GP Appointment Availability

Laurence Robertson Excerpts

Tuesday 26th October 2021 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission. Please give each other and members of staff space when seated, and when entering and leaving the room.

[Joy Morrissey (Beaconsfield) (Con)]

I beg to move,

That this House has considered GP appointment availability.

It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. The chances of misdiagnosis can increase dramatically if GPs rely on emails or telephone calls exclusively. I speak from experience: for days, my mother-in-law was misdiagnosed as having a urinary tract infection, when she had actually suffered a severe stroke. Precious time was lost, and terrible damage done, because she was not seen by a GP. For every 100 ailments that can be diagnosed safely without seeing a GP, there will be one that cannot—one that could prove to be fatal, which is not a price worth paying.

I thank NHS workers and GPs for working tirelessly throughout the pandemic. I was encouraged to apply for this debate by my constituents, who came to see me again and again about this issue. I wanted to make sure that their voice was heard. I will read out some of their actual cases, because it is important to hear from them about what they have been experiencing. I would say that they are divided into two categories. The first is those who are disabled and perhaps suffer from dementia or other cognitive impairments, who find talking on the phone very difficult, and who really need to see a GP in person. The second is those who are happy to speak over the phone when they need a GP appointment, but find that the IT systems in place in certain GP surgeries cause issues with access to GPs.

The first example is from Marlow. A lady wrote to me and asked for an appointment to see me. She said:

“When I got through to the surgery, we were told that we should have a telephone appointment first. The GPs have my daughter’s number, as she cares for her grandmother. I explained that we do not live with her and cannot sit at her house and wait for a call. Also, there was a phone for her to sit around all day, and no one answers. She isn’t good with IT and has trouble explaining and expressing herself and telling someone what is wrong over the phone. I understand we are in extremely unusual circumstances, but there has to be exceptions, and there must be a way for elderly, and in some cases disabled, people to be able to get an appointment. Many do not have the capability to use the internet, and even phones in some cases.”

That was particularly true in the case of my mother-in-law, who had had a stroke. Luckily, we had power of attorney, but many people do not. I appreciate that the Government have made great strides in this regard, but we need to look at how we can protect those who are disabled, who perhaps have cognitive impairments and who need to have a carer come with them to a GP surgery in order to express what is wrong and explain what condition they have. Greater attention should be paid to this in the future.

We also have the issue of general IT and phone challenges. A resident in Farnham Common wrote to me and said:

“We have difficulty making the initial contact with GP surgeries. Most GPs operate a system which requires the patient to telephone when the surgery opens at 7 am to seek a consultation for that day. In our collective experience, it is often extremely difficult to get through. It takes a very long period of repeated calling. One friend recorded 140 unsuccessful attempts to reach the GP surgery.”

Some of the GP surgeries in my constituency are excellent. They were excellent during the vaccine roll-out and through covid, but we have certain GP surgeries that have had challenges meeting residents, challenges with the vaccine roll-out, and challenges in general throughout the covid period. Quite a number of residents have written to me and spoken to me about Burnham Health Centre, so I want to share specifically the IT challenges that it seems to face consistently.

One resident, Colin, said that if you are lucky enough to be 29th in the queue that morning at 7 am, you may get a message that says no appointments are left for the day. You can hang on in silence, or you may get to speak to a person—you may get through to a human being. You are told that there are no appointments and that you need to use Patient Access. When you try to book an appointment via Patient Access, it gives you possible ways to book, but only for things like contraceptive appointments, and nothing else. When Colin tried to access Patient Access, he was given an electronic form which he completed several times. It kept coming back saying that it could not be processed. He tried dozens of times and finally gave up and decided that Patient Access was not working.

He was not the only resident in Burnham who complained about Burnham Health Centre and Patient Access; several more wrote to me about the same issue. One said:

“I do think it’s ridiculous that you cannot get an appointment when you call, I am happy to wait a day or two, if it is urgent, there is always 111. The practice of releasing a limited amount of appointments at a certain time is not fair and just causes a bun fight. I do think the staff would benefit from customer service training”—

for everyone’s benefit.

A set amount of appointments are on a first-come, first-served basis. This seems to be unique to this GP surgery, but it has become a very agitating issue for people in the area who already suffer from some health inequality. They perhaps do not have the financial ability to go privately. Many are older and vulnerable, and it is demoralising that they often cannot get hold of a GP for even a phone call and consultation. Just getting a phone call would be a positive step in certain cases in my patch.

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[Margaret Greenwood]

Does the hon. Lady share my concerns about the provision in the Health and Care Bill for the assessment of patients to take place after they have been discharged from hospital instead of before, as happens at the moment? I have very serious concerns about that issue. I tabled a couple of parliamentary questions, which were answered by a different Minister to the one who is here in Westminster Hall today. One question was about the fact that this discharge-to-assess approach has been going on under the Coronavirus Act; I asked how many patients had been discharged that way. The reply came back that 4 million patients had been discharged from hospital without having their assessment. I asked how many of those had been readmitted within 30 days; the Minister replied that the Government did not know because the information was not held nationally.

This is a very serious concern, because we are talking about vulnerable people. I know the hon. Member for Beaconsfield is talking about a particular relative. The idea that somebody with dementia, or early-stage dementia that has not been fully diagnosed yet, should be discharged before their needs are fully understood is very alarming. An independent review of this is going on at the moment, and I would be grateful if the Minister could give us an idea when that is going to be published. It is meant to be this autumn. I would like to raise this with the Minister as a very serious issue and wondered if she would like to comment on it.

[Mr Laurence Robertson (in the Chair)]

Order. I remind hon. Members that interventions need to be brief.

[Joy Morrissey]

I recall the Member speaking on this topic previously. I commented only because of my personal experience. The change is well intended, and I understand where it is coming from, but for a disabled person, and for someone who cannot advocate for their own care needs, having a care plan in place before leaving hospital helps with accountability and the structure of the care. From my own personal experience, as someone who has taken care of a very disabled relative who cannot advocate for herself, I can only say that having this agreed before she came out of hospital made it easier for our family to co-ordinate the care. It is difficult to know which funding pathway is linked to what care once someone leaves hospital; there is a statutory responsibility, but then there is the question of who picks up the care once that period out of hospital has finished. For someone who is disabled, has had a stroke or requires long-term rehabilitation, that is a very sticky issue because whichever organisation within the health structure picks up the statutory duty picks up a huge cost. I think it is a very nuanced issue and we need another debate on it to flesh out all the different challenges. However, I take on board the comments made by the hon. Member for Wirral West and recall supporting what she said when she spoke several months ago.

I understand that these are unprecedented times, and there are great challenges for everyone across the health sector. This is not to criticise anyone; it is just about how we can positively move forward into the new covid era in which we find ourselves, and into the winter months when there are more challenges. It is about how we can work together to find solutions, particularly for the vulnerable, the disabled and those who cannot advocate for their own care needs. I am very grateful that we have been given time to debate this topic.

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[Several hon. Members rose—]

[Mr Laurence Robertson (in the Chair)]

I ask hon. Members to now limit their speeches to six minutes, so that we can get everyone in.

--- Later in debate ---

[James Sunderland (Bracknell) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend the Member for Beaconsfield (Joy Morrissey) on securing the debate. I listened to the speech by my hon. Friend the Member for Waveney (Peter Aldous)—I am sure he was looking over my shoulder when I wrote mine, because some of the themes are quite similar.

I find myself in the curious situation of raising the issue of NHS services in east Berkshire. Why is that curious? Because we are pretty well served, actually. The NHS is pretty good locally. We have three fantastic hospitals on the doorstep. The Frimley ICS is one of the best-performing care systems in the country and recently had a reprieve from the new Health Secretary, who had looked at breaking it up. We are in a pretty good place, and I do not tend to get letters from constituents about the healthcare that they receive, which is very good. In this case, however, I have been receiving letters, and I am quite concerned about it.

What is the perception, and what are people saying to me? Under the current policy, GP practices must now ensure that they offer face-to-face appointments. Only 57% of appointments across the UK are currently face to face, versus 79% before the pandemic, so there is an issue. There is also a perception that it is difficult to get through to practices on the phone, and that there is low availability of appointments and a lack of face-to-face care. Constituents are never wrong, my constituents are not wrong, and if they are writing to me repeatedly about these issues, clearly it is incumbent upon me as their MP to raise them.

What is the good news? Nationally, the narrative is actually very positive. If we look at the current statistics from the Care Quality Commission, the scores on GP access are the highest they have ever been, with a 67% satisfaction rate now, compared with 63% last year. Same-day appointments have gone up. People are satisfied with what they are getting from their GP, with an 88.7% satisfaction rating of “good” or “very good”. As of August 2021, 23.9 million GP appointments were offered and recorded, compared with 23.4 million two years ago, so things are getting better. Things are going up. That is in addition to the 1.5 million covid-19 vaccination appointments delivered in August 2021 by GP surgeries. The service, statistically, is improving. It is good news.

However, the data appears to contrast with what I am hearing locally. I agree with what my hon. Friend the Member for Bolton West (Chris Green) said earlier about how there could be a postcode lottery, or it could be related to the service provider at individual constituency surgeries. Demand is clearly outstripping supply, so Houston, we’ve got a problem.

As an example, one constituent spent 45 minutes on the phone to a particular surgery, tried 159 times to get through and was then offered a telephone consultation for a lump on her neck, which is not great. Constituents have dialled 111 and been advised to contact their GP, then after being unable to get through, they phone 111. We have had multiple complaints from certain constituents in a certain part of my constituency—it would not be fair for me to say where—informing me that the practice has 20,000 patients and only two doctors. The figures do not work. Telephone triage is being used instead of an immediate face-to-face. For flu vaccinations, one particular group practice is advising constituents to travel to the central hub in Bracknell, which causes issues for those less able to get there. We have a capacity problem.

However, it is unacceptable that staff are working under challenging circumstances and facing levels of abuse not previously seen. GPs and staff are working harder than ever before. Retention and staff satisfaction are an issue. Therefore, MPs like me must do more to help to redress that balance, and to balance the narrative. By the same token, GP surgeries also need to take the inquiries that we raise with them more seriously. The GP is not the enemy, and nor is the MP.

My general advice to GP surgeries is this: I think that there are things we can do. We need more staff. Let us do more to recruit staff, particularly receptionist and telephone staff. We need to reassure patients a bit more; they want some TLC after the pandemic, and it is right that they get it. We need to sort out the phone lines. We need to improve electronic referral systems. In Bracknell, we have the new primary care network phone system, whereby calls that cannot be answered by a particular surgery will be rerouted to another, which is quite exciting. We also need communication between surgeries and their patients: tell the constituents what is going on and explain to them why their calls are going unanswered. MPs need to visit surgeries, as I am next week. Basically, let us improve customer service.

I have three points to conclude with. First, care providers in East Berkshire and across the country are working miracles, but are accountable to their customers. I would urge GP surgeries to think about what their customers are saying to them, and to do what they can to reassure them. My second point is addressed to the Minister. The new IPC guidance is forthcoming. When will it be published, and when will GP surgeries get more guidance on what it means? Lastly, I urge everyone listening to this to watch the language being used. We are all in the same space and working hard; doctors and staff are working really hard. Let us please tone it down. All of us are part of the problem, but we are also all part of the solution.

[Mr Laurence Robertson (in the Chair)]

We now come to Front-Bench speeches. I would like to leave a couple of minutes at the end for the mover of the motion to wind up.