General Practitioners: Appointments

Lord Hunt of Kings Heath Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the noble Earl, Lord Attlee, for allowing us to debate this very important question and congratulate him on the quality and range of his contribution, which was extremely interesting. I echo his initial comments about the value of the National Health Service. However, he also referred to the considerable challenges we face, not least the amount of money that is being made available. I note the comments that the noble Lord, Lord Rennard, made and I will be most interested in the Minister’s response to his suggestion that we need to move to hypothecated taxation. Interestingly, we have a recommendation from the Liaison Committee—of which I am a member—which I hope will come to the House next week to establish a special Select Committee in the next Session looking at the long-term sustainability of the NHS. I think that that will be a very interesting discussion, not least because it is clear, as the noble Earl said, that alongside A&E and ambulance services, general practice is facing considerable pressure.

Like my noble friend Lord Turnberg I am very lucky to enjoy an exceptional GP practice, which is a small branch of a large inner-city practice. It is clear from the comments of noble Lords and from the regular GP patient survey that people’s experiences are very mixed. The noble Earl focused on economically active members of society, but his comments could have applied to all patients. Noble Lords are often fond of quoting the Commonwealth Fund’s international comparators, which do not always compare with the OECD research covering the same ground. I was interested in its latest report on public perception of primary care in the UK and the fact that there has been a dramatic drop in the positive view of how primary care works, with the percentage of those expressing satisfaction going down from nearly 50% in 2009 and 2012 to just over 20% in 2015. So there has no doubt been an appreciable change in attitude by the public in relation to GP services. The GP patient survey shows, for instance, that only 70.4% of patients find it easy to get through to someone at their GP surgery on the phone. This is down from previous figures. It also showed that 6.5% book their appointments online, up from 3.2% in December 2012. It is really disappointing that such a low number of people actually take advantage of online booking or, indeed, that such a low number of practices promote online booking. Obviously, it would make life so much easier if it were easier for people to do that, and it would deal with the problem that the noble Earl, Lord Attlee, described, about the differentiation between an urgent appointment and one that is important but does not have to take place within 48 hours. Many GP practices seem quite unable to devise a system to cope with those circumstances.

It is also interesting that the GP patient survey showed that 23.1% see their preferred GP a lot of the time. We need to think through the implications of that, particularly with seven-day working, because I suggest that with the move into larger federations, which I support, the seven-day working concept inevitably means that people will have less opportunity to see their preferred GP—particularly, as we know, when many GPs do not want to work full time any more. That seems to me to depend on information, particularly electronic information, being available, so that a patient does not have continually to tell different GPs in a practice about their conditions, because they actually have systems where that is noted down.

I also note that in the survey 57.7% were happy with the amount of time that they had to wait for an appointment. Again, that is down—it is not a great figure. The overall satisfaction with GP opening hours, at 74.8%, is down and again not very satisfactory.

The noble Lord, Lord Rennard, referred to the PAC report on access to general practice, which came out only a couple of weeks ago. I thought that it was a very interesting report and, no doubt, the Government will respond in due course. But it showed that we have problems with retention and recruitment, that good access to GP care is too dependent on where patients live, and there is an unacceptable variation in patients’ practices and in the appointments system. Tellingly, it said that the Department of Health and NHS England do not have enough information—that is a point that the noble Lord made—on demand, activity or capacity, which one would have thought might have been of interest to NHS England. I think that it is clear that both the department and NHS England has really failed to ensure that staffing in general practice has kept pace with growing demand. I think that they have been complacent about general practitioners’ ability and, indeed, willingness to cope with the increase in demand caused by rising public expectations and the needs of an ageing population.

No doubt the Minister will tell us about recent initiatives, which are welcome in themselves, but a lot of changes will come about because GPs themselves will make them happen. I am really impressed by the large federations that have been established. There is one very large one in west Birmingham and the Black Country, which has had some incredibly impressive results in relation to access. It is through having a large enough federation that you can meet the work patterns of individual GPs, and it is through the simple use of phone and email to have much more flexible appointments. I do not know whether the noble Lord has read a report from David Pannell, the chief executive of Suffolk GP Federation, which complains that the department is not really giving support to the development of provider networks and federations and that the only initiative promoting working at scale was the Prime Minister’s GP access fund, which was doing little to diverge from the traditional model of contracting with individual practices.

The point being made here is that every single contract which is part of the PM’s access fund has been a traditional primary medical services or general medical services one with an individual practice. Would the Minister be prepared to have a look at this and to talk to the National Association of Provider Organisations? Its chair has commented:

“Whereas NHS England supported the vanguards programme, there has been virtually no support for the leadership of federations which are not part of a vanguard”.

I have quoted from a story in the Heath Service Journal and I have also looked at comments which have been made on it. One comment, which was anonymous—I do not know why—said:

“Brighton and Hove CCG have been developing a really innovative and ambitious contract with GPs working at scale which the LMC have supported”.

It may well be worth looking at that to see whether more can be encouraged.

Finally, I wonder if the development of federations means that the Government need to look at CCG governance. If you have a large-scale federation covering an area roughly the same size as a CCG, I can see a potential conflict of interest. The federation could dominate the election of members to the CCG board. The contracts should be at that level, not held by NHS England, so I wonder if we need to go back to the issue of CCG governance and have a majority of lay people on CCG boards. That would enable the Government to be much more proactive in supporting these federations. I am convinced that they are the only way we can deal with the problems raised by the noble Earl.