Primary Care: North Essex

Debate between Bernard Jenkin and David Mowat

Tuesday 14th March 2017 Westminster Hall

[David Mowat]

My hon. Friend may be relieved to hear that Colchester general hospital is not in my portfolio, but I will speak to my ministerial colleagues about it being a pilot and write to him.

[Mr Jenkin]

A moment ago the Minister mentioned some extra money for primary care. Who is responsible for investing that money? Does it come from NHS England and not from the CCG? How do we influence how that money is spent, so that there is some accountability in the process?

[David Mowat]

All money goes into the health service through NHS England, which used to be called the NHS Commissioning Board. The money is then given to the CCGs around the country to spend. In terms of a funding formula and so on, there are some specific primary care initiatives, including infrastructure-based ones for new premises and things of that type, and specific ones, which I am about to talk about, such as recruiting more GPs. We absolutely need more GPs, not only in Essex but across the country, although we do need them in particular in parts of Essex. The responsibility for that lies with NHS England, through the CCG. It is the CCG that has the accountability—to answer the earlier question, “Who do we blame for this situation?”—and I want to make that quite clear.

As for what all that means, we have workforce issues in primary care, and the Government and NHS England are committed to having 5,000 more doctors working in primary care by 2020, which should mean more availability and vacant jobs in Clacton being filled. We are determined to meet that commitment with progress made this year, with more medical students going into GP training than has ever been the case before in the history of the NHS—just over 3,000 of them. The hon. Member for Clacton was right to talk about pharmacists, and we also need to make progress with them. We aim to have 2,000 pharmacists working in primary care by 2020, as well as 3,000 mental health therapists.

All of that matters, but in addition we have to allow people to work in a different way from how they have up to now, and some of that is happening across the CCG in Essex. Broadly speaking, however, we find that a GP hub of 30,000 to 40,000 patients enables more scale. That would let us employ physios, pharmacists, mental health therapists and, indeed, social workers—in terms of the relationship with hospitals and the transfer of patients—and to have longer opening hours. I therefore completely accept the hon. Gentleman’s points about working and being open on a Saturday. We are determined to achieve that by 2020, although we are starting from a difficult position in Essex, given the lack of GPs generally. Only by collaboration and working across practices will we make progress. The model of a single GP practice—and such practices still exist—is self-evidently not viable and does not allow us to do some of the things that we need to in primary care, such as employing pharmacists and other such disciplines.

Those are my general comments, but I completely agree that unless all that lands in Essex, it is just words. Judge and jury on it will be the extent to which we are successful in landing some of that stuff in Essex. To address the specific issues, I will now talk about a number of things that have gone on in the hon. Gentleman’s local CCG. Of the nine practices in Clacton, a number have been closed to new patients, as he said. I am informed that the East Lynne practice, the Ranworth practice and the St James practice all closed to new patients in 2015, but two of those are now completely opened. The other has temporarily closed again but is expected to reopen soon. On the statistic he cited at the start, my understanding is that only one practice in Clacton now has no immediate opening in its list. The CCG has worked hard on that.

There are clearly specific issues with getting people with a GP background to move into the area. The CCG has put in place a workforce plan to address matters of recruitment and retention of GPs principally, but also of pharmacists, nurses and allied health professionals. Again, the judging of that will be in something actually happening and the vacancies in Clacton being filled. The plan exists and is being managed, and I understand that the CCG expects to make progress with it.

The practices in the CCG have come together in three collaborative groups, covering about 80% of the total number of patients seen, although the patient who sees the same GPs from the same practice and goes to the same clinic might not realise that. GPs are working collaboratively in a way that should enable better leverage of their time—I return to that point made in connection with pharmacists. We have to get away from every patient’s principal contact in the primary care system having to be a GP, rather than other professionals who could help a great deal. For example, I was recently in a practice where a pharmacist was conducting a diabetes clinic. Diabetes clinics are routine, happening perhaps every month or so, with a set of standard questions to be asked, and there is absolutely no reason why they need to be conducted by a GP, as opposed to a pharmacist. That applies in Essex, too.

I draw the attention of hon. Members from Essex to a couple of grants lately given to practices in their area. A £46,000 resilience funding grant has gone to the Clacton GP Alliance and, in a specific effort, almost £400,000 of capital funding to three GP practices that are coming together I think in Clacton hospital. The CCG understands that the standard of premises and infrastructure in Clacton is generally weaker than in other parts of the country—certainly weaker than is needed to attract the sort of talent necessary.

I have a “jam tomorrow” point to make, but it is worth putting it on the record. There is a plan to have a medical school in Essex, in Chelmsford, I think in 2018. That will obviously help, because people who train as doctors in that part of Essex will be more likely to live there, enjoy living there and, in time, make their careers and lives there. We have found that to be so in other parts of the country; I hope it works for Essex.

In connection with the minor injuries and walk-in centres, I want to speak briefly about the consultation. Members have pointed out that it would be absolutely ridiculous if, by closing those centres or doing anything to affect patient flows, more patients were to go to Colchester hospital. That is self-evidently true, and the CCG believes so too. Interested Members will know that the consultation, which set out four options, has received more than 3,500 replies. In all fairness, I do not believe that the CCG was consulting in order to close; it was consulting because contracts were up, and it wanted to look at the options and how to do better. One view given to me was it was more confusing than it ought to be for patients to know where they ought to be.

I cannot say anything today about the outcome of the consultation, other than that the CCG board will consider the recommendations received in the 3,500 responses and the various other pressures that have been discussed today. Frankly, people in the CCG will also be listening to our debate today. I would be surprised if closure of the centres was top of the list, given the other pressures on GP practices, the hospital and so on. The decision will be made by the CCG at the board meeting on 30 May.

I will finish as I started, by saying that there is a problem with the number of GPs in Clacton and North Essex. The problem is understood and action is being taken that I hope does not all amount to “jam tomorrow”, to use the phrase of the hon. Member for Clacton. Although progress has been made in getting lists open and so on, clearly a lot more needs to be done. I am happy to continue to meet the hon. Gentleman in the months ahead if we are not making progress and getting things better.

Question put and agreed to.

Scotland Bill

Debate between Bernard Jenkin and David Mowat

Monday 8th June 2015 Commons Chamber

[David Mowat]

No. I have given way twice, and I need to make some progress.

A needs-based review must be something that I would be delighted to accept if I came to Westminster representing a progressive party. Surely my progressiveness would not allow me simply to say, “We will have all we can get in Scotland”—which, as we heard from the right hon. Member for Gordon, is what was on the front page of the Daily Record. A progressive party should say, “We are not going to take all this money, because we are progressive. The settlement needs to be fair to Wales and to parts of England, where there is a great deal of deprivation.”

[Mr Jenkin]

And that would be a step towards full fiscal autonomy.

[David Mowat]

Indeed. I understand that full fiscal autonomy would take the problem away, which is, of course, why we are now seeking to implement it “in the medium term”, whatever that means.

Of course I support the vow. Of course I support the mandate that SNP Members have achieved through their spectacular election victory. It is right for us to implement this settlement, and I will vote with the Government tonight and in the future to ensure that that happens. However, I must ask the Secretary of State to reflect on the phrase that he used in his speech—“fair and lasting”—and to ask himself whether he really believes that a fiscal settlement that is absolutely and clearly not based on need can ever be described as fair and lasting. That may yet cause us problems.

Devolution (Scotland Referendum)

Debate between Bernard Jenkin and David Mowat

Tuesday 14th October 2014 Commons Chamber

[Mr Jenkin]

No, I think it was a panic reaction to a late poll. It was something that they were desperate to do. I believe that the very fact that it was a close poll was enough to turn people away from voting yes, because they suddenly realised that their vote might make a difference. Most pollsters would agree that that was the effect of the very close poll.

The vow stated:

“We agree that the UK exists to ensure opportunity and security for all by sharing our resources equitably across all four nations”.

That is fine; I think we would all agree with that. Then, however, it goes on to reaffirm the Barnett formula. There are two things about the Barnett formula, the first of which is that if Scotland is to raise more of its own resources, the formula will become a much less significant component of the allocation of resources. Secondly, the formula actually represents the opposite of

“sharing our resources equitably across all four nations”.

It cements in place an artificial bias in favour of funding in Scotland, which is no doubt why Scottish politicians campaign so vociferously in favour of it.

[David Mowat (Warrington South) (Con)]

Will my hon. Friend give way?

[Mr Jenkin]

I have given way twice already; I do apologise.

The House of Lords produced a very good report in 2009 which concluded

“that the Barnett formula should no longer be used to determine annual increases in the block grant for the United Kingdom’s devolved administrations.”

It stated:

“A new system which allocates resources to the devolved administrations based on an explicit assessment of their relative needs should be introduced.”

The question is: how are we going to get from A to B? Lord Strathclyde has recommended a convocation in which the four component parts of the Union should be represented on equal terms in a single body. The question of the fair allocation of resources among the four parts of the United Kingdom deserves to be discussed in such an impartial forum. This cannot be imposed by the Treasury. It cannot be imposed by a system that we have inherited from a period when there was no devolution and no devolved tax-raising powers at all, so we need a new system. If we are going to learn from this referendum, it would be much more honest if we all agreed that, over time, we will need to move on from the Barnett formula.

Let us deal with the question of what the promises mean. If we ever want evidence of the chaos in the no campaign, we need only see that, even after the referendum, we still have three separate proposals in this Command Paper for what is to be devolved, and an unseemly scrap between the Westminster parties over what should be devolved. I have no doubt that agreement will be reached, and I commend the SNP for being determined to bring its good will to the party in order to get an agreement, because that has to be our objective. However, as part of that agreement, there is now huge awareness across the United Kingdom of English votes on English laws.