Primary and Community Care: Improving Patient Outcomes

Lord Hunt of Kings Heath Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to follow the noble Lord and to thank the noble Lord, Lord Patel, for his speech. I fully echo his desire to see a special Select Committee created; I hope that the Liaison Committee members present will take note of that.

The noble Lord said that primary care is the bedrock of our health service, and I agree. If it does not function effectively, the whole healthcare system suffers, and it is clearly suffering greatly at the moment. It is not just workforce shortages or the crumbling estate. A recent Civitas report made for sober reading. It ranked the performance of the UK healthcare system with that of 18 comparable countries and, lamentably, it placed the UK second to bottom across a series of major healthcare outcomes, including life expectancy and survival rates from cancer, strokes and heart attacks. Recently, the Health Foundation has drawn attention to the UK having an astonishingly low number of MRI machines and CT scanners: fewer per person, according to the OECD, than any other developed country. That is besides having fewer doctors and nurses than our north European neighbours and very poor uptake of new medicines.

We see England’s hospitals being caught in a vice. On the one hand, the race to work through the enormous backlog of care means an unceasing stream of new patients into fewer beds. On the other hand, a decade of flatlining, at best, funds for social care means that even when treatment is concluded, thousands of patients remain in hospital beds waiting for follow-up care. Emergency departments have no beds to send new arrivals to the wards, patients with urgent needs wait for hours on end, ambulances cannot hand over patients, and are stuck in a queue outside A&E. We have to see the inadequacies of primary care in this much wider context.

The pandemic has accelerated the move to online booking and phone consultations with general practitioners. That has made care quicker and easier for many people, and we should not ignore that. On the other hand, it has led to many other patients facing enormous difficulties in getting face-to-face access to their general practitioner. The NHS England stat last October which showed that over 15% of practices recorded less than 20% of their GP appointments being held face-to-face is very worrying indeed. Last month, Pulse magazine reported that 1.5 million patients had lost their GP in the last eight years after the closure of almost 500 practices. Recruitment issues were part of the problem but we should not ignore the issue of workload, inadequate premises and sheer morale issues.

The noble Lord, Lord Patel, mentioned Dr Claire Fuller’s very interesting report to the NHS England CEO. She concluded that patient satisfaction with access to general practice is at an all-time low and described the 8 am Monday scramble for appointments as synonymous with huge patient frustrations. She said:

“left as it is, primary care … will become unsustainable in a relatively short period of time.”

We have all had evidence from the Royal College of GPs, which says that despite a government agreement to an increase of 6,000 in GPs, the number of fully qualified full-time equivalents has actually fallen by 1,622 between September 2015 and 2021. I mention again that I do not understand how the Government could have reduced the number of medical training places to 7,500 this year, following two years of there being about 10,500. It is amazing and extraordinary that the Government could have allowed that to happen. I had better declare my interest as a GMC member in that regard. The Health Foundation predicts that the shortage of GPs is set to become worse. It thinks that the current 4,200 shortfall will rise to more than 10,000 by the end of this decade.

Noble Lords have mentioned the recommendations of the Royal College of GPs: a new recruitment campaign, freeing up bureaucracy and investing in new technology—and I very much agree with the noble Lord, Lord Bethell, on that. But that is really not sufficient to tackle the fundamental issues we face. Noble Lords may be aware of a recent report by your Lordships’ Public Services Committee which looked at public service workforce issues generally. The stark conclusion is that every part of the public sector has targets for recruitment and none of them will be met. There is a lack of realism in accepting that and starting to do the work that needs to be done when faced with these acute problems. Again, I agree with the noble Lord, Lord Bethell, on that.

We need a realistic conversation about what we can expect primary care to do in future. Most of the evidence we have received says basically that we need more GPs but assumes that we carry on with the same 1948 model of primary care. That is not sustainable at all. We must be realistic and start talking about why that can no longer be the way we go forward.

Dr Fuller’s report to the NHS CEO was interesting. She argued for the streaming of services, with access to care for people who get ill but use health services only infrequently, and a distinction between their needs and those of people who are chronically ill and need care, to know their GP and access to multidisciplinary support. That is the start of thinking more fundamentally about primary care in future.

We must ask ourselves about the role of gatekeeper. People are wedded to the idea of the GP as gatekeeper—or, let us be truthful, as rationer of services. But when we look at outcome figures for, say, cancer, we must ask whether the lack of direct access to specialist care is one of the reasons that our outcomes are so poor. I do not know whether that is true or not, but we certainly need to ask the question.

How can we increase GPs’ job satisfaction? We must do something to give them the confidence to carry on in primary care in a way in which they get job satisfaction. We have many overseas doctors coming to work in the hospital sector. Can we change some of the rules and understandings in primary care to enable them to work there as well?

Finally, is the organisational model fit for purpose? We know that many GPs no longer aspire to partnership. What ought to take the place of that? If we are moving to a salaried service, partly in the employ of private-sector providers, how can we ensure that those GPs are getting the support, professional leadership and confidence to wish to stay in the sector in future?

I look forward to the Minister’s response. We do not need a lot of statistics, which, frankly, is not the answer to the fundamental issues we face. If ever we needed a special Select Committee, this is it.