GP Appointments

Lord Markham Excerpts

Thursday 23rd February 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of (1) the impact that the logistical difficulties of getting a GP appointment has on patient outcomes, and (2) the extent to which the needs and choice of individual patients are being met in making healthcare appointments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We recognise that some people have struggled to access timely care from their general practice. We are taking action to expand general practice times to increase the availability of appointments, upgrade practice telephone systems, and publish data about how practices are performing so that patients can make informed choices when registering and commissioners can help the service to improve. In 2022, nine out 10 patients felt that their needs were met at their last general practice appointment.

[Baroness Merron (Lab)]

My Lords, the latest GP Patient Survey shows that more than one in four of those needing an appointment actually avoid making one because it is just too difficult. So does the Minister accept that practices such as being made to ring at 8 am, long phone queues, waiting hours for a call back and no online booking, all stack up more serious problems for the patient and the National Health Service? What are the Government doing to tackle these very basic practices, so that people can get to their GP in a way that suits them?

[Lord Markham (Con)]

Absolutely. One of the things I am very proud to be leading on the NHS side is our whole digital way of addressing access to the health service. This will be fundamental to how people make their hospital appointments and take control of their own health, so it will be the main thing that will help with the 8 am appointments, alongside the increased telephony services and everything else. Just as every walk of life is coming down to being able, at your fingertips, to make appointments and bookings and get your own records, this will also be the case with GP surgeries and I think it will fundamentally change the way that we address our whole health.

[Baroness Jolly (LD)]

My Lords, part of the problem is where there is no mobile phone signal. People who live or who have homes in Cornwall will identify with that. Does the Minister have any idea what proportion of patients find accessing their GP difficult? What advice has been given to practitioners on resolving the issue? In rural areas such as Cornwall and Northumberland, there are poor bus services, if any. Getting home can mean a really long wait—sometimes half a day if there are only two buses a day. What advice would the Minister give to the GP and to the patient?

[Lord Markham (Con)]

First, my understanding is that the vast majority of homes in Cornwall have broadband, to which your mobile phone will of course connect. That is where people will be making appointments from. They can use digital to do that. Secondly, we are rapidly increasing the number of doctors’ appointments. We made a pledge to increase the number of appointments by 50 million. To date, we have increased them by 36 million—11% up since 2019. So we are making more appointments available. Do we want to do more? Absolutely. Are we going to publish a primary care plan shortly to show how we will address those additional needs? Yes.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Deprived communities often have the most acute shortages of general practitioners, yet it is among those populations that there is the greatest burden of chronic comorbidity that requires integrated care, with a particular focus on communities where outcomes are the poorest and the healthy life years are the shortest. What do His Majesty’s Government propose to do about addressing the specific issue of GP shortages in deprived communities?

[Lord Markham (Con)]

As mentioned, we are increasing the number of doctors. We have 2,000 more versus 2019. The House will be pleased to know that that is a key part of the workforce plan for recruiting and retaining more doctors. As to comorbidities and deprived areas, clearly that is the role of the integrated care boards. They are set up very much to understand the needs of their areas and to make sure that they are looked after properly. In a lot of cases that means investing in primary care. We all know that a lot of the reason why we have a lot of people in A&E is that they cannot get GP-type services, so getting upstream of that issue and investing in primary care is the direction in which we need to go.

[Lord Sandhurst (Con)]

My Lords, it is often forgotten that general practitioners, unlike salaried NHS doctors, are self-employed contractors under contract to provide services. What plans, if any, do the Government have to review the existing GP contract to ensure that new terms are imposed to require better delivery of services by general practitioners?

[Lord Markham (Con)]

My understanding is that the new GP contract is part of live conversations with the BMA that we are about to get into—I think it is over the summer that those negotiations will start to take place. Within all of that, we will be looking at all those sorts of things in terms of how we want to see the GP service evolve. At the same time, we will be talking openly to the BMA about what it wants for its doctors, so that we get an outcome that works well for both sides.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, has the Minister seen the report produced today by the Auditor-General for Scotland? It is devastating about every aspect of the NHS in Scotland, including access to GPs. How much of this is because of underfunding by the UK Tory Government and how much because of the devastating administration of the Scottish Government?

[A noble Lord]

Go on.

[Lord Markham (Con)]

Are you going to dare me?

Sorry, I think a diplomatic response is probably wise at this stage. I note that, under the Barnett formula, per person funding for the NHS is Scotland is higher than it is in England. So there is significant funding in place. How well it is administered north of the border is probably a matter for the Scottish Government.

[Lord Bellingham (Con)]

My Lords, is it not the case that many European countries charge patients who fail to turn up for appointments without due cause? Is this something we are going to look at in this country?

[Lord Markham (Con)]

I am clearly aware of that. At the same time, I am very aware that we want to make sure that people are able to see a doctor when they need to and are not deterred from that. So we would have to tread very carefully and it is definitely not in our plans at the moment.

[Baroness Bull (CB)]

My Lords, given that a dual system of online and in-person GP interaction is inevitably the future and that virtual appointments are clinically appropriate in some circumstances, what are the Government doing to increase public confidence in virtual interactions with their GP? How will they ensure that all triage systems do not disadvantage those groups who are less likely to vocalise their preference or to advocate for the urgency of their own needs?

[Lord Markham (Con)]

Absolutely. One of the key benefits of the digital approach is the triage system. We all know that a lot of people who call at 8 am for an appointment could probably be well served by a pharmacy, a physio service or nursing. So proper triage through a digital-type system is a big step forward. It will end up with them being able to make an appointment with the pharmacy, physio—or the GP in this case. It will also free up resources so that those people who are not able to access digital services are able to get through at 8 am and speak to a person. So I really believe there is a win-win for both sides and personally I am very excited to take this through the House later in the year and see all the services that will be launched.

[Lord Allan of Hallam (LD)]

My Lords, following on from the Minister’s previous answer, what steps are the Government taking to develop the profession of care navigator? They are skilled staff who can make sure that people are directed to the right resource, whether a GP, nurse or pharmacist. Some people can use digital, but others need a personal contact for that direction process.

[Lord Markham (Con)]

Absolutely. I know that a lot of the best trusts that I have seen and visited have that right at their front door. It applies to A&E as well. One of the first comments I made when I joined the department was about expanding pharmacy services. That is brilliant and is part of the increase we are seeing but, if we are not telling people when they should go and under what circumstances, how is this going to help? So, yes, there will be both digital and analogue navigation.

[Lord Wigley (PC)]

My Lords, the Minister referred to the generous provision of finance to Scotland through the Barnett formula. In that case, does he accept the underfunding of Wales through that formula? This has been recognised by a committee of this House. Does he therefore recognise that the pressures on the health service in Wales faced by the Government in Cardiff are a direct consequence of this underfunding?

[Lord Markham (Con)]

Again, my understanding is that Wales receives more health funding per person under the Barnett formula than England. I am pretty sure I am right on that—I will confirm if I am wrong, but I am pretty sure I am correct. So both the Welsh and Scottish Governments have more funding than England. Do they get better outcomes? Well, I would rather be living in England, let me put it that way.