GP Recruitment and Retention

Debate between Bridget Phillipson and Rosie Cooper

Wednesday 28th March 2018 Westminster Hall

[Bridget Phillipson]

Attracting medical students to areas of the country with the greatest need is important. That is something I have been seeking to do, and I am sure the hon. Gentleman will continue to make that case as well.

[Rosie Cooper (West Lancashire) (Lab)]

I am absolutely delighted that Edge Hill University in my constituency has just been granted a medical school. Does my hon. Friend, or indeed the Minister, have any view on how to retain the doctors who will train there and ensure that they can practise in the area? Lancashire has seen the largest fall in the number of GPs of any county since 2015—it is nearly 10% down. We need solutions to make areas attractive in order to retain the medical students who train there.

[Bridget Phillipson]

My hon. Friend is entirely right. I will say a bit more about Sunderland’s successful bid for a medical school—a number of parts of the country have benefited from those new schools. She will no doubt accept that this is part of a much longer-term solution to resolving the crisis we face. Meanwhile, we need action from Ministers to deal with some of the short-term pressures on local services.

The most vulnerable patients, who already find it difficult to get to their local practice, will undoubtedly be further inconvenienced if that practice moves further away. The creation of larger super-practices also risks breaking the critical link between family doctors and the patients they serve. In any case, the national and local strategic push for larger practices appears to be having little impact on GP numbers, as I have sought to make abundantly clear.

I do not believe that we can go on like this. We should rightly celebrate that people are living longer, which is in part a testament to the world-class care that the NHS provides, but we need to acknowledge that an ageing population with increasingly complex long-term care needs is likely to put further pressure on GP services in years to come. The British Medical Association is clear that general practice in England is under unprecedented pressure to deliver more support to patients with fewer resources. As the problems grow increasingly severe, GPs are being forced to test their resilience beyond reasonable limits and to confront issues from a multitude of directions.

I am deeply concerned that eight out of 10 GPs feel unable to deliver safe care; that seven in 10 feel that patient access to services has decreased of late; and that six in 10 have reported a rise in their stress levels. There is a workload limit beyond which we cannot reasonably expect family doctors to go. Given that more than half are now considering the temporary suspension of new patient registrations to ease the burden, it seems that we are close to that point.

If we are to address the crisis in general practice, we must first consider the factors that drive it. The Sunderland CCG practice area is grappling with several problems that I am sure will be familiar to GPs in other parts of the country. I have mentioned the long-term challenge of coping with an ageing population that has longer and more complex care needs, but that is coupled with rising public expectations of what their local general practice should be able to deliver. Let me be clear: demands for flexibility in terms of evening and weekend opening hours are not unreasonable at a time when so many people work during the week. After all, public services must be responsive to how people live their lives. That said, it is inevitable that offering round-the-clock access to GP practices will increase the pressure on existing workloads unless more family doctors come into the system.

Unfortunately, the opposite is happening in my area, where there are significant issues with recruitment not only of GPs, but of nurses and other healthcare professionals. Meanwhile, existing GPs and practice managers are dealing with additional work moving from hospitals into the community without associated funding. Added to that is the increased pressure on budgets resulting from rising estate costs from NHS Property Services, and the fact that the percentage of the NHS budget allocated to general practice has not kept pace with the rest of the health service. Finally, the cost of medical indemnity for GPs has risen significantly in recent years, pushing up the cost of insurance and making some work, especially unscheduled care, prohibitively expensive for GPs.

We therefore have a perfect storm of pressures on general practice that is driving experienced family doctors from the profession, with a third of GPs in the Sunderland CCG area considering retirement in the next five years. The dramatic fall in the number of GP partners over the last year should also come as no shock given the increasing responsibilities of running a practice where income is falling but workload is rising. In that context, it is easy to understand why more and more experienced GPs are opting for locum work instead, which allows them to work set hours with a set fee to a very specific set of tasks.

However, the cost to the NHS of this shift in culture cannot be measured only in financial terms, although that is certainly a major concern. As I mentioned earlier, the closure of a local practice is often devastating for a local community and can leave the most vulnerable patients with less access to the long-term care they need.

The crisis in GP retention therefore needs to be urgently addressed, and I ask the Minister to explain what the Government are doing to stem the flow of GPs quitting the workforce or rejecting partnerships. The GP retention scheme has proved a popular way to help family doctors who are considering leaving the profession to remain in work for a reduced number of sessions, but the Government simply must do more to ease their workload if they are serious about their commitment to attract and retain at least an extra 5,000 GPs in England.

On the other side of the coin is recruitment. Given the challenges for retention I have outlined, improving recruitment is critical if the general practice forward view target of increasing the number of GPs by 5,000 by 2020 is to be met. The BMA has warned that that target looks increasingly unachievable without a significant increase in the number of doctors through the expanded international GP recruitment programme.

Sunderland CCG is part of the NHS Cumbria and North East submission to that programme, and at least four local practices have expressed an interest in hosting a minimum of 10 GPs. In addition, the CCG is running other schemes to attract more family doctors, such as the GP career start scheme, the golden hello scheme and the GP bursary, yet whatever additions those can make to the workforce will clearly be insufficient to address the long-term drop in the number of hours made available for general practice in our area, with the number of full-time equivalent GPs falling from 201 in 2013 to just 139 in December last year. I know that the methodology for measuring that number has changed, but it is evident, whatever way the figures are measured, that there are simply not enough new doctors coming on stream to plug the ever-widening gap in service need in Sunderland.

I hope the Minister will take responsibility for this situation, and that he will agree that this is a national crisis, rather than an issue to be dealt with by local NHS managers. He will be aware that, in addition to the GP shortages we have discussed, the most recent figures show more than 100,000 NHS posts currently lying vacant—this is before we have even left the European Union.

What assessment has he made of the impact of Brexit on EU workers in the NHS, and does he agree that the Government’s increasingly hostile attitude towards migrants from both inside and outside the EU risks exacerbating the jobs crisis within the NHS at a critical moment? Rather than creating a hostile environment, should the Government not celebrate those who have come to our country to keep our NHS going, and who have made such a fantastic contribution to our health service since its inception?

I hope the Minister will at least acknowledge the problems that the north-east faces in recruiting new medical students into general practice. We in the House have a duty to confront those challenges and to support creative efforts to help the NHS to attract more students into the profession in the areas of greatest need. That is why I was so delighted by the news last week that the University of Sunderland was successful in its bid to set up a new medical school. My hon. Friend the Member for Sunderland Central (Julie Elliott) and I supported the bid, because the school will focus specifically on addressing workforce need in general practice and psychiatry in the north-east. It will deliver an additional 150 graduates into general practice between 2024 and 2028. All the experience is that GPs tend to stay in the longer term in the areas where they train, so the creation of a dedicated medical school in Sunderland is an important development for the city and the wider area.

The bid should also be praised for seeking to widen access to medical schools by ensuring that those with the talent and motivation to succeed are encouraged to apply regardless of background or social connections. The new medical school will champion general practice as a career path for researchers, offering them opportunities to explore their chosen field of interest after their training is complete. It will focus on reflection, responsibility, leadership and motivation when recruiting students to the programme in order to identify those who are most passionate about building a career in general practice. The creation of an institute for primary care practice and a general practice society should also help to foster communities of practice that will last for many years to come.

I have every confidence that the new medical school will play an important role in addressing health inequalities across the north-east in the long term, while improving social mobility in the region. I therefore wish it every success and hope that other medical schools will replicate its innovative approach to attracting talented students from less advantaged backgrounds into medicine and, specifically, general practice. I want to take this opportunity to thank all those who were involved in putting together the bid, especially Professor Scott Wilkes and Vice-Chancellor Shirley Atkinson. Without their determination, dedication and leadership, the bid would never have succeeded. They deserve a great deal of credit.

We can all agree that training new family doctors in this country is the most sensible and sustainable way to improve recruitment and retention in general practice in the long term, but that will do nothing to address the immediate crisis facing the GP workforce. I have already discussed some of the programmes that have been put in place to meet the target of 5,000 new GPs by 2020, and I agree with the BMA that it is encouraging that the number of GPs entering training has risen for the third year in a row. However, as I mentioned, those gains are being offset by the fact that many existing GPs are choosing to work less or retire completely because of rising workload pressures. Furthermore, the BMA is clear that the overall intake for GP training places still falls far short of the Health Education England target.

Nowhere is the problem more apparent than in the north-east, where the fill rate for GP specialty training vacancies last year was just 77%. That is by far the worst rate in England and it is nothing new. Two years ago, for example, the north-east fill rate was a shocking 62%, which at the time was the lowest in the whole country. There is a real problem in relation to general practice in the region that has some of the most acute health inequalities in the country. Sunderland, South Tyneside and Hartlepool are ranked in the top 20 of 326 local authorities for bad or very bad health, and Sunderland has some of the worst health metrics in the UK for diabetes, hypertension, respiratory disease and many other health conditions. Setting aside for a second the increased demands that the forecasted ageing population will place on primary care provision, we can see that there is an urgent need for more family doctors to deliver health improvements today.

I raised this issue with senior NHS leaders during a recent session of the Public Accounts Committee, but I want to put it to the Minister again. Will he tell the House what exactly the Government are doing to ensure that the regional imbalances in GP recruitment are addressed, and how does he intend to ensure that the right people are trained in the right places? That is a crucial aspect of the challenges facing general practice in my area, and put simply, we need to know that Ministers and the Department have got a handle on it. Furthermore, will the Minister tell us whether his Department is looking at ways to open up access to medicine more broadly—not just supplementing existing provision, but looking at creating new and different ways of getting people into medicine in the way the University of Sunderland is seeking to do? Those are critical questions and they deserve concrete answers. I am sure the Minister will not disappoint.

On that note, I will draw my remarks to a close. I am sure that all hon. Members in the Chamber will agree that the challenges for general practice are significant and require a range of approaches, none of which will be quick fixes. To meet those challenges, the Government need to take a long, hard look at the things that they can do in the short, medium and long term to help to reverse the growing crisis in GP recruitment and retention. We cannot do otherwise, because this is simply too important to our constituents and to the future sustainability of our precious NHS.