GP Services

Natascha Engel Excerpts

Thursday 5th February 2015 Commons Chamber

[Natascha Engel (North East Derbyshire) (Lab)]

It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow) who, in his previous role as Minister responsible in this area, gained a wealth of knowledge of primary care, mental health and social care, something I want to pick up on in terms of GP services.

I do not want to repeat everything that has been said before, but without a doubt GP services are facing a real crisis. Everybody has mentioned how many people use their GPs. Most people have a GP. Over 90% of all contacts made in the NHS are made through GP services. GPs and GP practices are the absolute bedrock on which the NHS is founded, so we must get this right. At the moment something is going very, very wrong.

I want to put this in context. The hon. Member for Clacton (Douglas Carswell) said earlier that this was about patients, not doctors. Unless we get right the framework in which the doctors are working, it is the patients who suffer. We also need to understand that, over the last 20 years, the number of GP consultations has risen by 25%. There are many more appointments, without the system having changed that much to accommodate that. The average person now sees a GP six times a year, which is double what it was a decade ago, but the word “average” hides something. I represent a constituency with quite high levels of deprivation, but there are a couple of perfectly well-to-do areas where the GP services are not in crisis and are absolutely fine. The problems are in those areas of greatest deprivation. Arguably those are the areas that most need GP services to be running as well as they can. It is also where GPs are under such a lot of strain; some are retiring early and others are not going into GP practice in the first place. I want to emphasise that if a person is deprived, they will use their GP services as much more of a lifeline than others who go to see their GP.

My hon. Friend the Member for Walthamstow (Stella Creasy) spoke passionately on behalf of her constituents. We found in one of our practices where services were starting to crumble that problems compounded each other. Once things start to go wrong, there is a terrible domino effect. A high number of patients are signed up to my practice and one of the partners retired. That one retirement caused the GP practice to go into crisis. We can all sometimes make the situation worse by highlighting an individual practice, in order to try to help as much as possible, and saying that it is in crisis. That means that GPs will not then apply to work there, when actually the issue is not about that one practice; it is one piece of an entire jigsaw. Patients then leave that practice and sign up at a neighbouring practice, causing that practice to go into crisis. We need to look at this not from the perspective of North East Derbyshire or Walthamstow, but as a national problem.

[Mr Jamie Reed (Copeland) (Lab)]

Does my hon. Friend share my concern that unless we as a country address these problems quickly, holistically and in a detailed way, we run the risk of creating a two-tier NHS service, in which those who, as she rightly points out, most need care are less able to access it?

[Natascha Engel]

Absolutely. I am deeply concerned about that, and about where the pots of money are that people are accessing. I will come to that in a moment. One thing I hear a lot locally is, “The problem is that we are all living longer.” Of course it is not a problem that we are living longer; it is fantastic, but we need to change the way we look after people as they get older. The problem is not just dementia, cancer or heart disease; diabetes, as we have heard, is an absolute killer. We need to invest much earlier to make sure that people can manage their illnesses or, hopefully, avoid them altogether. GPs have a fundamental role in that.

What I really wanted to talk about was the interconnection locally. We have had enormous cuts to the budgets of local authorities. Derbyshire county council, which is responsible for social care, has had its budget slashed to a point where it is difficult to provide the levels of care that were provided before. I have a sheltered housing facility called Mallard Court, where 50 people are living independently because they have a warden service. That warden service and the care line allow people to live active, social and healthy lives with a minimum level of support. Cuts to local authority funding mean that that social care can no longer be provided. We are looking at finding other ways to provide it, but taking that warden away means that those people will, in a matter of weeks or months, go into crisis, whereas now they are living independent lives. In looking at GP services, we need to look at that issue as well, as it is the local GP practices who will feel all the pressure of those 50 individuals.

That goes back to my point about pots of money and the ring-fencing of them. We can have social services, GP services and acute care in different places, which sucks up all the money in the NHS. Unless we start to look at all of this, as my hon. Friend the Member for Copeland (Mr Reed) said, as one big picture, the solutions will not be found.

Younger generations are much more demanding, and people have access to the internet. It is good that people are more demanding. That gives a rocket boost to the NHS by making people develop and keeping them on their toes, but we really need to make sure that people are realistic in their demands. The group of practice managers that I meet regularly—they have joined us here today—would say that it is a question of people being realistic in the demands they make on GP services. As MPs, we need to promote that.

I want to talk about normal GP practices. Most of my practices have multiple members. At the moment, there is immense stress and strain on GPs who are partners and own the building that the practice is in. Those employed just as GPs in the practices do not have the same pressure, financial uncertainty and risk that a partner does.

What often happens is that partners retire young and sell their shares in the ownership of the practice. People are not taking on that risk, but are instead working, often in the same practice, as locums. As locums, they can earn around £100 an hour, and that is before they start charging for additional things on top. Rather than having all that stress and strain, and never really having the time to take a step back and look at the bigger picture of where the GP practice is going, partners are standing down and working as a locum, doing the work that they want to do and getting highly paid for it; that is, so far as I can see, a no-brainer.

[Tim Loughton]

The hon. Lady makes a very good point. I, too, mentioned locums. Are not the pressures on and requirements of partnered GPs deterring many people? That is why it is easier for Worthing hospital to recruit doctors; it is looking to take on directly salaried GPs to place in the A and E department to relieve pressures there.

[Natascha Engel]

Absolutely, and we ought to look at the issue of ownership of GP practices quite quickly; perhaps more imaginative ways can be found of ensuring that NHS England and those in the areas finding things most difficult can take on ownership of individual practices and GP services. We need to consider all these different issues. The Royal College of General Practitioners has said that there is a shortage of 10,000 GPs, and we need to get on top of that urgently. We need to make it more attractive for GPs to go into practice. As the hon. Member for Clacton said, it is patients who suffer when there are not enough GPs in the service.

I have worked closely with Steve Lloyd, a GP who is chair of the Hardwick clinical commissioning group, which covers the southern part of my constituency. He took me through all the facts and figures, but the big point he made at the end was, “Cherish it or lose it.” I want to end on that note.