Access to Primary Healthcare

Beccy Cooper Excerpts

Wednesday 16th October 2024 Commons Chamber

[Mr James Frith (Bury North) (Lab)]

Some of us newly elected or returning MPs have only just got our accommodation and offices sorted out, so I commend the Government on the speed with which they have got surgeons back to work, resolved the doctors’ strike, reviewed and assessed the crisis and made announcements for a decade of national renewal. They have also affirmed the view that our NHS should be treated not as a shrine or beyond question, but as something that must be returned to deep service to our country and play its part as a health and economic public service.

Lord Darzi’s review for the Government highlights the critical issues in the NHS and the state we are in, and particularly the underfunding of primary care. It has been neglected in favour of a creeping trend towards hospital services, under the failed principle of leaving it late—the crisis mode setting that applied across our public services under the last Government. By design, people ended up in A&E because of a failure to plan for GP and primary care, with 16% fewer GPs than other high-income countries. The review also points out significant health inequalities, with deprived areas historically receiving insufficient resources. In Bury North, child poverty is up to 43%, densely concentrated in just three of our nine wards. Life expectancy for those living in Bury North ranges enormously: the difference in life expectancy between North Manor and East Ward is five years for women and nearly seven years for men.

[Dr Beccy Cooper (Worthing West) (Lab)]

Public health interventions cost only a quarter of the amount that clinical interventions do to add an extra year to life expectancy, so does my hon. Friend agree that the reduction of the public health grant was an appalling false economy and should be restored, as soon as finances allow, to at least 2015-16 levels of funding?

[Mr Frith]

My colleague makes a valid point; I defer to her knowledge of the public health system.

The distance of a mile or so has a huge impact for the men and women living in east Bury. I urge those carrying out the Government review to see how, in constituencies like mine, specific interventions could address those deep health inequalities and identify the work we need to do to resolve that impoverishment in densely populated areas and that ingrained health inequality. I urge the Government also to adopt multidisciplinary care models and shift care closer to home to address these issues—a sentiment that I know Ministers share.

Taking a wider view, the funding formulas are outdated and an update is long overdue. That update should take into account the weight of funding pressures for areas such as mine, with a mix of economic and demographic inequality, including the fact that so much of the revenue that our local authority raises is immediately swallowed up by adult care and the disastrous special educational needs system—a symptom of the crisis mode mentality under the previous Government.

The Government have wasted no time, investing £82 million to recruit a thousand newly qualified GPs and addressing the dental care crisis with 700,000 urgent dental appointments. The Government also aim to expand the role of pharmacies—a measure I hugely welcome—to reduce the burden on our GP and hospital care, and crucially also for those living with chronic illness or conditions. A boost to the engagement patients can have with health decision makers via the NHS app and an improved trusted status for healthcare professionals will boost this too and reduce the bureaucracy in our caring system.

There is a well known saying in good hospitals, “The best hospitals keep people out of them and get people out of them.” This principle strikes at the heart of what has gone wrong in recent years. The problems in A&E, emergency services and waiting times stem from a failure over the past 14 years to design by this doctrine. The key to resolving those issues lies in primary care—preventing people from needing hospital services in the first place and enabling faster discharges when they do. That is where the focus must be.

--- Later in debate ---

[Dr Beccy Cooper (Worthing West) (Lab)]

The Darzi review has effectively shone a spotlight on the key issues that GPs and all in the healthcare profession have experienced over the past 14 years. It rightly highlights the detrimental impact of austerity and the increased pressure that the pandemic put on an already stressed service. It also draws attention to the ongoing excellent work that is being done by NHS staff across the country in spite of, rather than because of, the facilities, systems and processes that are not fit for purpose and must now undergo intelligent reform. Primary care is an essential part of our health system. It is where prevention meets treatment, and GPs can effectively undertake secondary prevention to keep people well for longer—for example, people with chronic conditions such as diabetes and hypertension.

As a public health consultant, I want to fight for our GPs and make sure that they have the resources they need, and I want to highlight three things today. I often speak to the Royal College of General Practitioners, and we are in sync on these three things. The first is the long-term workforce plan. It is due for review next year. It has been underfunded in previous times, and we have to look at the modelling that is in the workforce plan now. If we are moving from a hospital model to a community model, we have to look at the rate of increase that we expect in our GP service. It currently stands at 4% for GPs and 49% for hospital consultants. This is in no way to denigrate my colleagues who are hospital consultants—they are incredibly important—but we need to review this workforce plan. I know that the Public Accounts Committee was looking at this issue prior to the election. As a new member of the Health and Social Care Committee, I will encourage the continuation of that work.

Secondly, we spoke earlier about a mixed model of GP provision and how that will work. In my constituency, the Worthing integrated care centre is due to open very soon. It is part of a neighbourhood model, where GPs will work with other healthcare professionals to provide a holistic wraparound service. As has been demonstrated in this Chamber today, there are already partner practices that are working effectively. This is about the interaction between neighbourhood hubs and those partner practices. It is pragmatic politics to get those to work, and work well, for our GP colleagues.

Finally, we have talked about the national retention strategy. GPs are currently leaving in their droves, and even though many people are coming forward as GP trainees, it has been said in this Chamber that we must ensure that we retain our GP colleagues. This issue is particularly acute in deprived areas. As a public health consultant, I know that health inequalities are one of the major issues in this country. In order to address that, and to ensure that prevention is writ large for those areas of health inequality, we must make sure that we are retaining our GP colleagues in those areas.