GP Services

Anne Marie Morris Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

As I will come to later in my speech, there are a number of things that the Government coming into office after the May election will have to deal with to address the sustainability of GP services. They will have to consider whether the training is correct and whether there are enough incentives for young people to go into general practice, or, indeed, other parts of the NHS. That will be an important part of any sustainable plan to make sure we have enough doctors throughout the health service, and in particular GPs. That is a point that needs addressing.

The British Medical Association is also concerned that not enough foundation doctors are choosing to pursue a career in general practice. Application rates for training programmes continue to fall year on year. According to figures from the National Recruitment Office for GP Training, the number of applications for 2014 was 5,477, which was a reduction from 6,034 in 2013. I am told that this is leaving GP vacancies unfilled in parts of the UK: in the east midlands and Merseyside just 62% and 72% respectively of vacancies are filled. To come back to the point Members have been making, 9% of the general practice work force are aged over 60 and 38% are aged 50 or over. Just 27% of the general practice work force are under 40 years of age.

One of the reasons for speaking today is to deal with the access problems. I am sure most, if not all, MPs will have had complaints about that raised with them by constituents and by GPs.

Last year, Healthwatch Halton carried out a GP access and out-of-hours provision survey, and it is important to share some of the key results with the House: 56% of people rated booking an appointment with their GP as “very difficult” or “not easy”; 33% of people rated the length of time it took to get through to their GP practice as “poor” or “very poor”; and 62% of people would like their practice to be open longer, particularly at weekends and in the evenings. That is a particularly important point when considering whether GPs are accessible and we should move to weekend working, which we have had and are debating. However, doing that requires resources. Importantly, a sizeable proportion—32%—were unhappy with the way in which their complaints were handled. That is roughly in line with national findings. On the very big plus side, the general satisfaction level of people with their GP was more than 90%, which is important.

The figures provided to me for Halton by the Royal College of General Practitioners—my constituency covers most but not all of Halton; some is covered by the hon. Member for Weaver Vale (Graham Evans)—show that we have 66 full-time equivalent GPs and that we need to increase that by 24, or 37%, by 2020. In one of the most deprived boroughs in the country we already have a shortage of GPs. My area deals with some of the most difficult health problems—high cancer rates, and high levels of chest disease and of heart disease—so being able to access a GP, and quickly, is very important. Any shortage has an impact on all that.

[Anne Marie Morris (Newton Abbot) (Con)]

The hon. Gentleman makes a good point about access and about the challenges in deprived communities. In Newton Abbot, we have faced a real challenge in trying to replace the services there. Does the research he refers to indicate any difference between rural and urban communities, and between deprived and well-heeled communities?

[Derek Twigg]

I cannot answer the hon. Lady’s question because I do not have those figures in front of me. I am sure that if she talks to the Royal College of General Practitioners or the BMA she will be able to find all those figures. I am sure she understands that I represent one of the most deprived urban constituencies in the country and so I am going to focus on that, as I am sure she would focus on her constituency.

Let me re-emphasise a point I made earlier: whoever forms the Government after 7 May, they will have to come forward with solutions to the mounting pressure on general practice and the NHS overall. There needs to be long-term, sustainable investment in GP services in order to attract, retain and expand the number of GPs. Retention is just as important as recruitment—a point made in the comments about GPs retiring early.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

There is absolutely no question but that we all have a huge respect and admiration for our general practitioners. They do a fantastic job, and I am immensely proud of our GPs in Devon. Indeed, my GPs do the out-of-hours services themselves; they created Devon Doctors. Although it is accessed through the 111 service, we all love it because we see it as our doctors.

It is unquestionable that GP services are currently challenged—in large part because there has been an awful lot of change. As previous speakers have commented, there are simply more people; we are building more houses; there are more homes. Although being able to live longer is a wonderful benefit, the fact that we have more elderly individuals with more complex needs puts a different level of pressure on GPs trying to deal with this challenge.

The issue of GP numbers is a complex problem. The issue involves training places, attracting people and a whole range of other things. As others have dealt with the matter very competently, my comments will not focus on that particular challenge, but I would reiterate some of the comments made by the hon. Member for North East Derbyshire (Natascha Engel) about the challenges of keeping partners and passing partnerships on to the next generation. The hon. Lady was right that the burden of paperwork and bureaucracy acts as a deterrent, and that being a locum provides a much easier lifestyle.

Capital cost is a major issue. I understand that in the old days a loan could be acquired through the primary care trusts—not directly, but there were schemes to enable people to buy into a practice so that the partner could retire—but that that option is no longer there. That shows that there are problems beyond the bureaucracy and red tape—particularly about financing the challenge of GP numbers.

One of my greatest concerns is about rural and deprived communities. I would like the Minister to undertake a proper analysis of where those deprived and those rural communities are. I am absolutely convinced that it is possible to work out what is where, and consider the quality and adequacy of the GP services within those different areas. We need to unpick the problems before we can ever find solutions.

I believe that we need a new model. This has been talked about for many years and under a number of Governments, but I am hopeful that, under Simon Stevens’s leadership, we will come up with something fit for purpose, on which all parties can agree. He is already indicating some changes. I would certainly not advocate another major reorganisation, but he is looking sensibly at the use of GPs in hospitals and similar issues. As I say, we need a new model.

Clearly, we need to consider the possibilities for integrating within primary care and across primary and secondary care. I do not believe in a one size fits all, but we need to look at a variety of models. I am pleased that in my local community, whether it be NHS, social care, the third sector or indeed the private sector, they are all working together to give the quality of care that constituents need. That is greatly to their credit.

I am pleased, too, that in Newton Abbott we have had funding from a pot of £3.5 million for a pilot scheme on dealing with the frail and elderly. It deals with how to look across the spectrum to ensure that these individuals can, with the right sort of support, stay for longer in their own homes, which is clearly better for them as well as reducing pressures on A and E. I very much look forward to seeing the results from that.

The overall model needs to take integration into account, because for too long primary and secondary have been seen as separate sectors, never mind their separation from social care. We need to look, too, at a new physical model. We talk about public health—a responsibility now given to our county councils or unitary authorities—and we need to consider what we can do to keep people healthy and fit. The concept of a hub is important, where medical care and social care, perhaps along with a gym, could be provided. We need something to pull all those things together—a way forward in some areas. I would like to think that that could be a practical solution in one of my towns such as Kingsteignton. It is challenging to find somewhere for a new GP practice: one integrated in that way would enable us to support the serious funding challenges . I would love to think that NHS England has limitless pots of money, but that is simply not true. That is why we need to involve the private sector—providing the gym or other attribute—in making the new hubs work.

We also need to look at non-physical structure, by which I mean telemedicine. A particular challenge for rural communities is how to use telemedicine more effectively. That could be an additional challenge, of course, because it depends on whether we have the internet and whether individuals know how to use it. It is a challenge that we need to take seriously none the less. We must be careful to ensure that we do not say, “If you live in a rural community, you can have just telemedicine”. That would be a great mistake. One of the greatest fears of my local rural community is that as it becomes more sparsely populated and people become older, they will effectively be forgotten. That would be absolutely wrong. Telemedicine has a place, but it cannot be the only solution.

The main challenge is to meet the need for a long-term plan. I hope the Minister will tell me that he and NHS England have a vision of how to deal with—or at least look at—urban and rural issues, how to deal with deprived and less deprived communities, how to deal with the physical versus the non-physical solution and how to deal with the issue of integration versus stand-alone. We must ensure that we have space and place for the new solutions and the new models.

One of my deepest frustrations is that a good local authority will take into account the housing numbers and the need for a new hospital or a new GP surgery, but because the NHS is not a statutory consultee of the planning process, it is not properly thought through. The challenge is to get the NHS involved. The average GP and indeed the CCG have enough on their plate without getting involved in planning issues. That said, it is crucial for us to get this right, because otherwise we shall be landed with huge challenges. New homes will be built, and there will be no local GP services. Our local plan for Kingsteignton, which was completed recently, provides for a substantial number of new houses, but does not reflect the clear need for additional general practices. We need to find, somewhere in the area, a new space and a new place.

When it comes to planning applications, the NHS is—again—not a statutory consultee, and therefore faces considerable challenges. The number of houses involved in an application can suddenly start to increase exponentially. In the north of my constituency, in the Dawlish and Starcross area, we were to have 1,000 new houses; now we are to have more than 2,000. The local general practices are very worried about how they will cope. Having looked at their existing sites to see how they can develop them, they apply to the council for planning permission, and they cannot get it. They are feeling incredibly frustrated, because they want to provide a service, but there is absolutely no way in which they can do so.

In the case of a development in Newton Abbot, a surgery has relocated, which is great—the accommodation is much better and more fit for purpose—but the issue of bus services has been overlooked, and many people have complained to me that it has not been thought through. That is partly because the NHS has simply not been involved, in any guise.

Local residents are deeply concerned about the changes, and I am regularly approached by patient groups who say, “What are we going to do? We absolutely need to support our local communities, but we cannot see a way forward. We face challenges because existing practices cannot expand, because we need funds so that new partners can replace those who wish to retire, and because the grand plan has not been thought through and our local NHS body has run out of money.” Although the financial year has not yet ended, there is no money, and if we are to have a new general practice, we must find another way of securing that money.

There is a huge fear that if the Government cannot come up with a better way of dealing with those challenges, large private organisations such as Boots will suddenly become the new general practices. Boots currently provides flu vaccinations and the like, but it is clear that it is only one step away from starting to look into how it could provide GP services alongside a supermarket or health hub. Access is obviously important, but the fear is that people in rural areas and the elderly who cannot get to Boots will not receive those services.

We need a plan, and that plan needs to be articulated. We must have a strategy to establish how we are to plan for all this—“plan” as in “planning”—and patients and residents must be involved in the decisions. At present, they feel that they are out of the loop. There is a real fear among rural and elderly communities that they will lose out, and we absolutely must ensure that that does not happen.