Access to GP Services and NHS Dentistry

Emma Hardy Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.

[Sajid Javid]

The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.

--- Later in debate ---

[David Johnston (Wantage) (Con)]

All the GP surgeries in my constituency have worked incredibly hard throughout this period. I saw some of that up close when I was volunteering with the vaccination effort in the weeks that I could. The entire period has been a complete whirlwind for them, and they went straight back into there being a huge demand for appointments. I commend them for what they did during covid and what they are doing now.

The job of an MP is to not just champion but challenge. As every other Member of the House has, I have heard complaints about the difficulty of getting GP appointments, which I need to raise with surgeries. Those complaints are about getting an appointment at all, getting a face-to-face appointment, getting through on the phone, or—more for dentists than GPs—being able to register.

We know that the covid pandemic is a huge part of that problem, because we asked the public to stay at home and protect the NHS, which they did almost to a fault. I remember Ministers at the Dispatch Box, as the pandemic went on, pleading with people to come forward if they thought they had something. Understandably, however, people did not want to burden their GP or hospital. They are now rightly coming forward, and they may have had hospital treatments delayed again because of the backlog, so they are going to their doctor instead.

Sometimes, my constituents are unhappy about not getting face-to-face appointments; they dislike eConsult and telephone appointments. I have used eConsult successfully, and I think it and telephone consultations have a place, but as a GP at one of my surgeries said, the risk with both of those is that GPs do not see the thing that the patient has not come in about. A patient may come in about their leg, and while they are there, the GP says, “Can I just have a look at the thing on your neck?”.

[Emma Hardy]

I completely agree with the hon. Gentleman’s point about GPs not being able to identify the issues that people have not come in for. Another thing that doctors can notice at face-to-face appointments is that someone is a victim of domestic abuse or violence.

[David Johnston]

I completely agree; the hon. Lady has made an important point. Sometimes, what people present with is not the biggest issue in their lives, and a skilled practitioner can uncover that.

As has been touched on, the issue is partly about telephone systems, bizarrely, as I will come on to, but it is also undoubtedly about a shortage of GPs. The Government have a grip on that: we have 1,500 more GPs now than in March 2019; 4,000 more trainees have taken up training places this year compared with 2014; and we have a health and social care levy which, as has been touched on, the Labour party opposes but which provides £12 billion a year to the health and care system, so there is more money to improve telephone systems and face-to-face appointments. Looking at the data this morning, we had 2 million more face-to-face appointments in April this year than in April last year, but we are still below pre-pandemic levels.

The complaints I get about dentistry are more about not being able to register anywhere. There is a particular issue with the promise that we make to pregnant women about being able to see a dentist, because even they cannot get registered. I met the Minister about that recently. The issue there is less about a shortage, as it is with GPs, and partly about the contract; there seems to be cross-party agreement that the 2006 Labour contract needs to be changed. I am also pleased that the Government will allow more internationally qualified dentists to support the dental system here.

There are two things that we need to get better at. One of them was touched on by my hon. Friend the Member for North East Bedfordshire (Richard Fuller). My constituency has also seen a huge growth in housing—we have two housing developments in Didcot alone, which will house 18,000 people—and the promised GP surgeries for these increased populations never arrive. As my hon. Friend said, we must get better at putting in the infrastructure first and at planning for the increased populations.

I shall finish on the second thing. Some Members may know that I worked in social mobility before I became an MP, running charities for disadvantaged young people. Unfortunately, the medical profession is the most socially exclusive profession in the country. Only 6% of doctors are from a working class background. A person is 24 times more likely to become a doctor if they have a parent who is a doctor. That is worse than politics, worse than the media, worse than the law, and worse than any other profession that we can think of. There are many reasons for that. It is about the allocation of work experience, how the recruitment process works, and the fact that 80% of applications to medical school come from 20% of schools. There is a whole range of things.

The young people with whom I worked were eligible for free school meals. A very high proportion were from ethnic minorities. Medicine was the profession that they most wanted to get into. It was the most popular profession. On the one hand, we have a shortage of GPs, and, on the other, we have this incredible talent pool that finds that it cannot get into the profession.

One thing the Government might consider, as well as how we get the infrastructure in first, is how we make what is a hugely popular profession more accessible for certain groups of young people with whom I used to work, because, at the moment, they simply do not get into it in the numbers that they should, and, if they did, they might help with this GP shortage.

--- Later in debate ---

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Before I turn to the main substance of my speech, I want to take advantage of the presence of the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is sitting there waiting to sum up the debate, by raising a few points further to my earlier intervention on the Secretary of State. They concern the Medicines and Healthcare products Regulatory Agency and the mandatory logging of mesh complications, which was a recommendation in the Cumberlege review. It has been more than a year since the most recent review, so I think that the Secretary of State may have been a little confused when, in his response, he referred to what was happening a year later. We have just learnt that the MHRA will continue the yellow card system, and will not be introducing mandatory reporting. I am keen to hear the Minister’s response to that point.

As joint chair of the all-party parliamentary group on endometriosis, I am also keen to hear from the Minister when we will see the women’s health strategy. Although that is not specific to the debate, it does relate to GP services. I should also like to hear her response to the anecdotal news I have been hearing that more appointments for gynaecological procedures are being cancelled than appointments for any other operations, and that gynaecological elective procedures are the least likely to take place. Again, it seems that there is a real issue surrounding women’s health.

I hope that the Minister will be able to address those issues of the women’s health strategy, endometriosis and mandatory reporting, but I will now turn to the main substance of my speech on access to GP services. Hull has only 40 GPs per 100,000 patients, which is one of the lowest proportions in the area. I want to draw attention to what two of my constituents have said. One, a gentleman called Rob Grimmer, told me about the birth of his granddaughter Nova. That was wonderful news, but unfortunately the family were unable to contact a GP surgery or get through to 111 when they needed to, and eventually they had to take the baby to A&E for treatment. The good news is that the baby is fine, but I am sure that Members can imagine the trauma involved. I have been a new mum myself, and I know that going to A&E with a new baby must be terrifying and very upsetting. I should like to hear from the Minister why we are seeing so many mums and babies having to go to A&E to obtain support.

Another constituent, a gentleman called Steven Draper, said that he waited three weeks for his grandson to see a GP. His grandson is only eight years old. What I really want the Government to take on board in this debate is the impact on children, and particularly on children’s education. If a child is repeatedly not feeling well and is unable to gain access to the services that they need, they will miss more school. The Department for Education says that attendance is very important and that it wants children to be back at school—Ofsted and a member of the Social Mobility Commission have also stressed the importance of attendance—but that does not seem to be joined up with children’s problems in accessing dental treatment and GP appointments, which lead to their having time off school.

I remember that when I was a primary school teacher there was a “brush bus”—I am not sure whether anyone else encountered one of these—which visited the school so that children could learn about the importance of brushing their teeth. There were even giant teeth in the classroom, which the children loved, so that they could see which bits get missed out during brushing. The problem is not just cuts in dental services, but cuts in public health provision, prevention measures and education. Long before the pandemic, we saw public health information services go.

Having teeth removed when a child is very small has an impact on that child’s education, not just in terms of time off but in terms of speech and language, and it will therefore affect phonics. It has a knock-on effect. I must emphasise to the Minister that we need to get this right. We are failing children when it comes to dental treatment. Indeed, we are failing people from cradle to grave, because we are also failing those at the other end of the spectrum.

This is another issue of which the Government should have been fully aware. They should have understood that people were ageing before the pandemic and that older people’s requirements are different. A few decades ago, most people in care homes had false teeth, which actually made them easier to look after, especially if they were dementia patients. I raised in Parliament, three or four years ago, the specific issue of dental care for people in care homes, particularly those suffering from dementia, who can find the whole procedure very traumatic while not understanding what is happening to them. This problem has existed for a long time, since way before the pandemic. There should have been plans that recognised that people were ageing, and ageing with their teeth, and would therefore continue to require dental treatment.

We are reaping what the Government have sown in the net spending cut of 25% between 2010 and 2025. We are reaping what they sowed in the five years before the pandemic, when the number of practices providing NHS dentistry fell by more than 1,200. I have huge sympathy for dentists and GPs in my constituency, and I want to add my thanks for everything that they do.

I was contacted by a local dentist about how she had been feeling. It was quite an upsetting letter. She had been pregnant and on maternity leave for part of the pandemic, but while she was pregnant she was trying to do her job in the middle of it. She was obviously worrying about her own baby, and she told me that she was having to give up being an NHS dentist because it was just not working out.

In her letter to me, she says:

“The Government have only offered £50 million in time limited funding which amounts to £40 a week per dentist. After a decade of savage cuts, it is no more than a sticking plaster of no consequence to the wider issues. I am likely going to go private this year despite enjoying helping high-need patients due to the Government’s poor contract and lack of funding.”

With respect, it is a bit odd for the Minister to blame the Labour party for not changing the dental contract when the Conservatives have had 12 years to look into it. I hope the Minister will urgently address the issue before more dentists step away from practice. That dentist had 3,200 patients in her practice, which means 3,200 more people now looking for support and help.

Unlike my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), I have not had a gentleman present me with his teeth, but I have had some really upsetting cases. A lady, who was pregnant and unable to access any other free NHS dental entitlement, said to me:

“Being entitled to free NHS dental care when you’re pregnant clearly isn’t an option any more. I think the situation needs to be addressed as I am sure it is not just in my area in Hull.”

She is absolutely right. Why is it that pregnant women are given free dental treatment? It is because pregnancy is likely to have an impact on teeth, so the lack of access to free treatment is storing up problems in the long run. I have had countless emails from people telling me they have been struck off their dentist’s list due to not attending during a period of illness. Someone else told me that despite the swelling in her mouth causing immense pain, she had been dismissed as a patient and told that there was a six-to-12-month waiting list even if she was accepted again. Another who needs dental treatment and whose dentist had passed away told me:

“I complained to the ombudsman service. The ombudsman has today telephoned with the news that they are so overwhelmed with complaints that they are only allocating caseworkers to cases where death or serious injury has occurred. Even the ombudsman service cannot cope with the incompetence and failure that we have in the NHS dental service.”

Another gentleman wrote to me about how he broke his tooth in July 2021 and was still waiting in pain to have it removed in February 2022. The list of people who have contacted me to say they cannot find a dentist goes on and on. We are storing up more problems for the future. Someone else contacted me to say that their one-year old son—aged one, children are meant to have a dental check whether they have teeth or not—is unable to get a dental appointment. If we do not treat people when they are younger, we will create more problems in the future. Mismanagement of our NHS and our public finances, because of a lack of preparation and things not being thought through, means that everything costs more in the long run,

Our dental services are in crisis. We are facing a collapse that will take years to put right. Waiting lists, delays, cancellations and shortages are the real growth areas in Conservative backlog Britain. My constituents, along with those in the rest of the country, have had enough.