GP Services

Philip Hollobone Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg (Halton) (Lab)]

I beg to move,

That this House notes the vital role played by local GP services in communities throughout the UK, with an estimated one million patients receiving care from a family doctor or nurse every day; believes that the UK’s tradition of excellent general practice provision is a central factor in the NHS being consistently ranked as one of the world’s best health services by the independent Commonwealth Fund; expresses concern, therefore, that the Royal College of General Practitioners (RCGP), through its Put patients first: Back general practice campaign, is warning that these services are under severe strain, with increasing concerns raised by constituents about access to their GP and 91 per cent of GPs saying general practice does not have sufficient resources to deliver high quality patient care; further notes that the share of NHS funding spent on general practice has fallen to an all-time low of 8.3 per cent, and that over 300,000 people across the UK have signed the campaign petition calling for this trend to be reversed; welcomes the emphasis placed in NHS England’s Five Year Forward View on strengthening general practice and giving GPs a central role in developing new models of care integrated around patients; and calls on the Secretary of State for Health to work with NHS England and the RCGP to secure the financial future of local GP services as a matter of urgency.

I am grateful to the Backbench Business Committee for providing the House with the opportunity to debate the important subject of sustainable GP services. I am also grateful for colleagues’ support for the debate application. Some of those Members are here, including the hon. Member for Brighton, Pavilion (Caroline Lucas), who spoke in the Committee in support of the application as a co-sponsor.

The debate is timely, given the increasing pressures on the NHS and its hard-working staff. I put on record my appreciation for the hard work and dedication of doctors, nurses and all the staff who work in our health service. Their dedication is keeping the health service going at a particularly difficult time. I also want to put on the record my thanks to the Royal College of General Practitioners for its support, the information it has provided and its campaign.

One of the key reasons for seeking the debate is that, increasingly, constituents have been contacting me to tell me that it is becoming more difficult to get an appointment with a GP of their choice without having to wait many days or even weeks. Sometimes they are not able to see the GP of their choice at all. That, of course, varies between practices. There is no doubt that the overwhelming majority of GPs do an excellent job. That has been demonstrated by patient surveys, but there is always room for improvement.

There is little doubt about the growing demands on general practice caused by demographic changes and more complex health needs, exacerbated by an ageing population. Increasingly, a large part of GPs’ daily work load is on mental health, which would probably merit a debate in itself. That matter needs to be addressed continuously.

[Mr Philip Hollobone (Kettering) (Con)]

I am enjoying the start of the hon. Gentleman’s speech immensely. He has raised an important issue for my constituents. Does he agree that there are also demographic pressures within the GP service in that many of them are in their 50s and about to reach retirement? All of a sudden, we will have a dearth of experienced GPs, which will be a difficult gap to fill.

[Derek Twigg]

The hon. Gentleman raises an important point and he is absolutely correct. I will refer to that later in my speech.

There can be no doubt that GP recruitment has not kept up with the demands of our population. That is the key problem today. In addition, the pressure on hospitals has increased massively because if people cannot see their GP they often go to A and E. That has been a problem in areas such as mine. There is also the inability of hospitals to discharge frail, elderly people from wards into the community because of the shortage of care in the community. Councils face massive budget cuts, so there are pressures all round. There are pressures on GPs in relation to access and there are pressures on hospitals and elsewhere.

I want to raise a particularly important point with the Minister that I have raised before. The Government are proposing to demand a 3.8% efficiency saving in the national tariff for 2015-16. That will push many hospitals to breaking point and possibly endanger patient safety. I hope that the Minister will look at that again. Members should read the briefing on that from NHS Providers.

There is clearly a view among many that general practice is heading for some sort of crisis. One GP in Halton told me recently:

“The overwhelming problem is the manpower crisis and the rock bottom morale of the Profession, which are interlinked. We are unable to recruit new GPs into practice or medical students into our specialty, training places are left unfilled and there are vacancies all over the country with very few applicants.”

It is hardly surprising we have that problem when we consider what the RCGP has said:

“Funding for general practice has fallen to an all-time low of only 8.3% of the overall NHS budget…GP surgeries are now seeing 372 million patients a day, compared to 300 million a day in 2008.”

Some family doctors are seeing 40 to 60 patients a day. That is unsustainable in the long term. Some 49% of GPs say that they can no longer guarantee safe care to their patients.

The RCGP tells me that the average coverage is 6.9 GPs per 10,000 of population. That is the lowest level of coverage since 2011. The RCGP estimates that up to 543 practices in England could face closure due to the fact that 90% of GPs working in those practices are 60 or over or are likely to retire soon. The hon. Member for Kettering (Mr Hollobone) made that point.

Child and Adolescent Mental Health Services

Philip Hollobone Excerpts

Monday 2nd February 2015 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

Which is the best CAMHS service in the country, why can it do it when others cannot, and what is stopping its best practice from being copied?

[Norman Lamb]

My hon. Friend makes an important point, and there are many excellent mental health services, as the hon. Member for somewhere in Birmingham—[Interruption.]—for Halesowen and Rowley Regis (James Morris), said earlier. If some areas can do things well with the available resources, then other areas can too. It is also true that some areas have chosen to cut funding for children’s mental health, in my view inappropriately.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 13th January 2015 Commons Chamber

[Norman Lamb]

The Nicholson challenge, which was published in the last year of the Labour Government, recognised that the whole system had to deliver efficiency savings, and I think that everyone understands that. But the answer to all of this is a significant shift of emphasis towards preventing ill health and preventing crises from occurring. Under the better care fund the NHS and the care system are for the first time being properly joined together.

[Mr Philip Hollobone (Kettering) (Con)]

The Northamptonshire clinical commissioning groups and Kettering general hospital are agreed that Kettering’s A and E department is too small and outdated and needs to be replaced with an urgent care hub in line with the NHS five-year forward view. Given that the three local MPs on a cross-party basis refused to treat our local A and E as a political football, will the Minister of State encourage his colleague, the hospitals Minister, to consider that proposal seriously when we come to see him this afternoon?

[Norman Lamb]

I understand that a meeting will take place very soon, and I certainly encourage my hon. Friend the hospitals Minister to ensure that he listens to the case being put by the hon. Gentleman and his colleagues this afternoon.

A and E (Major Incidents)

Philip Hollobone Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Speaker]

Order. A very large number of hon. and right hon. Members are still seeking to catch my eye. As always, I am keen to accommodate as many as possible, but I simply point out to the House that there is a statement to follow by the Secretary of State for Northern Ireland and other business. I therefore appeal to the House to help me to help individual Members. That is to say, prolonged statements prior to questions are undesirable. Pithy and succinct questions are the order of the day, in which important exercise I think we can be led by an illustrious parliamentarian, Mr Philip Hollobone.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?

[Mr Hunt]

I think that my hon. Friend should always be able to count on being received warmly and favourably. There are particular pressures in Northamptonshire. I am planning to have a conversation with the chief executive of Northamptonshire county council in the next week to see whether there is anything more that can be done to facilitate discharges and relieve the pressure at Kettering.

UK Ebola Preparedness

Philip Hollobone Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right that we need all countries to play their part. We have been very involved in international efforts to try to ensure that other countries, particularly in Europe, play their part as we in the UK have been doing. I commend her constituents who work at the Royal Free for their remarkable work, which really is world beating and incredibly impressive. It is also very challenging. The situation that Pauline is in is very difficult for them to cope with, but they are doing so with the highest levels of professionalism. On rural areas, DFID has been focused from the start on how to ramp up community care in rural areas. She is right to say that that is a very important priority.

[Mr Philip Hollobone (Kettering) (Con)]

I thank the Secretary of State for the tone and content of his statement. Nevertheless, I think my constituents in Kettering would have two concerns about the Pauline Cafferkey incident. First, what my constituents do not understand is why, when this health worker reported feeling unwell, caution was not prioritised and she was not tested before travelling, as we now know on a crowded underground train into the centre of London. Secondly, I understand that she travelled back to this country with quite a large number of other health workers. When an airport knows that a large number of health workers are about to descend on it, why are resources not in place to deal with quite a large number of people all in one go?

[Mr Hunt]

We have learned the lessons to speed up the process so that people, I trust, will not have to wait as long. One of the lessons we learned in the Christmas period is that we do not want people to have to wait as long. I want to stress to my hon. Friend—perhaps he could stress this to his constituents—that the clinical risk of contracting Ebola from sitting next to someone who is not exhibiting feverish symptoms is very low. That is why the clinical advice was, and remains, that it is perfectly safe for someone to travel on a train if they are not displaying the symptoms. We want to go further, however. We recognise that we do not know everything about this disease and therefore want to be precautionary. That is why we have said that if people in the high-risk categories—those who have had contact with Ebola patients—say they are unwell, we will have a different protocol going forward even if their temperature is within the normal range. I hope that will reassure his constituents.

General Dental Council

Philip Hollobone Excerpts

Tuesday 9th December 2014 Westminster Hall

[Dr Poulter]

If we look at similar organisations, we see that the GMC, for example, has similar practices and processes. The Nursing and Midwifery Council has a very small fee rise, but has seen a similar section 60 process take place. All those regulators, in my view, have taken every step possible to look at their annual fee in the context of the section 60 orders, and with the mindset that any fee rise needs to be fully evidence based and appropriately proportionate. From my conversations, and from the practice of other health care regulators, I think that there is very good evidence that that is a consistent pattern of behaviour. As I said, the GDC’s fee rise is unprecedentedly large, and its behaviour is not consistent or in keeping with that of any of the other health care regulators, from what I can see.

In addition to the GDC-related section 60 order, the Government are taking forward a number of key pieces of secondary legislation in this Parliament to address priority areas that we have identified after discussion with the regulatory bodies and other stakeholders; I mentioned other section 60 orders. We are also working on a response to the Law Commission’s valuable work on proposals for more wide-ranging reforms.

I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties. However, that decision provides an opportunity to invest time in ensuring that that important legislative change is got right, for the benefit of those who will ultimately be affected by it. My hon. Friend outlined very articulately some of the challenges that need to be considered in putting together the Bill. We are committed—I would like to put this on the record again—to bringing forward primary legislation to address wider reforms to the system of professional regulation when parliamentary time allows, but in the meantime, working with the regulators, we have put in place, or have in train, a number of section 60 orders. They are about streamlining processes, providing efficiencies to the regulators and, most important of all, protecting patients and the public.

Let me say a quick word about the GDC’s general performance. It is very important that the GDC manages its rising volumes of complaints as well as the other issues raised by the Professional Standards Authority as part of its annual performance review. In due course, the GDC will need to demonstrate what it has done to address the recommendations made.

Hon. Members may be aware that the Professional Standards Authority is also conducting an investigation of the GDC after claims were made by a whistleblower about the management and support processes of the GDC’s investigating committee. I understand that the Professional Standards Authority has concluded the evidence-gathering phase of the investigation, is in the process of compiling the investigation report, and will provide that report to the Select Committee on Health and publish it on its website in due course.

I have outlined a number of issues and concerns about the unprecedentedly high rise in the GDC fee. As we have discussed, it is out of keeping and inconsistent with the behaviour of many other health care regulators. I am not convinced, from the evidence that I have been presented with, that there is a strongly evidenced case to support that fee rise, and it goes against Government policy, which is to encourage regulators to set appropriate and proportionate fee rises, to show restraint where appropriate and to be mindful of the effects of fees on registrants.

I want to make it clear, in drawing to a conclusion, that I am not raising any doubt about the fact that the GDC continues to fulfil its statutory duties. However, it will need to make significant improvements to meet the challenges set out in the annual performance review undertaken by the Professional Standards Authority. Registrants, patients and the public need to be able to have confidence in the performance of the GDC and to see improvements in its operation, effectiveness and efficiency. I hope that I have answered all the points raised in the debate, and I again thank my hon. Friend the Member for Mole Valley for raising a very important issue that I am sure is filling many MPs’ postbags.

[Mr Philip Hollobone (in the Chair)]

I thank all hon. Members who took part in the debate.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

This is what the EU chief negotiator said to the former Labour shadow Health Secretary, who is chair of the all-party group on TTIP:

“the rights of EU Member States to manage their health systems according to their various needs can be fully safeguarded…There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.”

It could not be clearer than that.

[Mr Philip Hollobone (Kettering) (Con)]

4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

In 2012-13 there were 85,497 in-patient finished consultant episodes at Kettering General Hospital NHS Foundation Trust, compared to 84,602 in 2011-12. There has also been an increase in the number of accident and emergency attendances, from 76,099 in 2010-11 to 84,055 in 2012-13. That increase is largely attributable to a high demand for services from a growing, ageing population.

[Mr Hollobone]

Kettering general hospital serves one of the areas with the fastest population growth and greatest ageing in the whole country. Today’s report from the Care Quality Commission shows that, while the hospital has some of the most caring staff in the whole of the NHS, many areas of the hospital require considerable improvement. Will the Minister ensure that future NHS funding decisions are better targeted at areas such as Kettering which have such costly demographics?

[Dr Poulter]

My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.

Five Year Forward View

Philip Hollobone Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Perhaps the simplest thing is to say to the hon. Member for Edinburgh East (Sheila Gilmore) that we inherited one of the poorest performing economies in Europe. We now have the fastest growing major economy in Europe and that is the best possible future for the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

The report makes it clear that with an increasing population and increasing proportion of elderly patients, the role of GPs will become even more important, yet the demographics of the GP profession mean that we will lose thousands of GPs to retirement in the next few years. What can be done to address this very important problem?

[Mr Hunt]

That is a very important issue and we need more GPs. We have about 1,000 more full-time equivalent GPs during this Parliament but we face the demographic issue that my hon. Friend identifies. That is why we are looking at how we can make it easier for GPs who have stopped practising, perhaps to have a family, to come back into the profession, and how we can make it easier for GPs to do part-time work. We are looking at all those issues because we are committed to reducing the burn-out that many GPs experience by improving and increasing the number of GPs actively practising.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

I welcome the fact that Labour is thinking about how to improve our performance on cancer, because in 2010 we had the worst cancer survival rates in western Europe. I gently say to the Labour party that the issue is only partly about the amount of time it takes to get a hospital appointment when one has a referral; a much bigger issue is the fact that we are not spotting cancers early enough in the first place. That is why I hope that Labour will also welcome the fact that in this Parliament we are on track to treat nearly 1 million more people for cancer than we did in the previous Parliament. That is real progress of which the whole House can be proud.

[Mr Philip Hollobone (Kettering) (Con)]

While it is working with one of the most outdated A and Es in the NHS, and one that will require fresh capital investment, does the Secretary of State recognise the tremendous improvement at Kettering general hospital’s A and E, which in the past year has gone from one of the worst performing to one of the best performing in the country?

[Mr Hunt]

I absolutely recognise that, and I congratulate my hon. Friend on the very close interest he takes in what is happening at Kettering hospital. I have visited the hospital, as he knows, and think that it is working very hard and that it offers a very good example of how, even when times are tough, finances are tough and there is increasing pressure from an ageing population, it is possible to increase and improve A and E performance. It has done a terrific job.

Ebola

Philip Hollobone Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The hon. Lady makes an important point, but I reiterate the point I made earlier to another hon. Member. The risk level to the UK general population remains low, so the measures we are taking are precautionary because of a possible increase in that risk level. As part of that, we are sending advice to everyone we think might be in contact with anyone who says that they have recently travelled to the Ebola-affected areas and who displays those symptoms. That is why alerts have gone out to hospitals, GP surgeries and ambulance services to ensure that they know the signs to look for and are equipped with that important advice.

[Mr Philip Hollobone (Kettering) (Con)]

To cross a typical western international border illegally, one needs a passport and passports are meant to have stamps in them. What steps are we taking with the seven most affected west African countries to ensure that they stamp the passports of people who go into and leave those countries so that we can readily identify the stamps in their passports should they come to the UK? What extra resources is Border Force putting into checking the stamps in people’s passports when they come to the United Kingdom?

[Mr Hunt]

I will get back to my hon. Friend with the exact details of what is happening with passport stamps, but I reassure him that we are working very closely with Border Force officials and we have a high degree of confidence that we will be able to identify the vast majority of people who travel from the most directly affected countries within the recent incubation period of the virus. It is important to remember that that incubation period is 21 days, so we are looking at the previous three weeks. We have a high degree of confidence, but I will get my hon. Friend information on whether passport stamps could be an additional source of security.