GP Services

Grahame Morris Excerpts

Thursday 5th February 2015 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing the debate, and all those right hon. and hon. Members who supported the bid to the Backbench Business Committee, and the Committee itself, on accommodating the debate.

It has been said before that when someone is the last person to speak in a long debate they find that perhaps everything has been said—but not everything has been said today. I will try not to repeat the arguments that have been rehearsed, but I wish to air two specific points that have not been covered. One is about the importance of GP work force planning, and the other is about the north-south divide and the need to refine our recruitment to address inequalities in areas of particular need.

We must accept, although Government Members are reluctant to do so, that we have a crisis on the front line—primary care and GP services are the first line of our NHS. I do not want to apportion blame—I can see the Minister staring at the heavens thinking, “Here we go again”—because I will let others do that. However, I wish to identify some problems and propose some practical solutions to address this crisis, because we face an unprecedented health challenge and it certainly has a bearing on what is happening elsewhere in the health service, particularly in accident and emergency.

We are all aware now, because it has been repeated many times, that we have an ageing population; people are living longer, and they are living with multiple and much more complex long-term conditions. Numbers have been given on the rapid increase even between 2008 and 2018, when we estimate that the number of people living with multiple long-term conditions will rise from 1.9 million to 2.9 million. Dramatic projections are made about the numbers of people who will have dementia, who will be living with cancer—surviving it and living beyond that—who will have diabetes, and who will have heart disease. Despite the increase in the age of the population and rising demand, GP numbers have not kept pace with population growth and with this increase in demand.

As today’s motion states, local GP services play a “vital role” in our communities, with 1 million patients every day receiving care from their family doctor or a nurse based in a GP practice. Many Members have mentioned being contacted by the Royal College of General Practitioners about its Put Patients First campaign, which highlights some alarming statistics: as many as 90% of doctors are saying that general practice does not have sufficient resources to cope; and spending on GP services as a share of the NHS budget has been falling and, at 8.3%, is at an all-time low. Surveys carried out by the BMA have been showing that six out of 10 GPs were considering taking early retirement because of the stress of an increasing work load, with a third of them actively planning for their retirement.

The problem we face relates not only to early retirement, but to retention and recruitment. A large number of GP trainee vacancies are unfilled and there is a stark north-south divide; almost all trainee posts were filled in the south, but in my region of the north-east—an area with the highest levels of deprivation and health inequality, where there is already an acute shortage of GPs—30% of training places were unfilled. That was confirmed by the deputy chair of the BMA, Richard Vautrey, who said:

“These figures are deeply concerning and represent a serious threat to the delivery of effective GP services to patients.

They show that we are experiencing serious shortfalls in the number of doctors choosing to train to become GPs, which will ultimately mean fewer GPs entering the workforce across large parts of the UK, most worryingly in already under-doctored areas such as the North”—

including the north-east—

“and the Midlands.”

We need to address the imbalance in posts between the north and the south, because if we do not, as my hon. Friend the Member for Copeland (Mr Reed) indicated from the Front Bench, we will see a division in the standard of care. There is always a risk of this in different parts of the country.

I also recommend the “Securing the Future GP Workforce: Delivering the Mandate on GP Expansion” report by Health Education England. It states:

“There is a variation in availability of GPs of more than 40% between the most under doctored areas”—

which include the area I represent—

“and the areas with most GPs. Our most under doctored areas tend to be those with most deprivation, and therefore with the highest incidence of health inequalities.”

The Centre for Workforce Intelligence analysis shows that GP coverage is especially critical in the north-west and north-east.

I welcome my party’s announcement in this area and the important commitments that have been made to improve the NHS and, in particular, access to GPs. Our £2.5 billion “time to care” fund will help to integrate health and social care services, with more health services delivered in our communities. Inevitably, that will create additional pressures on primary care, and I fully support the aim of setting aside funding to employ 8,000 more GPs. I wish, however, to raise a question with my Front Benchers as well as the Government’s. Increasing the number of GPs alone will not address health inequalities, nor will it improve the health care services of my constituents if those resources are not properly targeted to the areas of greatest need, so I want to see real and practical solutions to the crisis.

First, I would like the Government to take a long-term approach, targeting and offering careers advice to children in secondary schools, sixth forms and colleges in areas where there are GP shortages, raising aspirations and promoting medicine as a viable career choice. If we increased the number of people from the north-east going into medicine, we would increase the pool of medical students willing to work in our communities, particularly if they have an affinity with and personal connection to the health and well-being of the community where they would be in general practice. The problem is that many newly qualified medical students are going back to their home areas in the home counties in the south and south-east.

Secondly, what steps are the Government taking to improve the number of GPs in under-doctored areas? Will they encourage postgraduate training in areas where there is the greatest work force need? One practical suggestion is to pay the student loans of medical students who are willing to work in under-doctored areas. In exchange, medical students would be expected to train and spend a specified number of years in employment in an under-served area. A survey by the BMA showed that up to 80% of medical students reacted positively to that option.

I am delighted to support today’s motion. I am interested to hear the responses from the Front-Bench teams on how we intend not only to increase GP numbers but to target and direct GP services to the areas of the greatest need. Without that distinction GP services will never be sustainable in the areas of highest deprivation, and the very communities that need access to greater GP services, such as east Durham, will not have it.

--- Later in debate ---

[Dr Poulter]

Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.

General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.

On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.

Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.

[Grahame M. Morris]

Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?

[Dr Poulter]

The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.

One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.