GP Recruitment and Retention

Jamie Stone Excerpts

Wednesday 28th March 2018 Westminster Hall

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a pleasure to speak under your chairmanship, Mrs Moon. I compliment the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on a real tour de force around the issues before us today. Like the hon. Member for Strangford (Jim Shannon), I will dwell on an aspect of the issue that affects a constituency that is part of a devolved Administration. I hope that what I am about to say will be helpful at the UK level and possibly at the Scottish Government level.

I come from the basic premise that no matter where someone lives they have an equality of right to decent health services. I represent the second biggest constituency in the UK, and there is a particular challenge in the north of Scotland in terms of access to GPs and other medical services. In that context, within the past few days a big issue has developed—it has been fairly well reported in one of Scotland’s main newspapers. In the Caithness part of my constituency, in the top right- hand corner of Scotland, GP provision and access to other health professionals is not what it should be, notwithstanding the best efforts of the professionals that we do have. In no way do I want anything I say to denigrate their efforts because they work exceedingly hard, but the issue is a big concern for my constituents, and they raise it with me repeatedly.

Out of fairness to the Scottish National party represented here, the matter is devolved, but I hope that what I suggest will be helpful. A group called the Caithness Health Action Team has been formed and it outlines the problem on its Facebook page probably more succinctly and better than I can during the brief time available to me. I give credit to the fact that the group is campaigning in a constructive way to try to help matters.

NHS Highland has recently admitted that the recruitment and retention of GPs and similar professionals in other branches of medicine is proving a real challenge in that remote area. It really prompts the question of whether we say there is nothing we can do about it. Do we have to walk away and accept that some parts of the UK or Scotland will not have equality of provision, or do we say we will roll up our sleeves and tackle it? In my book, the answer is the latter.

Before I return to recruitment specifically, one of the most irritating things, or perhaps encouraging things, is that when we recruit a health professional in somewhere like my part of the world—although I daresay it is also true of Plymouth—after a while they begin to love it. There is every chance they might settle and their children be educated locally, and that is good for the community. That is a prize worth remembering.

I want to mention two specific points. Several Members have already mentioned a kind of bursary, a cash incentive to encourage someone to do GP training. We all know how expensive medicine is, how student debt can be built up and the length of time it takes to qualify. This is just a suggestion and it might not be possible within UK recruitment law—I am prepared to be corrected—but I am keenly aware that the armed forces can offer a bursary to go to college or university to be trained, but part of the deal is that when the person graduates the armed forces can send them to where they are needed most. I have a daughter who is serving in the armed forces and she knew right from the start that that was part of the deal. Whether that can be done within UK law, I do not know, but it might be worth looking at. A given health authority could help someone through their five years of GP training, but then have the right to say that for the next two or three years they will be placed in Plymouth, Wick or wherever in the UK. I think a cross-border UK-wide solution is best in that respect.

My second point is an old one. I remember that when I was a kid the nurse got a house. There were doctors’ houses, and that made a difference in recruiting people. As far as I am aware, the nurses’ houses have all gone and no longer exist, but it was part of the local authority’s responsibility to allocate such housing.

The answer in the Scottish context is for NHS Highland and probably the Scottish Government to take a co-ordinated and targeted approach to a specific problem in a specific part of the highlands. I think the willingness is probably there, to give credit where it is due. As and when a solution is found as to how we get people into the area, that experience could be useful to UK Government Ministers as well. There is everything to be learnt from each other. Should the Minister or the UK Government find a way to deal with these problems before the Scottish Government do—

[Ross Thomson]

As a constituency MP, the hon. Gentleman has no doubt had the same correspondence that I have had from Scottish students who have been denied access to Scottish medical school. I do not know whether he shares my concern that the current cap by the Scottish Government on Scottish domiciled student places means that only 51% of current medical places at university are filled by Scots.

[Jamie Stone]

That is a relevant point, and I share that experience. I do not want to go into the specifics, but within the past two days I have encountered the case of a sixth-year pupil at a school in my constituency who, because of the curriculum limitations in the sixth year, will be unable to pursue the tertiary education in the medical field that she would like to. It is a worry, but I shall take that up with the director of education.

The matter we are debating is a big issue in my constituency. It is particularly acute because of the distances involved, and it is at the forefront of my constituents’ concerns. I accept that it is devolved, but I feel duty-bound to air the matter in this place.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Moon.

I declare an interest, in that my other half is a GP. He is German and has been here in our service for 32 years. That highlights a particular problem that we shall face in the next few years because of Brexit. As the hon. Member for Houghton and Sunderland South (Bridget Phillipson) mentioned, GPs are not just gatekeepers, but are the core and heart of general practice, which is where most interactions occur. They specialise in teamwork and continuity. They may know their patients for years and over generations. All UK health services face three key problems. We all face tight budgets and increasing demand because of an ageing population, and the workforce is bringing those things to a head in relatively short order.

There is a drive in Scotland and England to rebalance the proportion of funding that goes towards primary care, to approximately 11% of the budget. With the climbing complexity of cancer care, emergency care, A&E and targets, more money has been moving into secondary and, indeed, tertiary care. The demand is still there. Having worked as a breast cancer surgeon for more than 30 years I can tell the House that we also face shortage and increased demand, so there is no easy solution—but if primary care fails, the entire system fails.

In Scotland the new GP contract was designed by working with the British Medical Association, and at the moment it is in phase 1, which is trying to stabilise the system. Two thirds of practices will have a significant increase in income, and the others will be protected so that no one experiences a fall. Phase 2, which will start next year, is an attempt to consider something a bit more radical. It touches on issues that have been raised by some Members, to do with changing the shape of primary care, and the system. The income of GPs varies hugely. Some practices are immensely profit-making and have a good income. In other areas the GP, despite perhaps working longer hours, may earn £20,000 or £30,000 a year less. That means that the area in question becomes relentlessly harder to recruit to. Consideration is being given to whether there should be a range of income, perhaps similar to what consultants have—an NHS salary.

That is obviously a huge change from the situation at the moment—the independent contractor status. Older GPs who have lived with independent contractor status certainly do not want it to go. They welcome the independence and the ability to design and run their practice as they see fit. However, it is important to recognise that the younger generation feel utterly differently. As has been mentioned, they are not interested in buying into a practice or even, necessarily, in being partners. They are not attracted to the businessman side of being a GP. Therefore we need contracts that do not destroy independent contractor status for those who already have it, or those who want it, but that enable people to work in practices where perhaps the building is provided by the health board, and where they are salaried and can create a more predictable work-life balance.

One of the small-print issues that is arising in England is the fact that no new general medical services contracts have been awarded since 2013; everything has been done on the basis of alternative provider contracts, which means that they are only for five years. It might be attractive to a big multinational to take on a franchise and hope that it gets the contract again; but there is no possibility that a family doctor would be interested in setting up or taking on a practice for a mere five years.

[Jamie Stone]

I am greatly interested in what the hon. Lady is saying, which is very constructive, good stuff. Would she, at this stage in her planning, factor in the extreme rural issue that I mentioned, in any way?

[Dr Whitford]

If the hon. Gentleman will bear with me, I shall come to that naturally later.

The issue of indemnity has been touched on. I am not sure whether it is realised how extreme the position is. GPs in England are paying three to four times the indemnity that GPs in Scotland are paying. The range in Scotland would be £1,500 to £2,300 on a range of half a dozen to 14 sessions, but in England that would be £5,500 to £9,500. That is a considerable chunk of money to ask of someone, and it is very significant when it comes to taking on the extra weekend surgeries of seven-day working, or out-of-hours work.