General Practitioners

Lord O'Shaughnessy Excerpts

Wednesday 17th October 2018 Lords Chamber

[Baroness Kennedy of Cradley]

To ask Her Majesty’s Government what progress they are making in increasing the number of general practitioners in England.

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

My Lords, the Government still intend to increase the number of doctors in general practice by 5,000, but we recognise that this will take longer than hoped. Last year we recruited the highest number of doctors into GP speciality training. There is also a broad offer for GPs to stay in the NHS, including a £10 million retention fund. Furthermore, since 2015, more than 3,000 other clinical staff are working in general practice.

[Baroness Kennedy of Cradley (Lab)]

My Lords, properly resourced, general practice is key to keeping people well and relieving wider pressures on the NHS, yet the Government’s target of 5,000 more GPs by 2020—or whatever date they are now going to set—is in tatters. Workload pressures, oversubscribed patient lists and funding shortfalls are driving down GP numbers. Statistics published this month show that the number of GPs has fallen by 6% since 2015, with the June 2018 figure 1,400 below the target set. Is there a plan to adjust the recruitment target to account for the year-on-year loss? Can the Minister confirm the actual delivery date for the target?

[Lord O'Shaughnessy]

The noble Baroness is correct, unfortunately: she is using accurate figures. We have not achieved the GPs numbers that we wanted but we still intend and need to recruit those other 5,000 GPs. It is worth pointing out that the funding for general practice will have increased by around £2.5 billion over the five years between 2015 and 2020, so I do not accept her point about funding shortfalls. The money is there, but we need to recruit more GPs and keep them in the service.

[Lord Forsyth of Drumlean (Con)]

Is my noble friend aware that one of the reasons that the numbers of GPs are falling is because, when they get to age 55, they find that their pension contributions are taxed at 55% due to the Government’s decision to lower the threshold for their pension funds? They then rejoin the health service as locum doctors, thus costing it more. Is it not time that the Treasury learned the unintended consequences of interfering with pension rules?

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[Lord O'Shaughnessy]

My noble friend will know that pension policy is not one of my areas. There are early retirements from general practice but, as he pointed out, a number of those GPs come back either as locums or as part-time doctors. It is important to entice more of them back. That is why we aim to have 500 people going through our refresher scheme to bring GPs back into the service.

[Baroness Walmsley (LD)]

My Lords, I was rather surprised to learn that the Government were trying to recruit more doctors from Australia, the very country to which a great many of our newly qualified doctors go for better pay and conditions. What are the Government doing to try to recoup the taxpayers’ money spent on their training? It is surprising that they go to developed countries such as Australia, and that we get no benefit from the cost of their training.

[Lord O'Shaughnessy]

Some people will inevitably travel abroad after their training, but the vast majority of doctors who train in this country stay here. We have more GPs than ever in training. That is obviously the way to solve the long-term challenges of having the right workforce. However, the noble Baroness is absolutely right that we need to recruit from abroad in the short-to-medium term. The NHS has a recruitment target of 2,000 doctors via that route.

[Lord Patel (CB)]

My Lords, one of the key recommendations made in the House of Lords report The Long-term Sustainability of the NHS and Adult Social Care related to training of health professionals. It was based on the evidence that we received of the very thing we are discussing today, which is poor recruitment, not only in general practice but in other areas in healthcare. The key recommendation was that NHS England be asked to review and come forward with a paper that will change the way we train health professionals, so that training is more flexible and integrated and encourages people to go into specialties that are currently in shortage. Does the Minister agree?

[Lord O'Shaughnessy]

I agree with that recommendation. It is certainly being considered as part of the long-term plan, for which workforce is clearly critical. That is one reason why it is significant that there are 3,000 more clinical staff in general practice who are not doctors—nurses, pharmacists and others. Clearly the nature of general practice is changing. Doctors do not have to do everything, and other well-qualified professionals can carry out essential roles.

[Baroness Pitkeathley (Lab)]

My Lords, when the Government launched their loneliness strategy last week, we learned that one in five people at GP surgeries is there for reasons caused by loneliness. Can the Minister expand on what is being done to change GPs’ training so that they can deal with such problems, or—following his answer to the previous question— on what other clinicians and associated professionals will be brought into the mix to help solve the loneliness issue?

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[Lord O'Shaughnessy]

The noble Baroness raises what is unfortunately a sad fact. One of the areas I highlight is the increasing use of social prescribing, which uses means such as joining clubs and taking part in activities that often have a social dimension to alleviate the problems associated with loneliness. Our new Secretary of State has made social prescribing a priority, because clearly it enables us to change people’s lives for the better without resorting to appointments and medicines.

[Baroness McIntosh of Pickering (Con)]

My Lords, I declare an interest as an adviser to the board of the Dispensing Doctors’ Association. Will my noble friend address the very real issue of recruiting and retaining GPs in rural areas? I declare an interest in that both my father and brother have been dispensing doctors. It is not just an issue of 55 year-old doctors’ pension contributions; increasingly there is a problem of attracting young doctors in their 30s and 40s and retaining them, because of the poorer pension provisions we have now.

[Lord O'Shaughnessy]

My noble friend makes an important point, and obviously she has first-hand experience of that. I am pleased to tell her that there is a targeted recruitment scheme that offers a £20,000 salary supplement for those who serve in hard-to-reach areas. In 2016, 122 places were offered on that scheme, and that number has now more than doubled in 2018, so we are putting more and more emphasis on that.