GP Services

Mark Reckless Excerpts

Thursday 5th February 2015 Commons Chamber

[Mark Reckless (Rochester and Strood) (UKIP)]

I thought that GPs had it rather good after their new 2004 contract. They were able to give up out-of-hours care on attractive terms, they saw their pay go up, and there was a system of quality and outcomes framework points which saw many GPs and practices move towards the maximum numbers quite quickly in what seemed to be more of a box-ticking exercise than had been anticipated, and for which there was further income.

However, the more I have looked at this and the more I have spoken to GPs in recent years, the more sympathetic I have become in relation to the pressures under which they operate. There clearly has been a great increase in demand for GP services. There is not agreement on the causes of that or on the importance of various factors, but several factors clearly have played a part. One of them is our population rising by close to 4 million in a decade. A significant part of that is due to immigration, and some is due to natural increase. The population is also ageing, which drives greater demand.

I am also concerned about the change from NHS Direct to the 111 service. I do not pretend to be an expert on this and to be able to give a definitive view, but there is at least some evidence to suggest that the 111 service with untrained staff, or at least not qualified nurses, taking calls has a significantly greater tendency to err on the side of sending people to their GP than the NHS Direct service did, and that that has been at least a partial cause of the increase in NHS demand.

There is great variety in how often people go to their GP. I am not a regular attender, although I have two young children and lean more towards going—and certainly taking them—than I did in the past. I think people generally come to fairly sensible judgments as to when they need to see their GP and when they can deal with a situation themselves or by visiting a pharmacy. I am not sure it is helpful to have a 111 system that leans so far in favour of being on the safe side and recommending people go to their GP. Clearly the 111 operators and the people running that service do not want to be blamed if someone is not sent to a GP or for medical intervention when they need it. On the other hand, they need to understand that if large numbers of people are sent on to those services when they do not strictly need to be, that will mean others do not get appointments and might not get the treatment they need.

Medway has seen significant population growth. We have particular challenges, but I am extremely impressed with our CCG and in particular Dr Peter Green and Dr Nathan Nathan who lead it. They have a go-ahead, ambitious attitude to what they can do both in their commissioning generally within the health service and now in the very positive approach of co-commissioning with GP surgeries, with GPs in the lead. They know best, and it is a very good basis for making commissioning decisions. I recognise the potential conflict of interest GPs have in commissioning for GP surgeries, but it is good to lean more in favour of having services provided in GP surgeries rather than in hospitals. That can be a positive thing, and I hope the three different models and working with NHS England will be a success in getting the right trade-off in this area.

Medway wants to attract and retain more GPs. That involves in part promoting Medway as a place and showing the opportunities it offers, such as relatively good value housing for somewhere as accessible to London, and a very good and improving living environment in both our rural and urban areas. I had the opportunity myself recently to attract quite a lot of publicity to the constituency and in particular to Rochester, which I hope will be to the good.

We must also deal with the large number of single-handed GPs. Some of them deliver very good care, and there are one or two who, in a self-deprecating way, may say there is a reason why they are single-handed when they are pressed to do things differently. Of course, single-handed GPs have a place in our system, but I believe it will be good if we can persuade larger numbers of these single-handed practices, even some of the smaller ones, to work more closely and to amalgamate. They could share the fixed costs, do less administration and be able to see more patients, or even have more time off in some cases.

It is also key to show that GPs in Medway are doing extra and interesting things. I am particularly impressed by the work that has recently been done on familial hypercholesterolemia. I am interested in that because there has been a collaboration between Medway GPs and the charity Heart UK, which was co-founded by my father. I understand that there is shortly to be a study of the success of this programme in Medway in the British Medical Journal. That could be an example to other areas. This work has been able to identify hypercholesterolemia not in one in 750 people as before, or in the one in 500 that was suggested may be the rate across the country, but in close to one in 350. By identifying those who suffer from that condition, we can put in place preventive measures to improve health and prevent heart attacks as well as other negative medical developments. The GPs in Medway should be congratulated on this groundbreaking project, of which I am very proud.

Finally, on the difficulties in getting appointments at our GP surgeries, I recognise that there is no perfect appointment system that everyone will be happy with, but we have a particular challenge in the rural part of the Hoo peninsula. The Elms medical practice has its main centre in Hoo and outposts around the peninsula. I recently talked to people in Allhallows, which is perhaps 10 miles from Strood, and Grain, which is 13 miles away from other care and facilities. There used to be two GP medical practices in Grain, but now there is just one. I understand that it is open only between 9 am and 11 am three days a week, although some people in the village say it may not even always be available during those hours—but I would like to speak to the Elms medical practice before saying anything definitive on that. Similarly, I have spoken to many people on the doorstep in Allhallows and although many are satisfied with their GP services, there is a perception that they are not available for as many hours during the week as they should be, and that one day or morning may be set aside for training at certain times. Again, I will check whether that is correct. People in those areas feel under-served. We have talked about a great increase in demand for GPs, but I am not sure that the supply has responded, at least in these rural areas, where there clearly is a need for greater GP services.

In two practices in Rochester people have faced problems with the booking system. At one, people are not allowed to book in advance by telephone or they find it difficult to get through—a lot of hon. Members will be aware of similar stories. This practice then allows people who come in person and queue up outside to jump the queue of people who are telephoning in. I have seen a large number of elderly and often ill people queuing, before 7.30 am in some cases, to try to get an appointment. That cannot be right and I hope we can find ways of ensuring that people do not have to do that.

At another practice in Rochester a lady called up on 30 January to ask for an appointment only to find that the first one that can be offered to her is on 16 March. Waiting for more than six weeks for a GP appointment cannot be right. I am also told that people who book online have preference, and people such as this lady, who do not have internet access, are clearly at a disadvantage. It is also difficult to get through to the telephone booking system, and then it has eight options and only when someone gets through to option 8 are they even allowed to start making an appointment. I recognise that there is no perfect system, but I hope to work with these surgeries to improve their accessibility to the public. I would also like to thank all the GPs and those who work with them in Medway for the work that they do.