Rural Healthcare

Cherilyn Mackrory Excerpts

Wednesday 12th October 2022 Westminster Hall

[Anne Marie Morris]

More than that, we need to look at the different pathways in rural communities for heart, cancer and stroke treatment. I agree with the hon. Gentleman, but there is a lot more than just cancer, and the rural pathway to care has to be reviewed to see what is realistic in a rural area.

All of this has been made worse by a funding formula that is not fit for purpose. Although there is provision to uplift for rurality, it is not enough and it has been done without any real understanding of some of the challenges.

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

Cornwall has more visitors outside of London than anywhere else in the country, so we have our winter pressures and then there is no respite in the summer months for our staff. We have issues with housing so we cannot recruit staff. Does my hon. Friend agree that there is a case to be made for extra funding for places such as Cornwall, and perhaps the wider south-west, to ensure that we have enough funding to treat all our visitors as well as our residents?

[Anne Marie Morris]

That is an exceptionally fine point. I have no issue with it because we have a similar problem in Devon. The solution is not just about more recruitment and doing things in the same way, because the people to be recruited do not exist. We need to look at doing things differently, by creating new career paths with shorter training periods and trying to train, so we can then recruit, locally. Generally, people will follow a career where they are trained. We need more rural training for doctors and nurses, and that training needs to be not in the local city, but in the rural areas. For example, in Plymouth we have a fine medical school— Peninsula Medical School—but the challenge is that the experience that the individual trainee doctors and nurses gain is not rural, and it needs to be.

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[Anne Marie Morris]

A point very well made, which I support.

Care, as we all know, is one of the biggest challenges. If we fix care, we will fix the backlog, so we also need to look at how we train and professionalise not care on its own, but care with health. We need to give care professionals the same respect as we give others—and, frankly, for the same sort of skill, we need to pay the same salary. That is crucial if we are ever to get this to work.

D for doctors is the last letter in the Government’s alphabet. The Government are looking for the GP appointments system to improve, so that anyone who needs to see a GP can do so within two weeks. They want to provide data so that individuals may choose which doctor they go to see, and they want to increase the use of pharmacies.

Now, all that is very worthy, but unfortunately, when it hits reality, it becomes the problem. In rural areas, there are too few doctors. If we had data, choice would be great, but there is no choice, because there is not another GP practice. The problem in rural areas is not the level of data, and it is not choice—there is none. It is recruiting the doctors we need. Recruitment in rural areas is in crisis. Yes, we should make more use of pharmacists—that would be fabulous—but in many rural areas pharmacies are closing because they cannot get enough pharmacists. We have a real conundrum, and that is crucial.

If we are to address the issue, we need proper rural medical schools, shorter career courses, and proper training for new routes into medicine and care. Physician associates are a great start, but the reality is that that is only one route, and it is still quite a long training period. More broadly, primary care is mission critical; we know that training in generalist skills across the doctoring profession, if I can put it like that, is done very early but not continued. We need those skills so that we have a much broader range of doctors who, when we have something like the pandemic, are able to cope with the issue. We also need more geriatricians.

D also stands for dentists. The new contract is welcome, but it has been discussed for eight years, I think. It needs to get done. Doctors and dentists need a fair return for the work done and they need to be incentivised to provide the best treatment for the patient. As I understand it, under the existing contract, dentists are in effect encouraged to sub-optimise. They are only paid a relatively small amount, so they will do the minimum rather than what is in the patient’s best interest. We need fairness for the dentist and for the individual patient to be at the forefront of the contract.

We need to step up recruitment, we need to create rural emergency hubs, and I think we need to appoint school dentists. In the same way that a GP is in charge of a particular care home, I see no reason why we should not have a dentist who is responsible for a particular school. I am not suggesting that they should go in and do fillings, but they would at least go in and do regular checks.

[Cherilyn Mackrory]

My hon. Friend is being very generous with her time, and I appreciate that. I remember—she may too—that, as schoolchildren, we had somebody come into school to check over our teeth, just to see if there was anything going on. It is my understanding that someone does not have to be a dentist to be able to tell whether something is going wrong; dental technicians, hygienists and others can do this work. Does she agree that it would be worth doing pilots around the country, particularly in rural areas, to see whether that could cut down some serious dental issues with our children?

[Anne Marie Morris]

That is an excellent suggestion. There is quite a lot for the Minister to take away and think about.

Having gone through the alphabet, I think there are a number of things that we need the Minister and his team to do, including recognising that rural really is different and that the way we look at it now simply does not work. We need to properly understand and investigate the need in different rural communities, and then we need proper funding. We need to look at how we train locally, which will improve recruitment and retention. We need to create new, shorter courses and new professions—and we need to do that now; otherwise, we are never going to get on top of the backlog. Waiting for degree-qualified nurses and doctors will simply take too long.

We need to equalise the professionalism and pay across health and care, and we need to integrate emergency response across all resources—police, fire, ambulance and first responders. I am happy to volunteer the south-west, which I think would be up for it, as a pilot area. I hope that the Minister will go away and think about that, and that he may be willing to meet those who have raised issues today to see if we cannot find some solutions and to discuss the other issues in my rural report.