GP Recruitment and Retention

Alex Chalk Excerpts

Wednesday 28th March 2018 Westminster Hall

[Luke Pollard]

The problem is that the schemes that currently exist are not having the effect that we need them to in Plymouth, because we have a crisis today.

I want to talk about the concern that a lot of GPs have expressed to me. My remarks will be about what GPs have told me, rather than my analysis of what I believe GPs are saying, because I think it is important that their voice is heard in this debate. Will the Minister meet those GPs so that they can raise their concerns in person? There are a number of GPs who have solutions or suggestions about what can be done.

At the moment each GP in Plymouth has about 2,364 patients. As we heard earlier, the average is about 1,700, so there is a greater demand on the GPs we have in Plymouth. One GP told me last night:

“I’ve just walked in the door after a day where I saw my first patient at 0825 and left my last patient’s home at 8.15pm. Because the district nursing service is currently unreliable (through no fault of their own), I will go back to the latter at 0800 tomorrow as the patient is housebound and needs blood tests.”

He went on to say:

“A large part of the pressures on...GP’s is the fact that other community services have had such drastic cutbacks.”

He said:

“I feel very...lucky to have a secure well-paid fascinating and rewarding job but it is all a little overwhelming and I constantly worry that just one major problem will mean things become very, very unsafe.”

[Alex Chalk (Cheltenham) (Con)]

Will the hon. Gentleman give way?

[Luke Pollard]

I will continue, if I may. Apologies.

Another GP, Dr Williams, said that the system is failing and it feels as though it might be intentional. GPs have heard NHS England say that it is watching Plymouth as a place where primary care could fall over, a sentiment that several GPs have expressed to me in private. They believe that Plymouth’s city-wide system is facing bigger concerns in primary care than elsewhere. A meeting with the Minister is vital, so that he can reassure those GPs that the Department of Health and NHS England are on top of this.

Another inner-city GP said:

“I became a GP to help people with physical and emotional health difficulties and this is a job I have really enjoyed for a number of years. During this time patient needs and demand on general practice has increased significantly but unfortunately funding has not kept pace...We only get...£115 per patient per year to provide the totality of patient care so it’s no surprise we are struggling when some patients consult us at least once a week.”

The general medical services contract includes between £73 and £117 per patient, but as we have seen in Plymouth where GP surgeries have fallen over and emergency providers have been brought in, there can be as much as £347 per patient under emergency access contracts. There seems to be a huge financial gap there that could be moderated by supporting GPs—not by giving them more money themselves, but by providing support and assistance so that they can hire more GPs, and by supporting the other professions that make for a successful GP practice.

Worryingly, the doctor I referred to said:

“I no longer enjoy being an NHS GP because I cannot keep pace with demand and I know our patients are getting frustrated with restricted access to their GP. Patients are complaining, and rightly so, but those complaints just compound my loss of joy from the job because I’m working harder than ever to try and provide the service patients want but the majority of feedback we get is negative.”

That has been echoed by a number of GPs in Plymouth, who really want to inject the joy and passion back into their role. They entered the profession not because it was easy—it was hard and difficult—but because their efforts would make a huge difference to their communities.

[Alex Chalk]

Will the hon. Gentleman give way?

[Luke Pollard]

I will continue, if I may.

I am genuinely worried that Plymouth’s primary care crisis is going to get worse in the coming days. We know that there are GPs who are considering whether to renew or to hand back their GP contract—a decision that will be made in the next couple of days. That is deeply worrying not only for them, but potentially for patients.

My GP surgery in Plymouth closed recently, so I know what it is like to lose my GP. At the moment I am especially concerned about people who do not reregister with a new GP, effectively becoming an unregistered cohort of people in the city who then can rely only on acute A&E services. Our staff at Derriford A&E do an absolutely fantastic job, but they cannot keep going if there is a continuing crisis.

The Plymouth Herald reports that a third of GP surgeries are at risk of closure as vacancies in primary care escalate. Will the Minister meet Plymouth GPs so that they can raise concerns directly with him? There is an opportunity to avoid the crisis getting any worse through proactive measures. I do not want to see the crisis getting worse and then more emergency access having to be put in place as GPs who have worked beyond the point of exhaustion hand back their contracts. That decision can be justified because of the pressure on them and their families, but we can avert that situation if we take action today. I hope the Minister will address that in his remarks.

--- Later in debate ---

[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.

[Alex Chalk]

That is an acute point. Does the hon. Lady share my consternation, particularly with respect to out-of-hours work, that in the past few years the premiums have been rising stratospherically? I think they went up by close to 10% last year.

[Dr Whitford]

I absolutely agree. As I have said, it is not particularly an issue in Scotland, but it is very much one in England. I know that it is being looked at under the new contract. Hon. Members may remember the Prime Minister’s challenge fund: extra surgeries at the weekend are better paid and do not involve the same indemnity issues as going to do a stint at the local out-of-hours. Unconsidered consequences of that kind must be looked at.

There is obviously increasing demand. We talk negatively about the ageing population, but living longer is a good thing, and I would like to recommend it. I spent 30 years trying to achieve it. In Scotland the number of GPs increased by 9% between 2005 and 2015, but the number of patients over 65 increased by 18%. Obviously, much innovation across the UK is to do with trying to reduce workload. Scotland was first to get rid of the quality and outcomes framework, which had encouraged significant quality improvements but grew into a huge bureaucratic machine. We are working on developing the multi- disciplinary team, with physios, access to counsellors, and pharmacists. That is happening in England as well. One innovation in England is known as “time for care” and concerns extra training at the frontline—reception—to encourage triage of patients to the right member of the team. However, my attention has been caught by the development of a new app that allows patients to book appointments directly; that would remove the option for triage. It is important for innovations to be joined up.

We need to innovate and to use all community resources. Scotland has for 10 years had community pharmacies providing minor ailment services. Our optometrists are allowed to make direct referrals to hospital for cataracts, and now they treat 90% of all acute eye problems. Those are things that may at the moment be referred to general practice simply to ask for a letter to be passed on. That is a waste.

There has, obviously, been a climb in the number of practice vacancies, including in Scotland. Our whole-time equivalent has fallen, in the past three years, by 1.9%—in England the figure is 2.8%. There has been a 50% increase in the number of GPs taking early retirement, at the age of about 57. Some of that is because of the change in pension tax rules. The problem of having too big a pension is a nice one to have; however, if people who invested 40 years ago in very expensive added years are finding suddenly, as they approach retirement age, that that means they are accruing no further pension, we have a problem.

Brexit is definitely a threat. In Scotland, 3.5% of the health and social care workforce—and 5.8% of doctors—are from the EU. In London the figure is 14%. We know that 14% of EU doctors in Scotland, and 19% in England, are already in the process of leaving and, as has been said, that is simply because they feel unwelcome. As we have seen with the difficulty of getting tier 2 visas over the past four months, recruiting from outside the EU is a real issue. Businesses in London can increase someone’s salary to get past the limitations, but the NHS is not able to be so flexible.