General Practitioners: Appointments

Lord Rennard Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Rennard (LD)]

My Lords, I declare my interests as in the register. There is of course much controversy at present concerning what I will call the Government’s preoccupation with the weekend working practices of junior hospital doctors but it seems to me that many people in need of medical support would have preferred the Government to keep concentrating on issues such as strengthening out-of-hours services for GPs and using modern technology to enable people more easily to interact with a GP.

Of course, much progress on these issues was being made prior to the general election and I am seeking some reassurance in this debate that that progress will continue. Just prior to the general election, it was announced that GPs in more than 1,400 practices across England would receive £550 million of government funding to reorganise their services so that surgeries could be open from 8 am to 8 pm, seven days a week. My good friend Norman Lamb, who was then the Care Minister, told me he hoped that some of this funding would lead to much greater use in those practices of patient consultations by videolink, email and telephone, together with a greater provision of online booking services. I hope that the Minister will be able to tell us about progress since that announcement last March.

That funding, however, was directed at slightly fewer than one in five GP practices in England so I hope that we might also hear more today about how the remaining 80% of GP practices can be supported in improving access for their patients. This is both very important in terms of improving patient care and essential if we are to avoid the crisis in our hospitals getting even worse. I would like to hear from the Minister about how the £250 million infrastructure fund, which was first announced in the 2014 Autumn Statement, is helping to improve and provide more integrated health centres and more use of technology. The Government’s press release at the time claimed that they would help to fund additional services, including on-site pharmacists, speech therapists, minor surgery and diagnostic tests. It was also intended to make it easier for GPs to return to the profession following a career break, encourage more medical students to take careers as GPs, and enable GPs considering retirement to work reduced hours in the interim. This timely debate will allow the Minister to describe, I hope, progress on these issues over the past 12 months.

However, we need to go much further and be much bolder in using new technology to improve access to GPs. Ten years ago I visited India and looked at the provision of health services in remote rural areas, where access to a GP, let alone a hospital, was bound to be extremely difficult. I was very impressed by the use of webcams in specially equipped vehicles that could tour rural areas and with the help of a trained nurse allow some basic tests to be undertaken and a face-to-face conversation to be held with a GP or even a consultant. This made me think about how we could do much more in this country, using new technology, to let people talk to a GP without necessarily visiting the surgery. As technology develops, those GPs or other people, including carers and family members, can monitor certain conditions remotely.

My own Fitbit tells me how many steps I have walked each day, and what my heart rate and my sleeping pattern are. While I do not wish to share this information with anybody else, it is easy to do so. I acknowledge at this point that it was active intervention by my own GP’s practice that led me to undertake a more active exercise regime and improve my own diabetic control. In time, I expect that my blood pressure and glucose levels will be monitored remotely by health professionals.

For some elderly or housebound residents, this could be a good way for GPs to help keep an eye on them without clogging up their surgeries, while enabling the professionals to determine properly whether or not an appointment is really necessary. At the moment, getting an appointment when needed is often very difficult. Getting access to a doctor at night is usually extremely difficult, but this was not always so. Something has gone wrong when people feel the need to turn up at A&E if they can or call an ambulance when they should really have been seen by a GP at a surgery or in their home.

These problems are well illustrated in the recent report by the Public Accounts Committee in the House of Commons, which highlighted the following facts. There are simply not enough GPs to meet demand. Deprived areas are particularly short of GPs and nurses. Finally, there is much variation in patients’ experience of getting and making appointments, with people who work full-time among those who are most disadvantaged.

It is also clear from that report that information about basic facts, such as services provided at GPs’ surgeries and the availability of those services, is sometimes difficult to obtain. The report also makes it clear that the Department of Health and NHS England do not have the data that they need to make well-informed decisions about how to improve access to general practice or where to direct their limited resources. In the long run, these issues come down to improving the way in which we try to do things, endeavouring to make efficiency savings. But without a doubt, funding is the major issue.

The results of the most recent general elections show people’s reluctance to pay higher levels of taxation and politicians’ reluctance to ask them to do so. This is in spite of the fact that people now expect a pension from the state for a much greater proportion of their lives than ever before; with this comes the probability of them needing greater provision of health and social care. Improving access to GPs and funding the health and social care services that we need may require the introduction of a hypothecated tax in future. I believe that all parties should be considering this option if they are to be honest about addressing these problems. I would welcome the views of the Minister on that.