Recovering Access to Primary Care

Lord Shipley Excerpts

Tuesday 9th May 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading out the Statement. No one can be in any doubt that patient access to primary care needs a great deal of recovering from the dire situation patients across the country find themselves in today. Millions of patients wait more than a month to see a GP—if they can get an appointment at all. Some 65% of the public think that access to GP services is getting worse, and over 40% report that they have to wait too long to see a GP. The 9 am rush and scramble to get an appointment, or even a response, is the reality for thousands of patients each day. Often, they are waiting in pain and discomfort, unable to go about their daily normal lives. While they wait, an illness goes undiagnosed and untreated, potentially getting ever more serious.

In today’s Statement the Government once again recognise the major role community pharmacies can play in relieving the pressure on GP appointments and primary care. As we have made clear, we fully support and welcome this extended role, including allowing pharmacies to provide prescriptions and routine health checks, and opening up more referral routes to NHS specialists, such as physios for back pain. However, only yesterday in the national media we heard that 670 community pharmacies have closed and the number of pharmacies across England is now the lowest since 2015, and about the impact caused by rising costs, major staff shortages and the 30% cut in government funding to date—all despite growing demand for services. The industry estimates a £1.1 billion funding shortfall each year, and that last year was the worst ever. Does the Minister acknowledge that, for many, today’s plan is too little too late when it comes to fixing the crisis in primary care?

The independent think tank the Health Foundation sums up the Government’s overall plan, saying that it

“falls well short of addressing the fundamental issues”

facing general practice. Of course, the key reason demand for GP services is so high is the sheer number of people on NHS waiting lists. The president of the Royal College of General Practitioners said recently:

“Patients are developing cancers and enduring so much pain that they cannot climb stairs”.


Do the Government acknowledge that, unless they urgently get a grip on waiting lists, the crisis in general practice will only deepen?

More phone lines and better mood music will not fix the fundamental issue: the shortage of GPs. Their numbers have been cut by 2,000 since 2015, and now the Government have abandoned their own target of 6,000 extra GPs by next year. The proposal to ease the current burden on hard-pressed GP reception staff with a £240 million investment in phone and call systems technology over the coming years is welcome, but does the Minister really think that this is a proportionate or urgent enough response to the scale of the crisis? Is the money for the new care navigator staff included in this funding? What role will these new staff play in GP surgeries? When will we have a detailed breakdown of how the overall funding will be spent, and when it will be allocated and delivered?

Even the Government’s own Benches in this House have accused them of being in total denial about the crisis facing community pharmacies. Much now needs to be discussed by the PSNC, the Department of Health and NHS England regarding the promised funding in the recovery plan, and to try to address the crisis; I hope the Minister will keep us as up to date as possible. Can he provide more detail on how the proposed new services for the seven common conditions and oral contraception are envisaged to operate and interface with GP and other primary care services?

Finally, we come back to the question of the all-important workforce plan—what else? We heard from the Minister in Questions today that he now thinks that spring runs to the end of June. On the radio today, the Commons Minister promised that we would have it in a couple of months. As with every other health and social care service and profession we speak about in this House, workforce is core. Pharmacy locum costs have increased by 80% in the past year alone. So I have two simple questions: why is the promised, fully costed workforce plan taking so long, and when will it finally be published?

[Lord Shipley (LD)]

My Lords, I support the comments made by the noble Baroness, Lady Wheeler, on the Statement. We on these Benches welcome the aspirational nature of what the Government are proposing. During the Covid pandemic, we all learned that community pharmacists play an absolutely key role in supporting the health system. In my personal experience of securing additional injections, I was very impressed by how well the whole NHS system worked in delivering the inoculation service through community pharmacies. One of the good things about it is that you can book a slot, in the same way you book a slot with a GP. However, for this to succeed—and to free up 30,000 GP slots, as the Government intend—booking an appointment with a pharmacist needs to be just as easy. We then need to be very clear about what pharmacists will do, and what GPs will no longer have a contractual obligation to do.

On the workforce shortages that have been referred to, it would help if the Minister could explain whether the manifesto commitment to deliver 26,000 more primary care staff by next March is deliverable. It is difficult to see how the Government will do that unless more money is made available, so I seek the Minister’s confirmation that more resource will be delivered on the back of this initiative to ensure that it happens.

I will ask the Minister three further questions. First, were patients of different backgrounds, genders and geographies involved in drawing up the plan, and can he outline the patient involvement? Secondly, is there sufficient qualified staff of all professions to deliver the multidisciplinary plan? Finally, as the noble Baroness, Lady Wheeler, asked, when does the Minister does expect the new plan to be up and running?

[Lord Markham (Con)]

I thank noble Lords for their comments and appreciate the general welcome for the tenets of the plan from all sides. I want to say that, rather than “too little, too late”, this is actually a plan that bolsters a service that is already on target for an increase of 50 million appointments from 2019—a service in which we are seeing a 10% increase per month versus pre-pandemic levels. I think that, on anyone’s reckoning, that is a pretty impressive achievement. The Pharmacy First plan that we talk about will free up another 10 million appointments a year in addition to that. Also, the use of digital technology will make it easier to get appointments and ensure that those who need them most can get them. It will ease the 8 am frustrations that we are all too aware of.

Addressing the comments on the pharmacy closures that have happened, this can only help pharmacists by increasing the income-generating services available to them and increasing the footfall into those pharmacies. This can only improve their income and so their overall viability. So I hope we will see, from all of this, an increase in the number of community pharmacies. To answer the point, we will be setting up booking systems so that you can digitally book your pharmacy appointment. Equally vital will be the use of the NHS app and other technologies, such as 111, to navigate through services, so you know when you should be booking an appointment with a doctor and when you should be booking it with a pharmacy. The use of technology will be a vital element in all that.

On the workforce, I absolutely acknowledge, as I think we all do, the importance of making sure we have the right workforce in place. That is why I think we are all pleased with and all supportive of the pension changes that will increase and retain the numbers of people. I am afraid I cannot give any more news on the date of the workforce announcement, but I can say that, as mentioned before, substantial work is going on in this place. Yes, we are committed to the increase of 26,000 staff, and this whole package has £1.2 billion of funding behind it, of which £645 million goes into the community Pharmacy First plan, because a vital part of all this, as noble Lords have said, is making sure that we have we have the qualified staff in place to do it.

So, I think we have a good plan here and it is probably best to hear what the industry has said. We have seen a welcome from across the board.

“This is the most significant investment in community pharmacy in well over a decade”


came from the Pharmaceutical Services Negotiating Committee. The Boots CEO said:

“We are really pleased … Our Boots pharmacy teams sit at the heart of communities, offering easy to access care and expert advice; it is great news that they’ll be able use their clinical expertise more widely to help patients”.


I really see this as a transformational step forward, united with the digital technology which will make huge differences. With that, I commend a plan that will make a real difference to patients and the services they receive from GPs in the community.