The Long-term Sustainability of the NHS and Adult Social Care

Baroness Meacher Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Meacher (CB)]

My Lords I, too, thank my noble friend Lord Patel for his thoughtful report. I will focus on primary care and consider the compounding challenges of the primary care workload, the GP workforce, the nurse workforce, the budget and the blame culture.

First, the GP workload has increased by 16% over the past seven years as a result of the ageing population, the shift towards community care for certain illnesses and the dearth of capacity in hospitals. As noble Lords know, there are fully 1 million more people over the age of 65 than there were a mere five years ago. This means a more complex and time-consuming workload. The fact is that 10 minutes just does not do it for an awful lot of patients these days. The cut of 11% in the social services budget in five years just makes matters worse.

At the same time as the workload has increased so dramatically, GP numbers are under threat. The number of GPs taking early retirement has risen sharply following the clampdown on GP pension pots, bringing the retirement age down by two years to 58 and a half years. This means a huge and growing waste of expensive, highly trained GP resources. GP practice closures have been at record levels recently, and things can only get worse—considerably worse. An RCGP survey found that 39% of doctors in England said that they are unlikely to be working in general practice within the next five years. I find that terrifying. Doctors warn that a town without any GPs has become a real possibility. GPs talk about not wanting to be the last person standing when all their colleagues have left. The main reasons GPs give for their plan to leave general practice early are stress and excessive workload.

The Government say that the answer is to bring in more nurses. Absolutely, if only it were possible. A recent Pulse survey showed that one in eight practice nurse places in the UK is vacant. The shortage is expected to get worse if the Government go ahead with the plan to make nurses pay for their training. The nursing profession is anyway facing a demographic time bomb with mass retirements. The average age of practice nurses is 55. The GP nurse crisis is also linked to the historic failure to invest in primary care nurse training, and the long-standing neglect of community care nurse recruitment—a bundle of problems.

In this situation, an appalling fact has been the decline in the proportion of the NHS budget going to general practice, from 10.7% in 2005-06 to a record low of 8.4% in 2011-12. How can any Government justify that in the context of a major policy shift towards community care? Yes, the NHS England’s General Practice Forward View, as others have mentioned, acknowledged at least some of the difficulties, and committed £200 million to some schemes. That is a small step in the right direction, but the need is for a serious assessment of the overall financial requirement of general practices to enable them to build the multi- disciplinary and multifunctional integrated organisations to meet the demand.

Another very significant problem in general practice, I have to say, is the blame culture. The sooner the GMC and the ombudsman adopt the airlines’ approach of learning lessons from errors—yes, terribly important—rather than crucifying anyone who makes a mistake, the sooner we will reduce the very high level of stress among GPs, and reduce the trend towards early retirement and quitting really quite early on in their careers. If a GP sees anything between 60 and 100 patients a day, which they do, the chances of a mistake must be high. Of course legitimate complaints must be taken seriously, but a lot of patients would be very happy if they felt that their complaint would lead to some improvement. A complaint undermines morale and takes many hours of a GP’s time—time that no GP has. Will the Minister agree to ensure that this issue of the blame culture is addressed?

I am very concerned that several witnesses to the committee talked about the anticipated drastic fall in GP and nurse numbers and the extraordinary fall in the general practice budget share, and came to the crazy conclusion that the general practice partnership model should be shaken up. Any top-down reorganisation of that kind would further undermine and demoralise general practice. No, general practice is transforming services, despite the pressures and lack of funding to facilitate change. These are the issues that need to be looked at.

The absolute priorities must be correcting the funding balance between primary and secondary care and increasing funding overall, as I think pretty well every contributor to the debate has said. The £50 billion figure is probably a useful guide, as mentioned by the noble Lord, Lord Prior. There also needs to be proper financial support to encourage the developments already under way in many areas—such as I have already mentioned, enlargement of practices, federation of practices, and crucially including psychological therapists, who could save GPs a great deal of time. That could be closely integrated with adequately funded social services. There are also innovations like the development of online services which I know the Minister supports. Then we have a chance of a sustainable primary care service. Can the Minister give an assurance that this is the approach that the department will take?