General Practitioners: Recruitment and Retention

Lord Markham Excerpts

Monday 12th June 2023 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest with Dispensing Doctors.

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

We acknowledge that there are challenges in growing GP numbers. We are working with NHS England and the profession to explore measures to boost recruitment, address the reasons why doctors leave the profession and encourage them to return to practice. As of March 2023, there were 1,903 more full-time equivalent doctors working in general practice compared with March 2019, and we have a record 4,000 doctors in GP training.

[Baroness McIntosh of Pickering (Con)]

I have slightly different figures, although I thank my noble friend for his Answer. Since 2015, there has been an 18% increase in the number of patients per GP but a 7% reduction in GPs, with potentially 39% of the GP workforce considering leaving the profession in the next five years. Does my noble friend share my concern about the recruitment and retention of GPs? What urgent action is he going to take to address the workforce strategy for GPs to double the number of medical training places and to ensure that general practice once again becomes an attractive place for doctors to work?

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[Lord Markham (Con)]

I agree with my noble friend that recruitment and retention are key. To clear up the figures, the numbers I gave referred to all doctors working in GP surgeries, including people who have been qualified for five years and are just finishing off the GP element. Within that we absolutely need to increase training numbers. We already have 4,000 doctors in training, which is a record number, but we are looking to grow that. We are introducing specific actions on retention, such as the new changes to pensions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, plugging the gap in relation to GPs will take many years. The noble Lord will know that in hospitals, specialist and associate specialist doctors have increased in number. Many would like to work in primary care but are prevented by bureaucratic barriers. Do the Government not think that one way to get an immediate injection of doctors into primary care is to get SAS doctors there and to lift the current barriers?

[Lord Markham (Con)]

I completely agree that we need to look creatively and flexibly. We are on target to deliver 50 million more appointments, which is 10% more each day. That is through recruiting more staff. We have about 29,000 more staff in the GP work space, and that is using them flexibly and creatively.

[Lord Stirrup (CB)]

My Lords, part of the pressure being experienced by secondary care specialists is as a consequence of inadequate time for appropriate diagnosis by primary care specialists—the GPs. Numbers are, of course, a part of this, but what are the Government going to do about setting targets for consultations with GPs that reduce the pressure on hospitals and see more patients dealt with in primary care?

[Lord Markham (Con)]

I totally agree; it is all about getting upstream of the problem. I visited an excellent surgery—Greystone House in Redhill—where they are doing exactly that. They are taking their most critical 1% of patients in respect of need and trying to get appointments in ahead of time so that they can move into preventive measures; I absolutely agree.

[Baroness Hodgson of Abinger (Con)]

My Lords, I understand that often locums are paid more than GPs in practice. How can we reverse this so that we can encourage young doctors to go into GP surgeries, become general practitioners and actually get to know their patients?

[Lord Markham (Con)]

First, I would agree—I think we all agree—that continuity of care is very important. We absolutely want a career structure that attracts and retains exactly those types of people, so that they feel it is more rewarding, both financially and as a job, to work in such a practice environment.

[Lord Allan of Hallam (LD)]

My Lords, I expected this Question to be the cue for our weekly reassurance from the Minister about the workforce plan, which will be coming “shortly”, “imminently”, “in the blink of an eye”, or whatever the latest formulation will be. In spite of all the reassurances that he has given about numbers, the stark reality remains that many people up and down the country find it extremely hard to see a GP when they need to, and that has knock-on effects for everyone else, including accident and emergency services. Does the Minister have anything new to offer that might give us some confidence that we will turn the corner in the near future?

[Lord Markham (Con)]

The primary care plan was a very good example of something new, substantial and backed by £1.2 billion of investment to beat the 8 am morning rush and use technology—which I know the noble Lord is very interested in—to allow people to self-help in a lot of these situations.

[Baroness Wheeler (Lab)]

The Minister will know that the Health Foundation independent think tank summed up the Government’s recent primary care recovery plan as falling

“well short of addressing the fundamental issues affecting general practice”.

Staff shortages and the sheer number on NHS waiting lists are a key reason for such high demand on GP services. Do the Government accept that, unless they urgently get a grip on waiting lists, the crisis in general practice will only deepen?

[Lord Markham (Con)]

What we totally accept and believe is that primary care is where a stitch in time saves nine, to take that saying. That is why I believe that the primary care plan is a big step forward. As I said, the fact that we are doing 10% more appointments per day is significant, as is the Pharmacy First initiative that we have announced, which will bring on stream another 10 million appointments a year, allowing people to navigate whether a pharmacy is the best place for them to get treatment, in which case they can go there first. These are all practical plans that are in place and are making a difference.

[Lord Singh of Wimbledon (CB)]

My Lords, I declare an interest as someone who has children and grandchildren in the medical profession. Would the Minister agree that there is something terribly wrong in the recruitment and retention of doctors when newly qualified doctors from Nigeria are paid more than those in this country when doctors find it easier and more profitable to do locums than stay in a fixed career path; and, finally, when doctors are being inundated with attractive requests from Australia and New Zealand to emigrate to those countries, leaving a dearth in this country?

[Lord Markham (Con)]

All the things that the noble Lord points towards are covered in our plan for recruitment and retention. The things that we have announced, particularly on pensions—a key reason why people were leaving—were welcomed by the sector and the fact that we have record numbers in training is also a step in the right direction. But, as we freely admit—this is what the primary care plan is all about—a lot more work needs to be done and is being done.

[Lord Naseby (Con)]

As my noble friend knows, we have an Armed Forces scheme for young doctors to train and they have to commit to five years in the Armed Forces. Is he also aware, as I am sure he is, that Singapore’s health service has a scheme whereby young medics who qualify have to work in the Singapore national health service? At a time when we see an increasing number of our qualifying young doctors going abroad, is it not time that we looked at both these schemes and modified them to the UK situation?

[Lord Markham (Con)]

My noble friend makes a good point: if we are investing eight years in training, in the case of a GP, to ensure that they are at the top of their profession, so to speak, it is reasonable to expect them to work for a number of years in the UK so as to make good on that investment.

[Lord Turnberg (Lab)]

My Lords, one way of encouraging retention would be to relieve GPs of the burden of having to manage their service by making them salaried employees. How far have we got with that proposal?

[Lord Markham (Con)]

I actually think the partner model works very well for a lot of people and has been the bedrock of our GP service, as we know, since the beginning of the NHS. However, what is critically important is reducing the admin so that GPs can get more face-to-face time. Again, at Greystone House surgery in Redhill on Friday, I saw excellent examples of where those admin duties are being taken away so that doctors can do what they want—and are best trained—to do, which is face-to-face treatment of patients.

[Baroness Hussein-Ece (LD)]

My Lords, is the Minister aware of how many GP practices are still insisting on online applications to get an appointment? Many people, such as those with learning disabilities or dementia, or older people, are not well versed in using online applications. Is anything being done to encourage GP practices to make sure that those people who are disadvantaged can access GP services, without being constantly referred back to doing everything online?

[Lord Markham (Con)]

Absolutely; I am a firm believer that you need to have lots of channels of distribution, for want of a better word. Online is a very important one, but being able to phone up is important. The primary care plan was all about making sure that we had enough capacity to beat the 8 am rush, and to let anyone who rings know that we are going to contact them if they cannot get through at that moment, at a time of their convenience, so that they can be certain that they will get the right treatment.