GP Recruitment and Retention

Michelle Donelan Excerpts

Wednesday 28th March 2018 Westminster Hall

[Bridget Phillipson]

I agree with my hon. Friend and I am sure his constituency, in common with mine, has significant problems with industrial illness and long-standing health problems, which means that we do not need just the national average number of GPs, or just enough to get by. To deal with the health need we face in the local population, we need a much better service to ensure that we drive down some of the health inequalities that most seriously affect communities such as mine and, I am sure, his.

More generally, constituents are also worried that changes to the GP workforce at their local practice are producing a less effective service. Many are concerned by rates of retirement, especially among family doctors with whom they have built up a close relationship over many years. They also believe that the overall decline in the number of family-run practices resulting from retirements is damaging the continuity of care they expect from their local practice.

On the securing of timely appointments, constituents who work full time are frustrated by restrictive booking systems and a lack of availability in the evenings and at weekends. Others complain that constraints in the system mean that the 10-minute consultation period is so strictly enforced that multiple appointments are necessary just to outline the problems that they face. Their frustration grows if they cannot see the same doctor on each occasion and have to repeat the same problems time and again.

There is a general sense among my constituents, and indeed in the comments posted on the House of Commons Facebook page ahead of this debate, that the pressures on general practice will only increase as more new homes are built in communities where public services are already under pressure.

[Michelle Donelan (Chippenham) (Con)]

Does the hon. Lady agree that the pressures have been compounded by the ageing population, by retirements and by an increase in expectations? Does she welcome the new hospital schools announced this week?

[Bridget Phillipson]

I will touch on all the points the hon. Lady raises as I continue through my contribution.

I am clear that addressing the housing crisis in our country should be an absolute priority for the Government, but I argue that building thousands of new homes without ensuring that the necessary infrastructure is in place to meet increased demand on health, transport and education services would be a recipe for disaster. Poorly planned housing developments that do not take account of local need will only undermine public confidence in supporting a housing revolution in this country.

It is not just our constituents who are concerned about the deteriorating state of general practice in the north-east. Just over 18 months ago I was contacted by the Sunderland local medical committee about the findings of a confidential survey of local GPs and practice managers, which showed that almost half of those surveyed had seen a large increase in their workload and a further 31% reported an increase to unsustainable levels. Although two thirds of practices had attempted to recruit new family doctors, many had found recruitment difficult, and a majority reported that patient care had been adversely affected by the failure to recruit and retain GPs, the increasing workload that imposed on existing GPs and the significant reduction in core funding allocated to their practices. As a result, 60% of Sunderland GPs and practice managers said that their practice was viable only for between one and three years, with many local doctors considering early retirement or a career change.

That survey highlighted the profound problems at the heart of general practice in Sunderland, further evidence of which was laid bare in statistics I requested from the Department of Health later in 2016. Those figures showed not only a shocking 25% reduction in the number of full-time equivalent GPs in the NHS Sunderland clinical commissioning group area between 2013 and 2015 but also an accelerating rate of decline from one year to the next. The way in which full-time equivalent GP numbers were measured changed in 2015, but the new methodology shows a continued decline of 9% in the Sunderland CCG area between September 2015 and December 2017.

I am sorry to say that the most recent figures for other parts of the north-east make for even more painful reading. In the Hartlepool and Stockton-on-Tees CCG area there was a 15% drop in numbers over the last two years. In the South Tees CCG area it was 14.9%. In the Darlington CCG area it was 13%, and in the Durham Dales, Easington and Sedgefield CCG area it was also 13%. I could go on, but it is obvious that the exodus of family doctors from the profession is having a serious impact on the number of hours being made available for general practice in our region.

As a result, the demand on family doctors who continue to soldier on is intensifying. Not one practice in my area has a lower ratio of patients to full-time equivalent GPs than the England average of 1,738:1. In fact, each and every practice is consistently and significantly above that. The situation will be similar, if not worse, in other parts of the north-east.

Coupled with the plummeting number of full-time equivalent GPs is the similarly concerning decline in the number of GP practices in the area, from 53 in 2013 to just 40 today. I accept that there are merits to the argument that consolidating practices makes them more sustainable in the long term by creating larger patient lists. However, it is really important to remember that practice closures can leave behind big holes in communities.

--- Later in debate ---

[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.”

--- Later in debate ---

[Dr Whitford]

I absolutely agree. As I have said, it is not particularly an issue in Scotland, but it is very much one in England. I know that it is being looked at under the new contract. Hon. Members may remember the Prime Minister’s challenge fund: extra surgeries at the weekend are better paid and do not involve the same indemnity issues as going to do a stint at the local out-of-hours. Unconsidered consequences of that kind must be looked at.

There is obviously increasing demand. We talk negatively about the ageing population, but living longer is a good thing, and I would like to recommend it. I spent 30 years trying to achieve it. In Scotland the number of GPs increased by 9% between 2005 and 2015, but the number of patients over 65 increased by 18%. Obviously, much innovation across the UK is to do with trying to reduce workload. Scotland was first to get rid of the quality and outcomes framework, which had encouraged significant quality improvements but grew into a huge bureaucratic machine. We are working on developing the multi- disciplinary team, with physios, access to counsellors, and pharmacists. That is happening in England as well. One innovation in England is known as “time for care” and concerns extra training at the frontline—reception—to encourage triage of patients to the right member of the team. However, my attention has been caught by the development of a new app that allows patients to book appointments directly; that would remove the option for triage. It is important for innovations to be joined up.

We need to innovate and to use all community resources. Scotland has for 10 years had community pharmacies providing minor ailment services. Our optometrists are allowed to make direct referrals to hospital for cataracts, and now they treat 90% of all acute eye problems. Those are things that may at the moment be referred to general practice simply to ask for a letter to be passed on. That is a waste.

There has, obviously, been a climb in the number of practice vacancies, including in Scotland. Our whole-time equivalent has fallen, in the past three years, by 1.9%—in England the figure is 2.8%. There has been a 50% increase in the number of GPs taking early retirement, at the age of about 57. Some of that is because of the change in pension tax rules. The problem of having too big a pension is a nice one to have; however, if people who invested 40 years ago in very expensive added years are finding suddenly, as they approach retirement age, that that means they are accruing no further pension, we have a problem.

Brexit is definitely a threat. In Scotland, 3.5% of the health and social care workforce—and 5.8% of doctors—are from the EU. In London the figure is 14%. We know that 14% of EU doctors in Scotland, and 19% in England, are already in the process of leaving and, as has been said, that is simply because they feel unwelcome. As we have seen with the difficulty of getting tier 2 visas over the past four months, recruiting from outside the EU is a real issue. Businesses in London can increase someone’s salary to get past the limitations, but the NHS is not able to be so flexible.

[Michelle Donelan]

Does the hon. Lady agree that we also need to tackle social injustices to ensure that the most disadvantaged in our society have the confidence and know-how to pursue a medical career? Does she welcome Government programmes to tackle that?

[Dr Whitford]

I absolutely welcome them. Similarly, in Scotland the new graduate medical programme will take on people who have done other degrees, and that is particularly aimed at encouraging those people to go into general practice and rural practice.