother of three young daughters: Summer Skye, Bonnie Rae and Bella-Mia. Her husband Michael Barlow is here in the Gallery with friends. His campaign, after the tragic loss of his wife Laura, is for more face-to-face appointments, and for patients to have the right to one if they feel they need it.
It is worth looking at the context of face-to-face appointments in our healthcare system. Going back some six years to 2019, around 80% of all GP appointments were face to face. According to NHS England, for the last two months, the figure is just over 64%. How do we compare to other nations? In European nations with different healthcare systems, the average is 84% or 85%. We have some 20% fewer face-to-face appointments than some of our international peers.
I am just a layman, not a doctor, but it must be common sense that an experienced, highly skilled, professional GP looking a patient in the eye to physically assess them face to face must give patients the greatest chance of a correct diagnosis. Sometimes, a GP will spot something that the patient was not even aware of.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman on securing the debate. GP face-to-face appointments are a massive issue in my constituency, and you, Madam Deputy Speaker, are probably inundated with constituents asking about the same thing. People —more often than not, elderly people—phone the emergency number at half-past 8 in the morning and hold on till 5 past 9. After they have held the phone for 35 minutes, a voice says, “By the way, you’re too late.” The system is not working. To be fair to the Minister, I understand that changes are coming. We need to know what they are, and whether they will improve the system. If they do not do so to the satisfaction of the hon. Gentleman, my constituents and me, something is drastically wrong, and that needs to be addressed immediately.
Richard Tice
The hon. Member makes some excellent points. There is clearly a place for telephone appointments. When researching the topic in more detail, I was astonished to find that of the gap between the 64% or 65% of face-to-face appointments and 100%, telephone appointments represent some 25% and Zoom or Teams appointments are just 5% to 7%. I would have thought it would have been the opposite. Surely it is better if GPs can see the pain that might be etched on a patient’s face.
We can look at the broader context—at what is happening to our population, and to the number of GPs, and at the pressures on GPs—and ask: is that why the percentage of face-to-face appointments has collapsed so significantly? In England, there are 6.5 million more people than in 2015—an increase of some 17%. Interestingly, the number of GP appointments increased in that period by a similar percentage, give or take; it went from just over 300 million appointments to over 360 million appointments. In fairness, and with due credit, there has been a recent increase, month on month, in GP appointments, which is to be commended, but it seems strange that the number of full-time, fully qualified GPs has barely moved in those 10 years. It is true that there are more trainee doctors and trainee GPs in the system, but the number of fully qualified, full-time-equivalent GPs has basically stayed static. That means, of course, that the number of patients that a GP has on their books has increased significantly, from over 1,900 per GP to over 2,300 per GP. We can therefore understand the increase in pressure on them. Given those health needs, they will feel the need to see as many people as possible, so we can see the temptation to hold telephone or Zoom appointments.
Lee Anderson (Ashfield) (Reform)
My hon. Friend is making some excellent points. Does he agree that there is a place for telephone appointments if a GP is giving guidance and support, or making a referral, but that any diagnosis should be made face to face?
Richard Tice
I thank my hon. Friend for that excellent intervention. This comes back to the basic concept of common sense. It must be easier for a GP to make the correct diagnosis when seeing someone face to face. We all make mistakes, but when our medical professionals on the frontline, whom we all admire, are under pressure and tired, and they make mistakes, that can have devastating, life-changing consequences.
We will never know the difference it may have made if Laura had the correct diagnosis in October 2023, but it must be right to give all patients the best opportunity. I know that the Secretary of State for Health and Social Care, who I have interacted with in the Chamber, is absolutely determined to make reforms across the healthcare system. He has started actively, abolishing NHS England, making changes to the Department, and doing much more. That brings me to what else can be done.
We can look at the pressures on GPs. I was astonished to read that almost 50% of all GPs are thinking of retiring in the next five years. Almost 50% of them cite the increased pressure of bureaucracy, paperwork and administration. Surely we want our trained GPs in front of patients; we do not want their time being absorbed by unnecessary burdens and paperwork. If that is driving our GPs away from the noble profession of curing and helping people, we have to look again. I hope the Health Secretary, the Minister and colleagues will drive a change in processes.
When I was with people in my constituency of Boston and Skegness recently, doing more research, I was astonished by what I found when I spoke to a GP and liaised with her. She gave me some examples of bureaucracy clogging up the system. For example, if a GP refers a patient to a consultant in hospital, and the consultant says, “Yes, the patient needs this, but I also need to refer them to another speciality just down the corridor in the same hospital,” that cannot be done directly. The consultant has to write back to the GP. That letter goes through the post, with a hundred other letters a day. Then the GP has to refer the patient back to a different consultant, with that different speciality, down the corridor in the hospital. That lacks common sense.
It appears that if the consultant wants to prescribe medication to the patient who has been referred, they are unable to do that directly; they have to refer back to the GP, who has to spend more time providing the prescription. That appears to lack common sense. If the consultant wants to request blood tests, on many occasions that will have to be referred back to the GP, by letter or maybe by email, so that the GP can request those tests. All that leads not only to delay for the patient, and to time being consumed, but to more work for the GP, who we all surely want to see more patients face to face.
There are other situations that seem to be clogging up the system. Take our old friend GDPR. It is well-intentioned, but when I went to a pharmacy in Boston a few weeks back, the pharmacist said, “We have the same software system as the GP surgery, right next door to us in the same building, but because we have different modules, and because GDPR does not let the modules talk to each other, it leads to increased delays and a lack of productivity and, for patients, a lower-quality service.” They went on: “We could do so much more. We could relieve the GPs of some of the work they are doing, so that they could see the patient face to face.”
Then, a week later, I was in a care home in Boston, with carers and experts in the room. We were talking through the issues. They said, “There are processes and procedures that we can do that we are not allowed to do, so a GP has to do it; or we have to request an ambulance from the hospital, clogging up ambulance waiting lists or clogging up A&E corridors, when we could do those procedures.” Again, the great concept of common sense cannot be applied. I think we all know that we can do so much better than that.
Then there is the issue of referrals. When a GP makes a referral to a consultant, that referral often gets assessed by a non-clinician as to whether it is correct. I would have thought that we should be able to trust highly trained, highly skilled professional GPs and back their judgment on the frontline. If they think someone needs to be referred to a consultant, surely that does not need double or triple-checking. Again, that delays good patient care and causes more blockages for the GP, more admin and more paperwork.
Then there are our friends at the Care Quality Commission: an important supervisory process and concept. I hear about the processes, the box-ticking, the patient panels—all that is just more admin, more time and more resources consumed outside the core function of face-to-face treatment and care for patients. It therefore seems that this is not a party political issue, but one of driving continuous improvement in our healthcare system, and of the Department, as it moves forward with the reforms we all want to see, saying, “Actually, let’s look at all the processes. How do we reduce the blockages? How do we remove any unnecessary paperwork and burdens? How do we improve the technology?”
Indeed, artificial intelligence, which is so recent, is a huge opportunity for healthcare and technology in healthcare, and for GPs to, for example, double-check or triple-check their own diagnoses. These are great opportunities facing us, but most fundamental of all, we must give our GPs every support, every ease of progress and the right technological assistance behind the scenes in the back office, so they can face all of us when we are unwell and need treatment, because that is when they can use their experience, wisdom and knowledge to get to the right diagnosis.
It would be a tribute to Laura—it would be her legacy—for patients to have the right to see a GP face to face. Easing the processes would make life easier for GPs and would make them want to stay in the profession, because they know that face to face they will achieve a great and noble cause and good.
The Minister for Care (Stephen Kinnock)
I thank the hon. Member for Boston and Skegness (Richard Tice) for raising GP access, which is a vital matter to many of our constituents. I want to start by paying tribute to Laura Barlow’s family, friends and loved ones and to her husband Michael, who is in the Gallery. It is a terrible tragedy that Laura’s cancer was not caught earlier, and I absolutely agree with the hon. Gentleman that the significant number of people who signed the petition shows real strength of feeling on this heartbreaking case.
When people are asked what their top priority for the NHS is, the chances are they will say, “Fix general practice” because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities across our country. Let me be crystal clear from this Dispatch Box: GPs must provide face-to-face appointments, alongside remote consultations. Online services must always be provided in addition to, rather than as a replacement for, in-person consultations. Patients have a right to request a face-to-face appointment, and practices must make every effort to meet their preference unless there are good clinical reasons to the contrary, such as in cases where the patient tests positive for an infectious disease.
There are clear benefits to attending an appointment in person. GPs pick up cues from body language and foster a more personal relationship with their patients, and that is important if we are to bring back the family doctor. Last year, GPs delivered 380 million appointments throughout England. Two thirds of those were in person, and I can tell the hon. Gentleman that the figures for his integrated care board in Lincolnshire are in line with the national average at 65%. It is possible that, in some practices, defaulting to remote appointments was a temporary and necessary measure during the pandemic, but in some cases, that may have become a habit that has become difficult to shake. Let us be clear that this is not the fault of GPs per se; it is the fault of the last Government, which left them underfunded, understaffed and in crisis. That is why we are doing everything we can to remedy the downward spiral that GP services have found themselves in after 14 years of Tory neglect and failure.
I was absolutely delighted that the general practitioners committee England voted in favour of this year’s GP contract last month. It is the first time that the contract has been accepted in four long years. The reformed contact agreed between the Government and the GPC will improve services for patients, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. That will free up time for patients who prefer to call or visit in person.
Those changes are backed by an extra £889 million, representing a cash growth of more than 7% in overall contract investment, bringing total spend on the GP contract to £13.2 billion this financial year. That is the largest uplift to GP funding in a generation, and it means we are beginning to reverse a decade of a dwindling share of NHS resources going to general practice.
It is not just about resource and funding, however. We are bulldozing bureaucracy for GPs, so that they spend less time pushing paper and more time seeing patients like Laura. We are training thousands more GPs, modernising the booking system, ending the 8 am scramble and bringing back the family doctor. Those measures should make it possible for GPs to guarantee a face-to-face appointment for all who want one.
The Government are committed to shifting the focus of our NHS from hospital to community. We will move towards a neighbourhood health service, improve continuity of care for those who would benefit from seeing the same clinician regularly, which is associated with better health outcomes and fewer A&E attendances, and we will drive the shift from analogue to digital by ensuring that all practices are employing the full functionality of GP Connect.
Let me turn to cancer. The Government are determined to tackle the biggest killers. My right hon. Friend the Health Secretary has announced that a national cancer plan for England will be published later this year. The plan will put patients at its heart and will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care. It will seek to improve every aspect of cancer care and the experience and outcomes for people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. The plan will spell out how we will improve outcomes for cancer patients, speed up diagnosis and treatment and ensure patients have access to the latest treatments and technology. We will bring this country’s survival rates back up to the best in the world.
Our NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Fourteen years of Tory failure left our NHS broken but not beaten. Everything this Government have done since the election has been geared towards saving the NHS and giving it back to the people. We are putting power back in patient hands, because it is their health service and it must work for them. Last week, my right hon. Friend the Prime Minister announced reforms that will shift power away from the centre. Patient choice is at the heart of this Government’s commitment to build an NHS fit for the future, and all patients should be offered face-to-face appointments when it is in their best interests.
Question put and agreed to.