GP Recruitment and Retention

Debate between Jamie Stone and Philippa Whitford

Wednesday 28th March 2018 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Moon.

I declare an interest, in that my other half is a GP. He is German and has been here in our service for 32 years. That highlights a particular problem that we shall face in the next few years because of Brexit. As the hon. Member for Houghton and Sunderland South (Bridget Phillipson) mentioned, GPs are not just gatekeepers, but are the core and heart of general practice, which is where most interactions occur. They specialise in teamwork and continuity. They may know their patients for years and over generations. All UK health services face three key problems. We all face tight budgets and increasing demand because of an ageing population, and the workforce is bringing those things to a head in relatively short order.

There is a drive in Scotland and England to rebalance the proportion of funding that goes towards primary care, to approximately 11% of the budget. With the climbing complexity of cancer care, emergency care, A&E and targets, more money has been moving into secondary and, indeed, tertiary care. The demand is still there. Having worked as a breast cancer surgeon for more than 30 years I can tell the House that we also face shortage and increased demand, so there is no easy solution—but if primary care fails, the entire system fails.

In Scotland the new GP contract was designed by working with the British Medical Association, and at the moment it is in phase 1, which is trying to stabilise the system. Two thirds of practices will have a significant increase in income, and the others will be protected so that no one experiences a fall. Phase 2, which will start next year, is an attempt to consider something a bit more radical. It touches on issues that have been raised by some Members, to do with changing the shape of primary care, and the system. The income of GPs varies hugely. Some practices are immensely profit-making and have a good income. In other areas the GP, despite perhaps working longer hours, may earn £20,000 or £30,000 a year less. That means that the area in question becomes relentlessly harder to recruit to. Consideration is being given to whether there should be a range of income, perhaps similar to what consultants have—an NHS salary.

That is obviously a huge change from the situation at the moment—the independent contractor status. Older GPs who have lived with independent contractor status certainly do not want it to go. They welcome the independence and the ability to design and run their practice as they see fit. However, it is important to recognise that the younger generation feel utterly differently. As has been mentioned, they are not interested in buying into a practice or even, necessarily, in being partners. They are not attracted to the businessman side of being a GP. Therefore we need contracts that do not destroy independent contractor status for those who already have it, or those who want it, but that enable people to work in practices where perhaps the building is provided by the health board, and where they are salaried and can create a more predictable work-life balance.

One of the small-print issues that is arising in England is the fact that no new general medical services contracts have been awarded since 2013; everything has been done on the basis of alternative provider contracts, which means that they are only for five years. It might be attractive to a big multinational to take on a franchise and hope that it gets the contract again; but there is no possibility that a family doctor would be interested in setting up or taking on a practice for a mere five years.

[Jamie Stone]

I am greatly interested in what the hon. Lady is saying, which is very constructive, good stuff. Would she, at this stage in her planning, factor in the extreme rural issue that I mentioned, in any way?

[Dr Whitford]

If the hon. Gentleman will bear with me, I shall come to that naturally later.

The issue of indemnity has been touched on. I am not sure whether it is realised how extreme the position is. GPs in England are paying three to four times the indemnity that GPs in Scotland are paying. The range in Scotland would be £1,500 to £2,300 on a range of half a dozen to 14 sessions, but in England that would be £5,500 to £9,500. That is a considerable chunk of money to ask of someone, and it is very significant when it comes to taking on the extra weekend surgeries of seven-day working, or out-of-hours work.