GP Services

Derek Twigg Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg (Halton) (Lab)]

I beg to move,

That this House notes the vital role played by local GP services in communities throughout the UK, with an estimated one million patients receiving care from a family doctor or nurse every day; believes that the UK’s tradition of excellent general practice provision is a central factor in the NHS being consistently ranked as one of the world’s best health services by the independent Commonwealth Fund; expresses concern, therefore, that the Royal College of General Practitioners (RCGP), through its Put patients first: Back general practice campaign, is warning that these services are under severe strain, with increasing concerns raised by constituents about access to their GP and 91 per cent of GPs saying general practice does not have sufficient resources to deliver high quality patient care; further notes that the share of NHS funding spent on general practice has fallen to an all-time low of 8.3 per cent, and that over 300,000 people across the UK have signed the campaign petition calling for this trend to be reversed; welcomes the emphasis placed in NHS England’s Five Year Forward View on strengthening general practice and giving GPs a central role in developing new models of care integrated around patients; and calls on the Secretary of State for Health to work with NHS England and the RCGP to secure the financial future of local GP services as a matter of urgency.

I am grateful to the Backbench Business Committee for providing the House with the opportunity to debate the important subject of sustainable GP services. I am also grateful for colleagues’ support for the debate application. Some of those Members are here, including the hon. Member for Brighton, Pavilion (Caroline Lucas), who spoke in the Committee in support of the application as a co-sponsor.

The debate is timely, given the increasing pressures on the NHS and its hard-working staff. I put on record my appreciation for the hard work and dedication of doctors, nurses and all the staff who work in our health service. Their dedication is keeping the health service going at a particularly difficult time. I also want to put on the record my thanks to the Royal College of General Practitioners for its support, the information it has provided and its campaign.

One of the key reasons for seeking the debate is that, increasingly, constituents have been contacting me to tell me that it is becoming more difficult to get an appointment with a GP of their choice without having to wait many days or even weeks. Sometimes they are not able to see the GP of their choice at all. That, of course, varies between practices. There is no doubt that the overwhelming majority of GPs do an excellent job. That has been demonstrated by patient surveys, but there is always room for improvement.

There is little doubt about the growing demands on general practice caused by demographic changes and more complex health needs, exacerbated by an ageing population. Increasingly, a large part of GPs’ daily work load is on mental health, which would probably merit a debate in itself. That matter needs to be addressed continuously.

[Mr Philip Hollobone (Kettering) (Con)]

I am enjoying the start of the hon. Gentleman’s speech immensely. He has raised an important issue for my constituents. Does he agree that there are also demographic pressures within the GP service in that many of them are in their 50s and about to reach retirement? All of a sudden, we will have a dearth of experienced GPs, which will be a difficult gap to fill.

[Derek Twigg]

The hon. Gentleman raises an important point and he is absolutely correct. I will refer to that later in my speech.

There can be no doubt that GP recruitment has not kept up with the demands of our population. That is the key problem today. In addition, the pressure on hospitals has increased massively because if people cannot see their GP they often go to A and E. That has been a problem in areas such as mine. There is also the inability of hospitals to discharge frail, elderly people from wards into the community because of the shortage of care in the community. Councils face massive budget cuts, so there are pressures all round. There are pressures on GPs in relation to access and there are pressures on hospitals and elsewhere.

I want to raise a particularly important point with the Minister that I have raised before. The Government are proposing to demand a 3.8% efficiency saving in the national tariff for 2015-16. That will push many hospitals to breaking point and possibly endanger patient safety. I hope that the Minister will look at that again. Members should read the briefing on that from NHS Providers.

There is clearly a view among many that general practice is heading for some sort of crisis. One GP in Halton told me recently:

“The overwhelming problem is the manpower crisis and the rock bottom morale of the Profession, which are interlinked. We are unable to recruit new GPs into practice or medical students into our specialty, training places are left unfilled and there are vacancies all over the country with very few applicants.”

It is hardly surprising we have that problem when we consider what the RCGP has said:

“Funding for general practice has fallen to an all-time low of only 8.3% of the overall NHS budget…GP surgeries are now seeing 372 million patients a day, compared to 300 million a day in 2008.”

Some family doctors are seeing 40 to 60 patients a day. That is unsustainable in the long term. Some 49% of GPs say that they can no longer guarantee safe care to their patients.

The RCGP tells me that the average coverage is 6.9 GPs per 10,000 of population. That is the lowest level of coverage since 2011. The RCGP estimates that up to 543 practices in England could face closure due to the fact that 90% of GPs working in those practices are 60 or over or are likely to retire soon. The hon. Member for Kettering (Mr Hollobone) made that point.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I certainly agree with my hon. Friend’s point, but does he also agree that the constant stop-go policies and the changes in contracts and the confusion over NHS England and clinical commissioning groups is adding to that problem? In my constituency we have the Bournbrook Varsity practice. It expanded and did everything that was asked of it by the primary care trust to create a broader health service. It now finds itself about to be penalised, have its funding cut and have to reduce staff in an area where there is a huge student population. Those students will inevitably gravitate to A and E if this service goes.

--- Later in debate ---

[Derek Twigg]

My hon. Friend raises an important point, and I know how committed he is to having a well-run health service. That is an important issue for his constituency. The structural changes that take place on a regular basis have been one of the complaints made by people who work in the health service.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

In the most stressful bits of the GP world, GPs are retiring very early, which is a great loss and is very worrying. I met two GPs recently who are retiring very early with so much still left to give. We are also finding that among A and E specialists. What a strange world it is when we cannot recruit doctors into general practice or A and E at a time when we need them so much.

[Derek Twigg]

My hon. Friend makes a powerful point and he is absolutely spot-on. That links with the comments made by other Members about GPs deciding to retire early because of the pressures and because they feel their profession is being let down and is not what it was when they began their career. Getting younger people into the profession is becoming more difficult. I will come to that.

The British Medical Association is concerned that there are inadequate numbers of GPs to meet the demand of a rising population, and in recent years annual increases in the number of GPs have been lower than the rate of population growth. That is a key part of this argument. The number of GPs we need is just not keeping up with the demands of the population.

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I congratulate the hon. Gentleman on securing this important debate. My own GPs, who do a fantastic job in Hertford, Ware and Bishops Stortford, say to me that while the pressures of the job are a critical reason why some are retiring early, one of the other problems is the change in the way people are trained, which is driving people away from general practice into other specialties. Does the hon. Gentleman agree with that analysis, and what do we need to do to change it?

[Derek Twigg]

As I will come to later in my speech, there are a number of things that the Government coming into office after the May election will have to deal with to address the sustainability of GP services. They will have to consider whether the training is correct and whether there are enough incentives for young people to go into general practice, or, indeed, other parts of the NHS. That will be an important part of any sustainable plan to make sure we have enough doctors throughout the health service, and in particular GPs. That is a point that needs addressing.

The British Medical Association is also concerned that not enough foundation doctors are choosing to pursue a career in general practice. Application rates for training programmes continue to fall year on year. According to figures from the National Recruitment Office for GP Training, the number of applications for 2014 was 5,477, which was a reduction from 6,034 in 2013. I am told that this is leaving GP vacancies unfilled in parts of the UK: in the east midlands and Merseyside just 62% and 72% respectively of vacancies are filled. To come back to the point Members have been making, 9% of the general practice work force are aged over 60 and 38% are aged 50 or over. Just 27% of the general practice work force are under 40 years of age.

One of the reasons for speaking today is to deal with the access problems. I am sure most, if not all, MPs will have had complaints about that raised with them by constituents and by GPs.

Last year, Healthwatch Halton carried out a GP access and out-of-hours provision survey, and it is important to share some of the key results with the House: 56% of people rated booking an appointment with their GP as “very difficult” or “not easy”; 33% of people rated the length of time it took to get through to their GP practice as “poor” or “very poor”; and 62% of people would like their practice to be open longer, particularly at weekends and in the evenings. That is a particularly important point when considering whether GPs are accessible and we should move to weekend working, which we have had and are debating. However, doing that requires resources. Importantly, a sizeable proportion—32%—were unhappy with the way in which their complaints were handled. That is roughly in line with national findings. On the very big plus side, the general satisfaction level of people with their GP was more than 90%, which is important.

The figures provided to me for Halton by the Royal College of General Practitioners—my constituency covers most but not all of Halton; some is covered by the hon. Member for Weaver Vale (Graham Evans)—show that we have 66 full-time equivalent GPs and that we need to increase that by 24, or 37%, by 2020. In one of the most deprived boroughs in the country we already have a shortage of GPs. My area deals with some of the most difficult health problems—high cancer rates, and high levels of chest disease and of heart disease—so being able to access a GP, and quickly, is very important. Any shortage has an impact on all that.

[Anne Marie Morris (Newton Abbot) (Con)]

The hon. Gentleman makes a good point about access and about the challenges in deprived communities. In Newton Abbot, we have faced a real challenge in trying to replace the services there. Does the research he refers to indicate any difference between rural and urban communities, and between deprived and well-heeled communities?

[Derek Twigg]

I cannot answer the hon. Lady’s question because I do not have those figures in front of me. I am sure that if she talks to the Royal College of General Practitioners or the BMA she will be able to find all those figures. I am sure she understands that I represent one of the most deprived urban constituencies in the country and so I am going to focus on that, as I am sure she would focus on her constituency.

Let me re-emphasise a point I made earlier: whoever forms the Government after 7 May, they will have to come forward with solutions to the mounting pressure on general practice and the NHS overall. There needs to be long-term, sustainable investment in GP services in order to attract, retain and expand the number of GPs. Retention is just as important as recruitment—a point made in the comments about GPs retiring early.

[Mr Simon Burns (Chelmsford) (Con)]

The hon. Gentleman raises an important issue. A significant amount of house building is going on and will be needed in the near future. Does he agree that to encourage people into general practice and to minimise the pressures, planning for any significant amounts of new housing should include health centres and facilities for GP practices, so as to make it easier for GP practices to be able to go to such places?

[Derek Twigg]

The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.

I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.

As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.

This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to

“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”

How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.

The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.

Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.

The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:

“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”

Those words are not mine but those of a GP: NHS 111 has caused some real concerns.

The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.

My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a time to care fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.

In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.

One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The hon. Gentleman is making some important points, but does he recognise the fact that it takes a number of years to train any medical specialist, including a GP? While he is talking about the previous Government’s investment in the NHS, would he like to explain why that forward work force planning was not done and how such planning may have helped with some of the issues that he is raising today?

[Derek Twigg]

The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.

[Mr Henry Bellingham (North West Norfolk) (Con)]

What is the hon. Gentleman’s view on the last Labour Government’s decision to change GPs’ contracts to relieve them of out-of-hours cover?

[Derek Twigg]

Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.

[Dr Poulter]

On long-term work force planning, the hon. Gentleman suggests that there is suddenly a crisis in GP recruitment—which I do not think is necessarily correct—but if the previous Government were serious about investing in general practice, they should have trained a lot more GPs than they did.

[Derek Twigg]

I know the Minister’s background, but he should read the figures on the number of GPs recruited by Labour when we were in power. Between 2000 and 2009, there were thousands of extra GPs, compared with the additional recruitment since this Government came to power. He should compare the two records.

I will not take any more interventions, Mr Speaker, because other Members want to speak.

Many local initiatives are trying to deal with the crisis in general practice and gaining access to GPs, or certainly to mitigate the effect. Clinical commissioning groups, such as Halton CCG, are working closely with partners to develop a strategy within the financial constraints. Halton CCG has told me:

“Delivery may be across the whole CCG on a Halton-wide footprint; by bringing more than one GP practice together to service distinct communities through a ‘hub’ based approach; by sustaining individual practices wherever appropriate and by giving local people and communities more opportunities to self-care and create resilience”.

It is working with partners to try to improve the situation, despite the financial constraints and the shortage of GPs, but we must attract more GPs.

The Royal College of GPs has told me that, in its view, it is vital that we increase the share of the NHS budget spent on general practice in England from 8.3% to 11%. That is one of the key parts of its campaign. That increase would help to reduce pressure on other parts of the NHS by supporting the delivery of more patient care in the community and keeping people out of hospital wherever possible.

The fact is that general practice cannot go on in this state. We need a sustainable, funded plan to ensure we have enough GPs to meet the population’s needs and to provide better care outside hospital. Clearly, patients should not have to wait days and sometimes weeks to see a GP or be constantly denied the opportunity to see the GP of their choice. We need to relieve the pressure on hard-pressed GPs, by ensuring that general practice is where more young doctors want a career, and in doing so we would have much better integrated care. We need better buildings to make general practice a more attractive place. We must of course constantly challenge the medical profession on how they can work better and deliver better services to patients within available resources. In the end, both politicians and clinicians must put the interests of patients first, while getting the best value for the taxpayer.

[Several hon. Members]

rose—

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[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I thank the hon. Members for Halton (Derek Twigg) and for Brighton, Pavilion (Caroline Lucas) for securing this debate today. I commend them for raising important issues about the resourcing of general practice, access to GP services and the future shape of general practice and how it will continue to deliver high-quality care to patients. In particular, I should like to praise the many GPs who work exceptionally hard every day for our NHS and deliver high-quality care to patients.

The hon. Member for Halton made some other important points about mental health training for GPs. Historically, GPs have not always received training in mental health. That must change. The Royal College of General Practitioners and the Royal College of Psychiatrists support that change, and that is why we have stipulated in Health Education England’s mandate that GPs should receive compulsory training in mental health in future. Health Education England is now working with the royal colleges to put that in place. That important step forward will benefit many patients throughout the country.

I will ask my right hon. and noble Friend Lord Howe to look into the issues raised by the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and to get back to them in due course. Although the hon. Member for Halton raised some important issues, some of which were echoed by the shadow Minister, the hon. Member for Copeland (Mr Reed), it is frankly not good enough to complain now about a GP work force crisis when they were in power for 13 years. It takes three years from the end of foundation training to train a GP, and training a part-time GP takes longer. If there is a work force crisis in general practice, it is because the previous Labour Government did not have the foresight to train enough GPs when they were in power.

[Derek Twigg]

rose—

[Dr Poulter]

I will give way in a moment.

Under this Government, 1,000 more GPs are working in the NHS or training. That is a move in the right direction. We have put in place long-term work force plans to ensure that there are 5,000 more by 2020. We have recognised the pressure that GPs are under, and we have trained and are training more. I hope that the hon. Gentleman will do better than he did in his speech and at least acknowledge the point I have made.

[Derek Twigg]

With respect to the Minister, I am not suggesting that everything that the Labour Government did was perfect or that we met every demand on us. I tried to make it clear, although he does not want to recognise this, that there were massive improvements in the number of GPs. The Library’s figures for 2003 to 2009 show an extra 5,000 GPs. Many of the GPs now coming into place were trained under the Labour Government.

--- Later in debate ---

[Derek Twigg]

I reiterate my thanks to my hon. Friend the Member for North East Derbyshire (Natascha Engel) and her colleagues on the Backbench Business Committee for finding the time for this important debate. I also thank my hon. Friend the shadow Minister and the Minister for their responses to the debate, whatever disagreements we might have.

We have had a very interesting debate. Every contribution has been important and well thought out. Many hon. Members made important points about their constituencies and the problems they face in general practice and other areas of health care. It has been a good opportunity to expose those issues. Having heard what they have said, I am in no doubt that there is a real problem with access to GPs in many areas, although in some areas access is worse than in others. There is a need to recruit more GPs and to get to better grips with the work force and how we recruit to general practice.

Without a doubt more needs to be done. We need to ensure that GP services are available to provide the best possible health care for our constituents. The pressures that GPs are currently facing and the lack of access in some areas is clearly putting that at risk. I hope that the Minister has listened carefully to the arguments made by colleagues today, because certainly more needs to be done.

Question put and agreed to.

Resolved,

That this House notes the vital role played by local GP services in communities throughout the UK, with an estimated one million patients receiving care from a family doctor or nurse every day; believes that the UK’s tradition of excellent general practice provision is a central factor in the NHS being consistently ranked as one of the world’s best health services by the independent Commonwealth Fund; expresses concern, therefore, that the Royal College of General Practitioners (RCGP), through its Put patients first: Back general practice campaign, is warning that these services are under severe strain, with increasing concerns raised by constituents about access to their GP and 91 per cent of GPs saying general practice does not have sufficient resources to deliver high quality patient care; further notes that the share of NHS funding spent on general practice has fallen to an all-time low of 8.3 per cent, and that over 300,000 people across the UK have signed the campaign petition calling for this trend to be reversed; welcomes the emphasis placed in NHS England’s Five Year Forward View on strengthening general practice and giving GPs a central role in developing new models of care integrated around patients; and calls on the Secretary of State for Health to work with NHS England and the RCGP to secure the financial future of local GP services as a matter of urgency.