GP-Patient Ratio: Swale

Caroline Dinenage Excerpts

Tuesday 19th March 2019 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Ms Buck, and I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this incredibly important debate. He speaks very passionately about his constituency and has raised a number of pressing issues that, to a greater and a lesser extent, I have responsibility for tackling. He has described the pressure that primary care is under in Swale very well. We know that Swale is not alone; I have received representations from other hon. Members, including my hon. Friend the Member for Horsham (Jeremy Quin), who raises very similar points about these pressures.

When my hon. Friend the Member for Sittingbourne and Sheppey talks about the impact of inadequate road infrastructure and excessive housing development exacerbating the challenges with GP accessibility, he could almost be speaking about my own constituency—it is like looking in a mirror in so many ways. I completely recognise the challenges he describes, because my constituency faces almost identical issues with accessing GPs, inadequate roads, housing developments and trying to attract GPs to the area. The Government recognise that this is an issue that affects the care patients receive. We are working very hard to address it and are pushing harder than ever to grow the workforce by the extra 5,000 GPs to which we have committed.

A growing, ageing population and patients with long-term conditions are putting strain on the system. We need to look very closely at recruiting and retaining GPs, but that is not the whole story; we must also look at what GPs are telling us are the biggest issues, including workload, indemnity and risks associated with the GP partnership model. There are a number of tasks that we have to consider.

We recognise the importance of general practice, which is the absolute heart of our NHS. In 2015 we set the ambitious target to grow the workforce by 5,000; we are a long way from achieving it, but more GPs are now in training than ever before. The NHS long-term plan made a very clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion a year more in real terms by 2023-24. That was followed by the new five-year GP contract, which will see billions of pounds of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.

The new GP contract will address workload in general practice as a result of the workforce shortage that my hon. Friend the Member for Sittingbourne and Sheppey so beautifully articulated. We need a culture change in the range of health professionals who people are prepared to see when they go and visit their local health centre. NHS England has committed to expanding community-based, multi-disciplinary teams, which will provide funding for 20,000 other staff in primary care networks, such as physician associates and social prescribers.

[Gordon Henderson]

I welcome the Minister’s words and accept that the Government are doing something. I also accept that it is not just my area that has a problem. Does she recognise, though, that Kent has a particular problem? To give an example, somebody living in north Kent can travel 20 minutes up the A2 and get £6,000 or £7,000 a year extra. Although the Government are expanding the opportunities for the other professionals, we cannot even get them. It is not just doctors; it is all the professionals.

[Caroline Dinenage]

My hon. Friend makes an excellent point, and I completely understand that places in the London catchment area can very easily lose key public sector professionals. It is very difficult to compete with the potential extra wages that they might be able to achieve by working in the Greater London area. It is important to acknowledge that diversifying the range of different medical professionals who people can see will immeasurably help general practice to cater for the additional number of patients. It means bigger teams of staff providing a wider range of care options for patients, which effectively frees up more time for GPs to focus on those with more complex needs.

I was very pleased to hear that the CCG general practice in Swale is already using the skills of a wider workforce, including pharmacists working alongside GPs and paramedics providing home visits. We are training more GPs than ever before, and last year Health Education England recruited the highest number of GP trainees ever: 3,473. As my hon. Friend said, a new medical school is opening in Kent next year.

It has been made easier and quicker for qualified doctors to return to the NHS through the national GP induction and refresher scheme. Yesterday NHS England launched a new “Return to Practice” campaign, which is aimed at promoting the support that is available to GPs who have left practice, with a view to trying to tempt them and encourage them back. To bridge the gap while that training is ongoing—my hon. Friend rightly says that it takes a very long time to make a GP—NHS England’s international GP recruitment programme is bringing suitably qualified doctors from overseas to work in English general practice.

[Helen Whately]

I completely agree with what the Minister is saying about the importance of a greater range of healthcare professionals—it is not always about seeing a GP, so there needs to be a shift in expectations—and the plans to increase the number of GPs in the system, including through the Kent medical school, for which I campaigned very hard. I urge the Minister to come, if she can, to my point about an access metric. It would be really helpful to have a better way for patients to know what level of access they should expect. At the moment, we seem to have the proxy of a GP-to-patients ratio, but it is not good enough. It would be helpful if she could address that.

[Caroline Dinenage]

It is quite tricky. As my hon. Friend knows, general practices are independent contractors. Each general practice is required to meet the reasonable needs of their registered population, so there is no exact metric or recommendation for how many patients a GP should have, as the demand that each individual places on a GP can be significantly different. There is obviously much greater pressure on a practice in an area with a much older population—with more retired people and those with more complex needs—than on practices in other areas. That is where the complicating factors arise.

It is really important to work on innovative ways not only to bring in a new raft of GPs, but to hold on to the ones that an area already has. I understand that Swale CCG is working with GP practices across the area to improve retention. Supported by funding from NHS England, it is shortly due to launch a pilot GP recruitment and retention scheme. It is being proactive in recruiting the next generation of general practice staff and has been working with local schools and colleges to encourage local students to consider healthcare, and particularly primary care. I understand that three training practices in Swale offer placements for trainee medics, to give them the opportunity to experience general practice and consider general practice training. As of December, there were 11 direct patient care apprentices working in general practice across Swale.

My hon. Friend the Member for Sittingbourne and Sheppey rightly made the point that three of the areas with the highest patient to GP ratios are in Kent. I have been advised that, alongside the CCG’s work, the Kent and Medway sustainability and transformation partnership has set up a primary care workforce group, and has secured £1.5 million from Health Education England and NHS England to implement its workforce transformation plan.

The range of other issues that deter medical graduates from general practice include the spiralling cost of purchasing professional indemnity cover, which is a major source of stress and financial burden. We have addressed that in the new GP contract and from 1 April this year, the new state-backed clinical negligence scheme for general practice will bring a permanent solution to indemnity costs and coverage. That will help drive recruitment and retention of GPs.

We recognise the huge contribution that the general practice partnership model has made to patients over the lifetime of the NHS, but we also recognise that increasingly that model faces challenges, as fewer young GPs want to become partners. An independent review, led by Dr Nigel Watson, reported in January and made seven recommendations on workforce business models and risk, to which we will respond shortly.

My hon. Friend made the point well that air pollution, road infrastructure and congestion contribute massively to the pressure on general practice. The Government recognise that air pollution poses one of the biggest environmental threats, particularly in the case of frail elderly people and young children. Removing congestion from roads is certainly one of the sure-fire ways to reduce some of the air pollution hotspots. My Department will always be happy to furnish him with data that he needs on the health impact of pollution, to support any of his activities for attracting the local road investment that will tackle the problem and help his constituents.

My hon. Friend also raised a concern that housing targets placed on Swale Borough Council by the Government put additional pressure on doctor’s surgeries. The national planning policy framework, which was published last year, makes it very clear that strategic policies must make sufficient provision for community facilities, such as health education and cultural infrastructure. As he says, it is not enough to build a building; we need staff inside it. The views of local clinical commissioning groups and NHS England must be sought with respect to the impact of any new development on health infrastructure and demand for healthcare services.

Examples of primary care being delivered in an innovative way can be found across the country, for example using other professionals to deliver care or GP practices grouping together to work more collaboratively. That is exactly the kind of innovation and co-operation envisaged in the long-term plan, which seeks to change the balance in how the NHS works by shifting more activity into primary and community care. That is enabled by expanding multidisciplinary team working. The NHS long-term plan also commits to the recruitment of 1,000 social prescribing link workers by 2020-21. I encourage my hon. Friend to have a conversation with Swale CCG to see if any of those innovative measures could be introduced to help his constituents.

[Gordon Henderson]

I assure the Minister that I meet my local CCG regularly—I have done since it was set up and will continue to do so.

[Caroline Dinenage]

That was never in any doubt as far as I am concerned, but sometimes CCGs may not have thought of some of the more innovative ideas that are used in other parts of the country. I am sure that my hon. Friend, in his highly esteemed role in the local community, is best placed to raise that issue with the CCG.

The Government are well aware that recruitment and retention of GPs is a huge issue. We know that there are problems and we are doing everything that we can to tackle them. We will keep my hon. Friend updated and I thank him for his contribution to the debate and for raising this very important matter.

Question put and agreed to.