Doctor Training

Mark Fletcher Excerpts

Tuesday 17th January 2023 Westminster Hall

[Mark Fletcher (Bolsover) (Con)]

It is a pleasure to serve under your chairmanship, Sir George. I thank my hon. Friend the Member for South Cambridgeshire (Anthony Browne) for putting together an incredibly eloquent argument on an important subject. I also thank the many doctors and nurses who work in our NHS. I declare a small interest in that I worked in healthcare for a little while, in particular around general practice, which is the topic I will focus on.

My hon. Friend touched on some of the workforce and planning pressures we are facing. It is important to reflect on some of the trends he touched on, particularly the geographical disparities—the doctor deserts that he mentioned. It is also worth reflecting on the fact that we have 35% more doctors now than we did in 2010, yet we feel like we need so many more. There are some shifts underlying that, including more part-time working; yes, we are seeing some doctors return, and some doctors leave through work stresses, but working practices are changing. Our ageing society and the demographic challenge in healthcare is another real issue, but it is worth bearing in mind that the rest of the world is evolving. We use technology more and more, and the way in which we interact with each other is changing more and more, but we are not necessarily doing the same when it comes to healthcare. We are incredibly wedded to a bricks and mortar, 1980s-style of healthcare.

I want to touch on the question of what we want the doctors we are training to do. That may seem like a strange question, but doctors—particularly those in general practice—have become almost a catch-all for all the problems we are looking to solve. Without identifying what the different strands of healthcare can do, we are creating a crisis in almost every bit of it. General practice is not working, and in my opinion is a model that needs reforming almost entirely, but that is creating a huge strain on our hospital system. When it comes to training young people, it is worth bearing in mind that there are three times more applicants to study medicine than there are places available; it is not that people do not want to become doctors. I know my hon. Friend the Member for Wantage (David Johnston) is going to talk about the people who want to become doctors, so I will not steal his thunder, even though he has a really good stat that I like a lot.

We need to look at the doctors we are hiring. I agree with my hon. Friend the Member for South Cambridgeshire that we need a covenant to say that people need to stay working in the NHS, although I do not think five years is anywhere near long enough because it costs £230,000 to train a doctor. If we are going to ask doctors to stay in the public sector, as we absolutely should, we need to square up with them and say, “Actually, we can use technology in a completely different way.” For example, people who are under 50 and have no underlying health conditions should be able to see a doctor in another part of the country using technology. That would help to solve a huge issue. We should train doctors to use technology for communication and for monitoring. We do not do that, despite huge advances on that front.

We also need to square with the public what healthcare is meant to be. I agree with many comments made about other aspects of healthcare, particularly regarding the way community pharmacists and diagnostic centres can take away some responsibilities from doctors. There is no point in hiring another 7,500 doctors every year if we reinforce the problems that are already built into the system.

Given that I have only five minutes to speak, I would like to finish with the thought that if we are going to try to train more doctors, let us use them wisely and think about the role they can fulfil. We are a long way from full utilisation, especially in general practice.

--- Later in debate ---

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this morning, Sir George. I thank the hon. Member for South Cambridgeshire (Anthony Browne) for bringing this important debate to Westminster Hall, and I praise the contributions of all Members, which covered the whole host of issues affecting the NHS workforce.

We have heard throughout the debate that we must train more doctors, yet this summer the Government cut medical school places by 30%, turning away thousands more straight-A students from training to become doctors when we need them more than ever, with the NHS in the midst of a chronic workforce crisis and people finding it impossible to get a GP appointment or an operation when they need one. We have 7.2 million people waiting to start planned NHS treatment; the Minister will want to know that that is nearly triple the number in 2010, when Labour left power.

As we have heard, there are over 133,000 NHS vacancies, 10,000 of which are for doctors. There are simply too few doctors to meet demand. The latest Royal College of Physicians census found that 52% of advertised consultant physician posts went unfilled in 2021, the highest rate since records began. I am therefore really pleased that we are discussing this issue today.

We cannot build a healthy economy without a healthy society, and we cannot have a healthy society without training more doctors. The chief executive of the NHS, Amanda Pritchard, said recently that more medical school places are needed. However, I worry that the Government are being short-sighted and are unwilling to provide those places. It was only recently that they finally heeded their own Chancellor’s calls to assess workforce needs.

The Government are missing open goals. This weekend, we heard that the Three Counties Medical School at the University of Worcester, a new school set up to boost the number of doctors in England, has been told that it will not receive funding for domestic students. This sounds mad but, during a massive crisis in the number of doctors, the Department of Health and Social Care is maintaining its cap on the number of university medical school places that it funds.

The University of Worcester says that, next year, it will have to recruit only international students, who are less likely to stay and work locally. That is despite the NHS Herefordshire and Worcestershire integrated care board spending over £70 million a year on locum and agency staff because it does not have enough doctors. Thousands of straight-A students are being turned away from studying medicine and the Government have no long-term answer or solution.

Members will not be surprised to hear that Labour does have a plan for the NHS—the hon. Member for South Cambridgeshire referred to it. Labour will double the number of medical school places from 7,500 to 15,000, train 10,000 extra nurses and midwives every year, double the number of district nurses qualifying each year and create 5,000 more health visitors. That will be paid for by abolishing non-dom tax status, because patients need treatment more than the wealthiest need the tax break.

[Mark Fletcher]

Will the hon. Lady give way?

[Feryal Clark]

I do not have much time, so I am going to continue.

The Government could have adopted Labour’s policy, which the Chancellor himself said that he agrees with. In an email to supporters of the patient safety charity that he founded, he wrote:

“The medical school place increase is something I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”

I would be grateful if the Minister set out why his party has decided not to listen to its own Chancellor.

Let me turn to retention. We need to train additional doctors—we have heard no opposition to that in today’s debate—but we must also focus on keeping the doctors that we already have. More than three quarters of respondents to a December 2022 survey of Royal College of Physicians members said that they were very or somewhat stressed at work, with clinical workload and staff vacancies in teams being the leading factors. The 2021 NHS staff survey found that 31% said they often thought about leaving. The Royal College of General Practitioners 2022 GP survey found that 42% of GPs say that they are planning to quit the profession in the next five years. I would be grateful if the Minister considered job satisfaction, and therefore retention of current staff, and set out what the Government are doing about that.

Existing doctors need support and additional training so as not to get burned out and to stay in the role, and training of new and current staff cannot come soon enough. Patients and NHS staff cannot afford to wait. I look forward to the Minister’s response.