Primary and Community Care: Improving Patient Outcomes

Baroness Hodgson of Abinger Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

It is a great pleasure to follow the noble Baroness, Lady Meacher. Like others, I thank the noble Lord, Lord Patel, for securing this debate and introducing it with his usual thorough and considered approach. It is particularly timely, given the recent Health and Social Care Committee report’s conclusion that healthcare providers in England are facing

“the greatest workforce crisis in their history.”

We have heard this from many speakers today. A cancer specialist wrote last weekend in the Daily Telegraph that NHS general practice had reached the “point of no return” and was “irrevocably broken”, citing that, since 2013, 474 practices had closed permanently, affecting 1.5 million patients.

We hear consistently about the crisis of patients not being able to access doctors, with only 56% of patients reporting that they had had a good experience in making an appointment and 53% saying that they found it easy to get through to the practice on the phone. Most worryingly, the survey also found that 55% of people—up by over 13% over the past year—said that they had avoided making a GP appointment, with the major reason being that it was too difficult.

Many GP practices have taken on the system of triaging patients. Although I understand that this can have some benefits for doctors, it can also be very intimidating. I have had an experience of a very aggressive triaging doctor shouting at me when I was asking for a doctor to come to my very sick elderly mother. It was extremely upsetting, especially because it was followed by a refusal to attend. People who are stressed or unwell are unable to deal with being treated like that, and it creates a barrier to people receiving the care that they should.

As the noble Baroness, Lady Pitkeathley, mentioned, the result of this can be that people give up trying to see their GP and go straight to A&E instead, causing increased overcrowding there, with the knock-on effect of ambulances being unable to discharge patients and then unable to attend other urgent cases. Although we are being urged to stay away from A&E, if patients cannot access their doctor, it may be their only option to get care. There is an enormous loss of faith in GP services. A British Social Attitudes survey found that, since 2019, the proportion of patients who were satisfied with their GP services has plummeted from 68% to 38%, the lowest level on record.

It is clear that GPs are also feeling hugely under pressure. A report published by the Health Foundation charity paints a picture of high stress and low satisfaction with workload among UK GPs. Just one in four UK GPs are satisfied with the time that they are able to spend with patients—appointment times are among the shortest of the 11 countries surveyed. As we heard, only one in four GPs in England is now working full time, and most GPs work three days a week or fewer.

Although I am sure that the pandemic has exacerbated this situation, the cracks were there before. One of major things that has gone wrong is that many doctors now do not know their patients. There is enormous benefit in knowing your GP, especially for the elderly, those with small children or those with serious and ongoing health issues, and it makes it much easier for GPs to treat them. I accept that that is not always the case for younger and healthier people, who may need to see their GP very infrequently.

Last year, a Norwegian study published in the British Journal of General Practice demonstrated this. It showed that those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year, rising to 30%, 28% and 25% respectively after they had had the same doctor for 15 years. Meirion Thomas, whom I referred to earlier, highlights that continuity of care is crucial in early cancer diagnosis. Survival rates in the UK lag behind almost all comparable high-income countries. Recent research has shown that 37% of patients with cancer in the UK present in A&E with acute symptoms and with advanced disease associated with a poor prognosis.

The Norwegian report stated:

“It can be lifesaving to be treated by a doctor who knows you”.


Smaller practices delivered this—yet, in the UK, the trend has been for GP practices to become bigger and pool their patients, thus eroding the relationship between doctors and patients. Although patients over 75 in the UK are given a named doctor, some doctors interpret this as just having to look at the patient’s records. Although I understand that patients who wish to be seen urgently cannot always see their GP that day, it is impossible for a doctor to be responsible and deliver appropriate care for a sick elderly patient without ever meeting them. Older GPs say their job satisfaction came from knowing patients, often whole families, and caring for them through the years. Yet so many doctors training as GPs then leave or work as locums because the pay is much better and there is less form filling.

The job has changed in other ways too. The head of the Royal College of General Practitioners recently said that family doctors were working at an intensity that was “unsustainable”, leading to many cutting their hours or taking early retirement—other speakers have referred to this. I gather that, on average, a doctor is asked to deal with 40 patients in a day, with some GPs being asked to see closer to 50. Apparently, GPs feel that the right number is probably around 30. This overload is leading to burnout and early retirement, as we have already heard. The Royal College of General Practitioners has said that 65% of GPs say patient safety is being compromised due to appointments being too short.

What can we do to improve all this? We had much better primary care 20 years ago; the damage started in 2004 with the change in the GP contract. We urgently need a system that works both for patients and doctors, but a health system needs to be patient-focused. As the noble Lord, Lord Patel, said, this is about caring for people. Training more GPs is perhaps an easy answer, but people also need to be encouraged to look after their own health so that they have fewer visits to a doctor and are healthier for longer—prevention is absolutely key. Health checks are very important. We should also include mobility checks. People who cannot exercise well can tend to put on weight, leading to diabetes and heart problems, and checks would also help the prevention of hip and knee problems.

I welcome the new women’s health strategy for England, which will tackle the gender health gap and improve the health and well-being of women and girls. We must make it advantageous for doctors to work in a practice rather than being a locum. We need to cut down on the number of patients they are asked to see daily, and make the job more enjoyable and satisfactory for them—less stress might encourage more to work full-time. We also need to encourage doctors to know their patients again; the system works best when doctors know their patients and patients have faith in their doctors. This will lead to better outcomes and help ease pressure on the whole system. If that is the case, Zoom appointments and phone calls—which can cut down on time—can be beneficial, but if a doctor does not know their patient, it is much harder to treat them satisfactorily in this way.

The NHS app is excellent for things such repeat prescriptions. Could modern technology do more to remove some of the bureaucratic functions and form filling? Practice nurses should be able to deal with more conditions, while qualified pharmacists could give a wider selection of medication without a prescription. Community nurses are a huge asset, and we need to ensure that doctors work closely with them. Mental health takes up more and more time: are there better ways of dealing with this, rather than endless medication? In addition, we should encourage people with certain conditions not to go first to their GP—for example, those with back pain should go to a physiotherapist, osteopath or sports therapist, and people should go elsewhere for sight and hearing checks.

It is urgent that primary healthcare works better for patients, as well as being a job that is once again enjoyed by doctors. Bold steps need to be taken. I absolutely support the suggestion by the noble Lord, Lord Patel, of setting up a Select Committee to look at this. If we can once again restore primary healthcare, it will greatly ease the whole health system and deliver better outcomes.