GP Recruitment and Retention

Luke Pollard Excerpts

Wednesday 28th March 2018 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I congratulate my hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson) on making such a powerful opening speech. I want to talk about primary care in Plymouth, because I am worried that the crisis we have is at risk of getting much worse in the coming months, as GPs are considering whether to hand back their contracts in the next couple of days.

A lot has been done in Plymouth to integrate our healthcare system and our social care system. Sometimes our distance from London has meant that we have managed to avoid the headlines, but not the hard work. There has been a huge effort of innovation and integration in the west country, merging social care, mental health provision and our acute hospital trust together. Enormous thanks and credit should go to the hard-working staff who have pioneered that, along with the city council and other providers.

There is, however, a problem with primary care in particular. That is exacerbated by other parts of the system that do not seem to work, as my hon. Friend the Member for Stroud (Dr Drew) said, but there does seem to be a real crisis in primary care that needs to be addressed. I welcome the news given by Simon Stevens on his visit to Plymouth last week that we will get an additional 12 GP training places for our university, but there is a real crisis today. I am looking for actions from the Minister to assist us in combating that crisis today.

Nurse and GP vacancies persist in Plymouth’s primary care sector, and waiting lists continue to be high. It is important to say that this is not because the superb staff in our NHS are not working their socks off, because they really are. However, there is persistent underfunding of not only general practice but the wider sector. NHS England estimates that one in seven GP posts in Plymouth have not been filled, which is an alarming statistic. I have heard of one GP surgery in the heart of the city that has been advertising a GP vacancy for a year and has had no applications so far.

[Michelle Donelan]

I have similar issues in Melksham in my constituency. Is the hon. Gentleman aware of the targeted enhanced recruitment scheme, which offers £20,000 to attract trainees in areas that have failed to fill places for a number of years? That is available in Swindon, in Wiltshire, but also in Plymouth.

[Luke Pollard]

The problem is that the schemes that currently exist are not having the effect that we need them to in Plymouth, because we have a crisis today.

I want to talk about the concern that a lot of GPs have expressed to me. My remarks will be about what GPs have told me, rather than my analysis of what I believe GPs are saying, because I think it is important that their voice is heard in this debate. Will the Minister meet those GPs so that they can raise their concerns in person? There are a number of GPs who have solutions or suggestions about what can be done.

At the moment each GP in Plymouth has about 2,364 patients. As we heard earlier, the average is about 1,700, so there is a greater demand on the GPs we have in Plymouth. One GP told me last night:

“I’ve just walked in the door after a day where I saw my first patient at 0825 and left my last patient’s home at 8.15pm. Because the district nursing service is currently unreliable (through no fault of their own), I will go back to the latter at 0800 tomorrow as the patient is housebound and needs blood tests.”

He went on to say:

“A large part of the pressures on...GP’s is the fact that other community services have had such drastic cutbacks.”

He said:

“I feel very...lucky to have a secure well-paid fascinating and rewarding job but it is all a little overwhelming and I constantly worry that just one major problem will mean things become very, very unsafe.”

[Alex Chalk (Cheltenham) (Con)]

Will the hon. Gentleman give way?

[Luke Pollard]

I will continue, if I may. Apologies.

Another GP, Dr Williams, said that the system is failing and it feels as though it might be intentional. GPs have heard NHS England say that it is watching Plymouth as a place where primary care could fall over, a sentiment that several GPs have expressed to me in private. They believe that Plymouth’s city-wide system is facing bigger concerns in primary care than elsewhere. A meeting with the Minister is vital, so that he can reassure those GPs that the Department of Health and NHS England are on top of this.

Another inner-city GP said:

“I became a GP to help people with physical and emotional health difficulties and this is a job I have really enjoyed for a number of years. During this time patient needs and demand on general practice has increased significantly but unfortunately funding has not kept pace...We only get...£115 per patient per year to provide the totality of patient care so it’s no surprise we are struggling when some patients consult us at least once a week.”

The general medical services contract includes between £73 and £117 per patient, but as we have seen in Plymouth where GP surgeries have fallen over and emergency providers have been brought in, there can be as much as £347 per patient under emergency access contracts. There seems to be a huge financial gap there that could be moderated by supporting GPs—not by giving them more money themselves, but by providing support and assistance so that they can hire more GPs, and by supporting the other professions that make for a successful GP practice.

Worryingly, the doctor I referred to said:

“I no longer enjoy being an NHS GP because I cannot keep pace with demand and I know our patients are getting frustrated with restricted access to their GP. Patients are complaining, and rightly so, but those complaints just compound my loss of joy from the job because I’m working harder than ever to try and provide the service patients want but the majority of feedback we get is negative.”

That has been echoed by a number of GPs in Plymouth, who really want to inject the joy and passion back into their role. They entered the profession not because it was easy—it was hard and difficult—but because their efforts would make a huge difference to their communities.

[Alex Chalk]

Will the hon. Gentleman give way?

[Luke Pollard]

I will continue, if I may.

I am genuinely worried that Plymouth’s primary care crisis is going to get worse in the coming days. We know that there are GPs who are considering whether to renew or to hand back their GP contract—a decision that will be made in the next couple of days. That is deeply worrying not only for them, but potentially for patients.

My GP surgery in Plymouth closed recently, so I know what it is like to lose my GP. At the moment I am especially concerned about people who do not reregister with a new GP, effectively becoming an unregistered cohort of people in the city who then can rely only on acute A&E services. Our staff at Derriford A&E do an absolutely fantastic job, but they cannot keep going if there is a continuing crisis.

The Plymouth Herald reports that a third of GP surgeries are at risk of closure as vacancies in primary care escalate. Will the Minister meet Plymouth GPs so that they can raise concerns directly with him? There is an opportunity to avoid the crisis getting any worse through proactive measures. I do not want to see the crisis getting worse and then more emergency access having to be put in place as GPs who have worked beyond the point of exhaustion hand back their contracts. That decision can be justified because of the pressure on them and their families, but we can avert that situation if we take action today. I hope the Minister will address that in his remarks.