Access to Primary Healthcare

Helen Morgan Excerpts

Wednesday 16th October 2024 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House regrets that the NHS has been plunged into crisis by years of neglect by the previous Government, leaving far too many people waiting weeks to see a GP or unable to find an NHS dentist, and children and adults waiting months or even years to receive the mental health care they need; believes that everyone should be able to access high-quality primary care services when they need them and where they need them; condemns the previous Government for presiding over a fall in the number of full-time equivalent fully qualified GPs and NHS dentists in the last Parliament; further regrets that the Government has not yet set out a plan to invest in primary care at the level needed to meet demand; calls on the Government to boost access to GPs, NHS dentists and community pharmacists; and further calls on the Government to give everyone the right to see a GP within seven days or within 24 hours if they urgently need to and to guarantee access to an NHS dentist for everyone needing urgent and emergency care.

It is a real honour to open this debate on the Liberal Democrats’ first Opposition day for 15 years. Primary care is the front door to the health service, but for too many people at the moment, that door is closed. Whether they are waking up and dealing with the 8 am calling frenzy to get a GP appointment, frantically ringing every dental practice in their area for an NHS dentist, or turning up at their local pharmacy to pick up a prescription for their loved one or themselves and finding it unexpectedly closed or the medicine out of stock, primary care is in terrible trouble and it needs fixing urgently. That is not only to make lives better for the people who are suffering because they cannot access the primary care they need, but to allow the NHS to function more efficiently. Accident and emergency is not a decent substitute door to the NHS.

I am an asthmatic and as a young person I had quite serious asthma. I can remember when primary care was absolutely there for me in the middle of the night. On lots of occasions when I needed help, my dad did not have to take me to the hospital in an ambulance. Somebody came to me with a nebuliser and got me sorted out within a couple of hours, and then we all went back to bed. Now, that is not an option for a lot of people. The NHS is in a crisis, and that is causing pain and suffering unnecessarily.

The crisis is also costing far more than we can afford. It is costly because early intervention and dealing with people in their community or at their home is so much more efficient than taking somebody to hospital, even if that is in a private car. And it is costly because it causes people genuine pain: the BBC reported that in Oswestry in my constituency this year, a man removed his molar with a pair of pliers because he could not find an NHS dentist. But it is also costly because people are unable to access work, and that is costing the economy. Polling commissioned by the Liberal Democrats showed that one in four people had been unable to go to work while waiting for a primary care appointment. That is not good for an economy that urgently needs to grow. We need urgent investment in primary care—in doctors, dentists and community pharmacists—to save people from having to go to hospital.

[Adrian Ramsay (Waveney Valley) (Green)]

On pharmacies, a new report from Healthwatch England reveals a worrying picture of pharmacy closures and reduced hours hitting older people and rural communities the hardest. NHS Norfolk and Waveney integrated care board, which covers much of my constituency, has reported the highest number of hours lost per pharmacy. Does the hon. Lady agree that we urgently need a national evaluation of pharmacy funding, including the size, role mix and distribution of the pharmacy workforce?

[Helen Morgan]

That is an important point. In my constituency, carers who go to pick up prescription medicines are finding that the pharmacists are not there because they are relying on locums. The pharmacy funding problem needs to be addressed as a matter of urgency, and I will say more about that later.

Growing the economy is so important that we need to get people off the waiting and referral lists and back into work. Liberal Democrats believe that people should be in control of their own lives, not “chained up” at home, unable to get out of bed, because they have no access to healthcare. They should be able to get the help that they need, when they need it, in their own homes and communities.

Let us start with GPs. The Liberal Democrat manifesto—it was well received, which is why there are so many Members sitting behind me on these Benches—called for the right to see a GP within seven days or 24 hours if the situation is urgent, and for those aged over 70 or with a chronic health condition to have access to a named GP. Those rights are extremely important. People who go to the same GP for more than 15 years have a 25% lower chance of dying than those who have seen a new GP in the last year. Primary care networks tell me that their inability to deliver continuity of care because of the shortage of GPs is one of the problems that worry them most.

[Tim Farron (Westmorland and Lonsdale) (LD)]

My hon. Friend is making a brilliant introductory speech. Is she aware that perhaps only a third of those leaving medical school and seeking to go into general practice are able to find jobs, partly because the additional roles reimbursement scheme—which does exist—cannot be extended to enable some of those would-be GPs to be recruited? Is it not mad that although we are creating enough potential GPs through medical school, we cannot give them jobs because of the funding mechanisms that this Government inherited from the last one? We are losing them from general practice, and, in some instances, losing them from the country altogether.

[Helen Morgan]

My hon. Friend is entirely right. I believe that the Government are taking steps to address that, but he has made an important point about the need for flexible GP funding. A general practice may have money to spend on professionals and need more fully qualified doctors to deal with its patient list, but can only spend that money on another pharmacist or another nurse. That is a ridiculous situation, and I am pleased that the Government are dealing with it.

[Shockat Adam (Leicester South) (Ind)]

Will the hon. Lady give way?

[Helen Morgan]

No, I will make some progress.

People do much better if they have access to continuity of care, but 8,000 more GPs are needed to deliver the rights that we laid out in our manifesto. We do not shy away from the fact that that is an ambitious objective, and we accept that it cannot be achieved through training and recruitment alone: we need to retain and incentivise our existing workforce. As I said earlier, seeing people in their communities avoids hospital admissions and saves money. Unfortunately, although the Conservatives promised us 6,000 more GPs in 2019, we ended up with 500 fewer. That is why people are so frustrated. According to the findings of research carried out by the House of Commons Library, GP funding has fallen by £350 million in real terms since 2019. As a result, not only are people struggling to gain access to basic care in their communities, but there is a postcode lottery when it comes to availability of that care.

In the area where I live, which is covered by NHS Shropshire, Telford and Wrekin, the number of fully qualified GPs fell from 280 in 2016 to 242 in 2023, despite an increased and increasingly ageing population with a much higher level of demand, while 43% of patients are waiting more than 28 days for non-urgent appointments. The Darzi report showed that the number of people waiting for long periods for appointments is rising throughout the country: it is a national issue. We know that from our own doorstep conversations.

Members might ask me, “Where are you going to get 8,000 more GPs from? That is a big number.” Apart from training new ones, we should value greatly our experienced ones. A recruitment and training programme is one idea, and, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) pointed out, using the dentists we have trained properly is extremely important, but we also need to focus on retention and incentivising our existing GPs, to ensure that we hold on to valuable experience and valuable patient continuity.

Let me move on from GPs to local pharmacies. Pharmacy First was a great idea of the previous Government —I am willing to give them credit—but pharmacists are under huge strain. According to the Darzi report, some 1,200 have closed since 2017, and spending under the community contract has fallen. Tomorrow I am going to visit Green End pharmacy in Whitchurch, in my constituency, which wrote to me:

“As an independent pharmacy, we’re unable to keep on absorbing costs with losses on dispensing.”

The pharmacy is struggling because it is making losses on the drugs that it gives out on prescription. Given that it is a small, independent pharmacy, it does not have a massive shop from which to make profits to subside that work.

In 2023, Community Pharmacy England warned of

“systemic pharmacy funding cuts of at least 25% in real terms since 2015.”

That has led to a postcode lottery of access, and to many pharmacies being unable to have a full-time pharmacist and relying on locums, which has led to a really poor and insecure level of service. That is impacting on people who just need to go and pick up their prescription and get on with their day.

[Wendy Chamberlain (North East Fife) (LD)]

The NHS is devolved in Scotland, but the UK Government have responsibility for continuity of supply of medications. I have constituents with attention deficit hyperactivity disorder who have been waiting for up to a year to secure that continuity of supply. Does my hon. Friend agree that we need to see more action from the Government, who should be proactive in that regard?

[Helen Morgan]

That is a really important point. A lot of people in my constituency have contacted me for help with drugs—for example, to deal with ADHD. People need to be able to access important medication readily.

We must not forget the dentistry element of primary care. A generation of children are at risk of poor oral health because of the mess in which dentistry has been left by the previous Government. Tooth decay is the biggest cause of children being admitted to hospital, with over 100,000 admitted since 2018. That is totally unacceptable. Some 4.4. million children have not been seen by an NHS dentist in the last year, according to the House of Commons Library.

Dentistry is really important for children—they have to keep their teeth for the rest of their lives—but this issue affects adults too. My constituent Ron Kelly, who is 62, is disabled and lives in Market Drayton. Members who have been around a while might know that it is not easy to catch a bus to anywhere from Market Drayton. He has not been able to find a dentist since 2019, and my caseworkers have rung every NHS dentist in our constituency. None of them is taking on new patients, so even if he was able to use the bus, he would not be able to find an NHS dentist in North Shropshire at the moment.

Office for National Statistics data released last week shows that, in the midlands, 99% of people who do not have an NHS dentist, and who are trying to find an appointment, cannot access one—99%! It is just unbelievable in a modern country in the 21st century.

[Lisa Smart (Hazel Grove) (LD)]

My hon. Friend mentions the challenges that many of our constituents face when trying to get access to NHS dentistry. I am thinking about some of my own constituents who have talked to me and, indeed, shown me their home dentistry results. [Hon. Members: “Urgh!”] Yes. Does my hon. Friend agree that we should learn from good practice that is taking place across the country? My Hazel Grove constituents were struggling to find dentists, but because of some reallocation of existing funding in Greater Manchester, new appointments have been made available. Does she agree that we should look at good practice to learn what can be delivered elsewhere across the country?

[Helen Morgan]

Flexibility of contracting is critical, and learning from best practice elsewhere in the country will help to address the problem.

I want to highlight how silly it is that people cannot find an NHS dentist when they need one, because NHS dental funding is actually going unspent. In Shropshire, Telford and Wrekin, the area I know about, £1 million was clawed back in 2022-23 because dentists were unable to spend the money allocated to them; they do not have enough staff to work the contracts with them. I met someone last year who had not had a day off work—we were in October by that point—and he had to hand back his contract. The Government have proposed golden handshakes, but I have heard on the ground that they do not work, certainly in Shropshire. We need a reformed contract, flexible commissioning, a proper statutory requirement for workforce planning, and the ability for dentists to use their funding to manage their own practices in a way that allows them to make a bit of money out of treating patients on the NHS.

I also want to highlight the public health grant cuts by the Conservatives and how important it is to reverse them is. It is a complete false economy to cut programmes that help with oral health and prevent poor teeth and future dental problems, when we could spend the money up front so that it would cost far less in the future.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Will the hon. Lady give way?

[Helen Morgan]

I will make some progress now, if that is okay, because I am conscious that lots of people want to get in and make full speeches.

We have called for a guarantee for urgent and emergency dental care. Check-ups for those people who are already eligible and those needing check-ups before things such as chemotherapy and surgery were also in our manifesto. It is only going to be possible to offer those guarantees if we deal with the issues in the dental contract and the flexibility of commissioning.

Primary care is the front door to the NHS, as I mentioned at the beginning, and Lord Darzi pointed out in his report that that is where we should be investing. At the moment, money is flowing to secondary care—to hospitals—yet most people’s experience of the NHS is with their doctor or dentist. We must ensure that that first point of call is a good point of call, and reduce the numbers of people going to A&E. That is so much more cost-effective, but it is also so much better for those people who could manage their health condition without a crisis and without ever having to go near a hospital.

We should also think of the knock-on impacts on those hospitals. We all have horror stories of ambulances queued up outside hospitals because so many people are in A&E and so few people can flow through the hospital. The issues around that are complex, and they link in to social care as well, but the reality is that if we can treat people in the community, we will save the lives of people who need emergency care. This is absolutely fundamental: we need investment in our GPs and in dental and pharmacy contracts because we cannot afford not to do it.

[Shockat Adam]

In addition to pharmacists and dentists, I would like to mention my profession. Optometrists can really play a role in reducing the strain on primary and secondary care.

[Helen Morgan]

I thank the hon. Gentleman for his intervention. That is an important point and I apologise for not making it in my speech. Optometry is really important, and as somebody who spends their whole life looking for their other glasses, I can absolutely appreciate his point.

[The Minister for Care (Stephen Kinnock)]

Should’ve gone to Specsavers! [Laughter.]

--- Later in debate ---

[Ed Davey (Kingston and Surbiton) (LD)]

Other opticians are available.

[Helen Morgan]

Other opticians are available, but I did!

The Liberal Democrat manifesto suggested solutions to these problems, and they have been well received, as I mentioned before. We have a record number of MPs, and that is because we put this issue front and centre of our election pledge. I urge the Government to reverse the catastrophic state that the NHS has been left in by the Conservatives, to take our ideas on board and to invest in primary care as soon as possible.

[Several hon. Members rose—]