NHS: General Medical Practitioners

Lord Evans of Rainow Excerpts

Monday 20th November 2023 Lords Chamber

[Lord Warner]

To ask His Majesty’s Government what was the net change in the number of NHS general medical practitioners (GPs) in England, after taking account of resignations and additional recruits, in the past three years; and how much improvement in the retention of GPs they are planning to make as a result of the NHS Long Term Plan published on 30 June.

[Lord Evans of Rainow (Con)]

My Lords, as of September 2023 there are 2,025 more full-time equivalent doctors in general practice than in September 2020. We are working with NHS England to increase the general practice workforce. This includes measures to boost recruitment, address why doctors leave the profession and encourage them to return to practice. Last year, a record 4,000 doctors accepted a GP training place. The long-term workforce plan has committed to increasing this to 6,000 by 2031-32.

[Lord Warner (CB)]

I suppose I should thank the Minister for that rather optimistic reply, but is he aware that the number of patients has increased by 20% since 2015 while the number of GPs has actually declined? I can tell him that 464 GP partners were lost last year and that a quarter of GPs work only part-time. A recent survey by the Royal College of General Practitioners revealed that 57% of GPs are now saying they will not be in general practice in five years. Can the Minister explain how the new long-term workforce plan will get us anywhere near the number of 6,000 that he mentioned, when the plan expects a retention figure that will expand the number of GPs by only 700 by 2036-37?

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[Lord Warner (CB)]

I am coming to the conclusion. Are we not in a situation where NHS England and the Department of Health and Social Care have failed and we need some new thinking to sort out the problems of GPs?

[Lord Evans of Rainow (Con)]

My Lords, I take this opportunity to congratulate the noble Lord on the work he did as a Labour Government Minister between 2003 and 2007. I am grateful for his question. We are incredibly grateful to GPs and their staff, whose hard work ensured that more than 32.6 million appointments were carried out until September 2023, more than two-thirds of which were face to face. On 30 June, NHS England published the NHS Long Term Workforce Plan. The plan sets out the steps that the NHS and its partners need to take to deliver the NHS workforce, including GPs, that meets the changing needs of the population over the next 15 years. We are working with NHS England to increase the general practice workforce in England. This includes measures to boost recruitment, to address the reasons why doctors leave the profession and to encourage them to return to practice. NHS England has made a number of retention schemes available to boost the general practice workforce.

[Lord Kirkhope of Harrogate (Con)]

My Lords, does my noble friend agree that it is also important to congratulate GPs and practices that are introducing innovations, such as weekend working, and their attention to the patients? They get an awful lot of attacks, but in my view they are in need of some congratulation as well.

[Lord Evans of Rainow (Con)]

I completely agree with my noble friend. The 2022 GP patient survey showed that 72% of patients reported a good overall experience at their GP practices. GP practices that innovate tend to get better results in customer patient satisfaction.

[The Lord Bishop of St Albans]

My Lords, how many doctors, including GPs, have come from outside the UK in the last year for which we have records? What long-term plan is there to stop us relying on having to bring in doctors from countries that need them far more than we do because they are much poorer than here in the UK?

[Lord Evans of Rainow (Con)]

The right reverend Prelate the Bishop of St Albans asks an important question but the recovery plan introduced new measures to support international medical students, who make up more than half of all doctors in GP training, so if we were to stop those students coming over we would be in real trouble ourselves. On his wider point he is absolutely right, but it is not just GPs and doctors; it is also healthcare professionals in social services and elsewhere.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a member of the GMC. On the increase in training places in medical schools, which is of course very welcome, does the Minister agree that this will not come off unless we increase the number of people training the GPs? Will he arrange for discussions between himself, the GMC, medical schools and NHS England to ensure that we get enough people to come in as trainers to enable even the modest workforce projections that are in the plan for medical schools to be put into action?

[Lord Evans of Rainow (Con)]

I absolutely agree with the noble Lord. If he is inviting me to do something with that, I will certainly take it back to the department based on his question.

[Lord Allan of Hallam (LD)]

My Lords, among the fastest-growing groups on the doctors register are so-called specialty and associate specialist doctors and locally employed doctors. These doctors are not currently able to work in primary care, although they are very skilled, and the long-term workforce plan says the Government will look into that. What progress have the Government made in talking to the relevant professional bodies about opening up general practice so that more sessions are available?

[Lord Evans of Rainow (Con)]

I do not have an answer in my pack to that specific question, but the noble Lord raises a very good point. It is very important that we bring more specialist skills into primary care, and GP practices are exactly the right place, but I will come back to the noble Lord on that specific point.

[Lord Patel (CB)]

My Lords, what assessment have the Government made of the number of general practitioners required to meet the needs of the population and for training purposes by the year 2030?

[Lord Evans of Rainow (Con)]

We are working with NHS England to increase the general practice workforce in England but, as the population grows, with the amount of building that goes on throughout the country, it is the responsibility of local authorities. There are two ways to do this: they can apply for capital funding for new GP practices; or they can apply through Section 106 agreements through local authorities. It is for the regions and for local authorities to plan ahead on that front.

[Lord Naseby (Con)]

Has not the time come for every new medical student to contract that they will, on qualification, work for perhaps five years in the NHS, similar to the existing contract for men and women in the Armed Forces who are medical practitioners, and perhaps modelled also on the Singapore scheme?

[Lord Evans of Rainow (Con)]

I am grateful to my noble friend. I am aware of the Armed Forces scheme—that if you train as a pilot, for example, you cannot leave the Royal Air Force to become an airline pilot. It is not the first time that this question has been asked, and I will feed it back to the department.

[Baroness Merron (Lab)]

My Lords, the Royal College of GPs reports that 40% of its members consider their premises not fit for purpose, something that is not addressed by the workforce plan. As the £10.2 billion backlog in maintenance continues to worsen as capital budgets continue to be raided for day-to-day spending, what strategy do the Government have to ensure that patients can receive care in modern, safe and properly maintained buildings, particularly where an increase in GPs and primary care staff teams is being promised?

[Lord Evans of Rainow (Con)]

The noble Baroness is absolutely right. GP practices’ premises vary throughout the country but, as I said earlier, there is capital funding available for new practices. From my own experience, when GP practices merge it gives an opportunity for them to have a purpose-built building. When I was a Member of Parliament there was a very good example of that where four GP practices throughout the constituency came together to form an outstanding modern GP practice with a new GP practice building.

[Lord Stirrup (CB)]

My Lords—

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[Lord Stirrup (CB)]

My Lords, it is clear that allowing doctors to spend more time with their patients would permit more searching diagnoses, leading to fewer unnecessary referrals and helping to take some of the pressure off secondary care waiting lists. What allowance has been made for this in the calculation of the total GP requirement?

[Lord Evans of Rainow (Con)]

The noble and gallant Lord raises a very important point. The delivery plan for recovering access is backed by a major investment in primary care services, up to £645 million over two years, to expand services such as community pharmacies. Getting more people to use community pharmacies and other such facilities enables GPs to focus on exactly what the noble and gallant Lord is talking about: those people who need to have diagnoses and very quick scans in hospitals.

[Lord Sikka (Lab)]

My Lords, England has 7.8 GPs per 10,000 of population, compared with the OECD average of 10.8. That is a gap of 16,700 GPs. Can the Minister explain how England has fallen so far behind other OECD countries and what the human consequences of this are?

[Lord Evans of Rainow (Con)]

The Government are working hard to make sure that we recruit more GPs. Last year we saw the highest ever number of doctors accepting a place on GP training—more than 4,000 trainees, up from 2,600 in 2014. The number of places available will grow to 6,000 by 2031-32.