General Practitioners: Appointments

Earl Attlee Excerpts

Thursday 17th March 2016 Grand Committee

Asked by

[Earl Attlee]

To ask Her Majesty’s Government what assessment they have made of how quickly an economically active patient should be able to secure an appointment with their GP and how that compares with other professions.

[Earl Attlee (Con)]

My Lords, the Committee will recall the fabulous opening ceremony for the 2012 Olympics held in London and its NHS component. Interestingly, some young indigenous Brits take for granted our fabulous health service, free at the point of delivery. They do not really appreciate how clever we have been as a nation, but hard-working immigrants from other countries certainly do. We have much to be proud of and I salute the efforts of all those involved. Our European partners have a variety of health systems that appear to work for them. However, you have only to look at the political challenges with the health system in the United States to see the problems that we have avoided and to understand that their healthcare costs are considerably higher than ours. There is no doubt that the NHS is very good if you are seriously ill, which is one reason why I am not the slightest bit interested in private healthcare. However, we would be deluding ourselves if we denied that we have some serious difficulties with the NHS; the most obvious are A&E and ambulance services, but I want to concentrate on GP services, although they are related.

I recently had to move house from one parish to an adjacent parish, but which was in a different GP catchment area. My original surgery was co-located with a rather good convenience store and the nearest ATM to my house. The surgery met all my requirements, I never had any difficulty in securing an appointment when I needed one, and the practice premises were purpose-built and relatively new. My new surgery’s building is old and small and there was local evidence that appointments could be a problem, probably due to increasing demand from a growing and also ageing population. Your Lordships will not be surprised to hear that I did not want to register at that new, nearest surgery but I was told that I had to. I am sorry to say that my worst fears were realised. The administration of the surgery was relatively poor from the start. Clearly not all practices operate to the same standard—though I hope that my noble friend Lord Bridgeman will describe to the Committee how a good practice works.

Worse still, several weeks ago now, I developed some slightly worrying symptoms. However, my judgment was—correctly—that I was not an urgent case and I was not prepared to claim otherwise. Unfortunately I could not secure an appointment at all. Given that men are notoriously bad at presenting with unpleasant symptoms, how can it possibly be right to deny a patient an appointment with the doctor? The fact is that people who are fit, well and working ask to see the doctor only when absolutely necessary. All they need is a bit of maintenance from time to time to keep being productive and generating the money needed to fund the NHS.

Before suggesting to the Committee what is going on, I want to make it clear that I fully appreciate that GPs have to deal with a wide range of patients, many of whom have serious conditions or are even terminally ill. I feel that practices fall into the trap of believing that they are providing a service to a certain standard and that patients should be grateful for what they get. Surgeries do not regard themselves as being competitive, which means that there is no mechanism for them to individually determine the appropriate level of service, although no doubt they try hard. It also means that they cannot determine what services to offer or how to provide them.

Take the appointments issue. Suppose I rang my solicitor’s office and said that I had had a fairly worrying meeting with another businessman who claimed that I was infringing his patent. I do not think that the solicitor’s office would say, “Well, we have no appointments available for the next two weeks. Try again next Monday, but make sure you ring early because the available slots go quickly”. I suggest that any professional services outfit with that sort of ethos would not stay in business very long. I have to tell the Committee that that is exactly what I experienced with my new GP surgery and I doubt that this is unusual. This is why my Question compares GPs to other professions.

Or take blood tests. GPs no longer seem to take blood samples. A separate appointment has to be made, either with the practice nurse or with a local hospital. This is fine if one is retired, but if one is working it is another appointment to be made which conflicts with economic activity. It also tends to lower productivity, which we know is a general UK problem. I have not been to an A&E department for many years, but it seems to me that the majority of walk-in patients could equally well be dealt with by a GP surgery, and far more quickly than the four-hour target, which is itself an admission of total failure. At present, GP surgeries do not market themselves for that business because they do not need to.

Surely, a practice in a competitive environment would say, “Why wait at least four hours in an A&E department for a minor injury when, if you were registered with us, you could be on your way within an hour?”. I am not suggesting for a moment having mini-A&E centres. Serious injuries and life-threatening conditions are clearly a matter for a large A&E department with the appropriate range of facilities.

Since the time when I was forced to change my GP the rules have changed, I am pleased to say, and with certain, sensible caveats one can register with whichever surgery one wants. I am pleased about this but there is still no evidence of any commercial competitive pressures between GP surgeries. I hope the Minister can tell the Committee what, if anything, he is doing to introduce competition between GP surgeries. Does he see this as being important, so that economic output is not lost due to a GP service that does not suit busy working people, especially if they work a long way from home? Does he agree that GPs should be doing more to relieve the unnecessary load on A&E departments?