GP Appointment Availability

Rachael Maskell Excerpts

Tuesday 26th October 2021 Westminster Hall

[Joy Morrissey]

I thank the hon. Lady for her contribution. I agree that the problem has a trickle-down effect throughout the NHS. We will see more people presenting at A&E and perhaps with more advanced stages of disease, because they have not been seen in person. Encouraging GPs or creating a covid incentive programme for them to see people in person will decrease the amount of hospital admissions and lead to earlier diagnosis for cancer and heart disease. These things can really only be done in person. If someone is healthy and just needs a phone appointment, that is fine, but certain things cannot be seen unless a person’s vitals—their heart pressure—can be physically checked. Only a GP can do that and really only in person. If we want to reduce the overall burden on the NHS this winter, finding a safe and secure way for more residents to see their GP will reduce the overall pressure long term on the NHS. I know we have an aging population, and that GPs are under huge amounts of pressure and strain, but I believe there is a way we can work together to find a solution.

[Rachael Maskell (York Central) (Lab/Co-op)]

The hon. Lady said that only a GP can check someone’s blood pressure. We know that many people can undertake many of the different clinical functions that a GP is asked to undertake. Is it not right, therefore, to look at a multidisciplinary clinical team and how to deploy it better, rather than just to focus on the GP?

[Joy Morrissey]

The hon. Lady is stealing my thunder, but I agree with that comment. With the multi-disciplinary approach, even nurse practitioners and others could be recruited into a GP surgery structure, to help with many of the ailments that people are presenting at A&E with or asking for an appointment about. There is a wide range of healthcare professionals who could help and support GPs, and I think this is an important issue that needs to be further discussed and debated.

When this matter came before the House in July, several relevant questions were raised. One of them was about NHS England and NHS Improvement, or NHSEI, which leads the programme of work support practices, using digital and online tools to widen access. I would just love to hear what progress has been made since this topic was debated in July. Also, what is the progress of NHSEI’s independent evaluation of GP appointments? Again, I would like to see whether we have had any progress on that independent evaluation. Finally, what is being done by the NHSEI access improvement programme to support practices where patients are experiencing the greatest access challenges, such as drops in appointment provision, long waiting times, poor patient experiences or difficulties in embedding new ways of working related to covid-19, such as remote consultations as part of triage? I would really welcome any updates on those questions.

We could perhaps discuss today how we can provide GPs and their surgeries with some kind of in-person patient incentive during covid. Perhaps that could come from existing regional funding streams. Perhaps each time a GP sees a patient in person, they could receive an extra payment, or they could receive an additional payment for visiting someone in their home. That would mitigate the additional cost of PPE and also the additional risk posed to the GP themselves by having to see people in person during covid or high levels of winter flu.

Some GP surgeries are already receiving additional funding for cervical cancer and diabetes screening, and we have seen uptake increased in those areas very successfully, so this type of programme has been modelled in the past. It would help to mitigate the risk and burden for GPs, while still getting as many of our constituents as possible into in-person appointments if they need them.

The NHS claims that it would like more patients treated at home rather than having to stay in hospital for extended periods of time. This model could be enhanced if GPs were given the financial incentive to carry out in-home treatments for patients who traditionally would have remained in hospital. Obviously, this allocation would have to be set by the integrated care system in each region and it would be decided on within regional NHS structures, but it is worth considering.

In my own personal experience with my mother-in-law, she has been at home all the time 24/7. She is now completely disabled and needs 24-hour care, but the most difficult challenge was the out-of-hospital care provision—getting the GP, the hospital and the council to co-ordinate the care effectively. It is a full-time job for someone to co-ordinate that care. If we can make those pathways of care and co-ordination easier for everyone, then, as was said earlier in the debate, it would reduce the overall pressure on the NHS.

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[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve with you in the Chair, Mr Robertson. I thank the hon. Member for Beaconsfield (Joy Morrissey) for calling today’s important debate. Let me set out the challenge, and how Government can make a difference.

York Medical Group has 44,000 patients on its books. In a single calendar month, it received 41,000 calls from people who needed to see a clinician—unprecedented demand, with higher acuity, co-morbidity and complex needs. When patients get through to the call-handling system, they are triaged and, when urgent attention is needed, that is followed up by a clinical conversation. Appointments are allocated, tests are ordered, referrals are made, and prescriptions are issued.

Of course, people are also applying to see a practitioner through the internet or are turning up at the surgery. That is managed by exceptional staff, who are really pulling out all the stops to support their local community. However, this logistical agility to meet the serious demand is outstripped by the pressures placed on it. When spending time embedded in the system—as I did, spending time with call handlers and with GPs—I saw how relentless they were in trying to meet that demand, but that demand is continuing to put pressure on them.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My constituency is only 25 miles from my hon. Friend’s. A constituent came to see me last week; they could not get an appointment with their GP, but were told to go to the accident and emergency department in Leeds. It took two hours at the A&E to be triaged, and they were then told it would be a further six to seven hours to see a doctor. They ended up going home because it was too cold at the hospital to wait. Does this issue not impose pressure right across our health system, to the point that it is near collapse? Winter has not even properly started yet.

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[Rachael Maskell]

My hon. Friend hits the nail on the head. We cannot look at part of the health service without looking at the entire health service, and the pressures that are brought to bear. As we have heard, many people do go to their A&E or urgent care centre, because that is the only way that they know they can confidently access the service, which puts more pressure on those parts of the service. We must look at the whole.

However, when it comes to trying to engage with our community practitioners—that is what primary care is all about: people who would traditionally have known the patient and the family—medicine has changed so much, yet we have not caught up with where it is. I saw both the call handlers and the GPs facing burnout. They are reducing the number of sessions that they are working because, we must remember, a session then extends right through into the night, as they are catching up with paperwork, ordering tests and following things through. Individuals are just saying “If I don’t step back, it will have a serious impact on my own wellbeing.” We have got to protect the wellbeing of GPs. They are a precious resource in delivering our healthcare services.

[Margaret Greenwood]

My hon. Friend is making an excellent speech. Does she share my concern about the shortage of GPs? The Government have committed to having an extra 6,000 GPs by 2024 or 2025, I think. The pressures GPs are under is a direct consequence of the failure to address the issue.

[Rachael Maskell]

My hon. Friend raises the next point in my speech. We are in this mess because for over a decade we have had failed workforce planning across the system. We have seen that most acutely in primary care. The pandemic continues to be mismanaged, which I want to stress. The Government may be looking at the numbers when it comes to intensive care and hospital admissions, but as people are less sick they instead go to see their primary care physician. That puts more pressure on them. We need to see more measurements and data on the pressure that has been put on primary care during the pandemic. In addition, we have long covid as well. In York there are around 3,000 cases. It is not coded, so can the Minister get that sorted urgently? We need to look at the support that people with long covid require.

[Mohammad Yasin (Bedford) (Lab)]

In the Bedfordshire, Luton and Milton Keynes clinical commissioning group area, there is only one GP for every 2,500 people, making it one of the worst hit by GP shortages in the country. The number of GPs employed in the area also has fallen by 12% to 390. Does my hon. Friend agree that we need an urgent independent review of access to general practice, not a “name and shame” league table that will only drive more overwhelmed GPs away from their profession?

[Rachael Maskell]

Absolutely. My hon. Friend speaks for himself. We need a shift from a sickness service to a health service. The Government scrapped the health checks that were vital in picking up ill health. We need to see prevention at the front of the queue, and we need to see investment in public health, which is currently being cut by local authorities. We need to make sure proper preventive measures are put in place.

The fact that the Government are not moving to plan B right now shows that they are escalating the challenges on general practice rather than diminishing them. They are putting the vaccine responsibility on GPs when it can be done elsewhere in the service, as it was by Nimbuscare. We need to look at how not only health professionals but volunteers and the Army, even, are working together to deliver healthcare. We need to think about the broadest team available. Pharmacy also plays a crucial role in making sure that we are protecting the health service.

Looking at prevention, we do not necessarily need to move towards an individual, one-on-one health system for everybody. We can socialise and communitise health, so that people can get health support in active communities. Peer support is vital in managing disease and ensuring that people can support one another through ill health. Occupational health services can make those early interventions in workforces, often where mental health problems show up when there is stress in the workplace. There are real opportunities to expand those services and look at deploying early intervention and education to turn around this system. It will only happen if proper investment is made and proper workforce planning is put in place. The Government have got to get to grips with the figures on staffing and ensure that investment is in place.

Staff are exhausted, tired and downtrodden. The trauma of covid is hitting right now. We need to ensure that staff are properly rewarded through their pension scheme and with a decent pay rise. Get it sorted.

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[Maria Caulfield]

We are committed to increasing GP numbers, as in our manifesto commitment. However, that does not stop us increasing the numbers of other healthcare professionals. We need to get the message out to patients that seeing a nurse, physio or paramedic at the GP surgery is not second best. These are highly qualified, experienced and educated professionals who often are better placed—though I do not want to upset the shadow Minister—to see a patient than a doctor. They can make a considerable difference, but very often patients feel they are being fobbed off or seeing the second best. We need to do a lot of work to reassure patients on that.

We have already recruited 10,000 of the additional 26,000 staff we stated in our manifesto would be working in general practice by the end of 2023-24. We are strengthening our plans to increase the number of doctors in general practice. To reassure Members, so far we have filled a record number of GP speciality training places this year, with the latest data showing that there are already 1,200 more full-time equivalent doctors in general practice than two years ago. It is a challenge; I am not going to say it is not, but we are making progress.

I feel particularly passionate about the use of community pharmacists. In many other countries, the pharmacist is the first port of call for minor ailments. They are highly qualified professionals with over five years of clinical training who are able to assist patients. Over 800 practices have already signed up to participate in the community pharmacist consultation service, which enables patients to see a pharmacist, on the same day in many cases, to deal with minor conditions. That will not only help patients, but it will free GPs up to see the patients that really need to see them for clinical conditions.

[Rachael Maskell]

Will the Minister also ensure that the funding goes into community pharmacies in the right way if they are to be utilised? Likewise, with the voluntary sector involved in providing support for people through different forms of wider health support, will she ensure that it too gets proper funding?

[Maria Caulfield]

I thank the hon. Lady. The spending review tomorrow may have further updates on that, so I will not comment on the funding for now. NHS England and the Department of Health and Social Care have asked the Royal College of General Practitioners to provide GPs with more guidance on how to blend face-to-face with virtual appointments. We do need a mix of both going forward, and the comms, as has been said so much this afternoon, will make a difference, so that patients know where to go, what is available and who they can see for their particular condition.



The issue of abuse has featured heavily this afternoon. The hon. Members for Batley and Spen and for Linlithgow and East Falkirk (Martyn Day), my hon. Friend the Member for Bracknell and for Waveney (Peter Aldous) and others have mentioned the impact of abuse. When patients have been waiting a long time to see a GP, cannot get through on the phone and are feeling unwell in very distressing situations, they often take it out on practice staff. It is unacceptable, and we all have a role in this place to say that we have zero tolerance for that.

We know as MPs what it is like to face a torrent of abuse. If it is not acceptable for us, it is certainly not acceptable for them. My message to general practice staff is that we are four-square behind them on this and will support them. As part of the winter support package, there is £5 million to facilitate extra security, be that CCTV, extra screens or door entry systems—whatever practices feel will make their staff more secure, that funding is available to them. That is not the only solution, and they should not face abuse in the first place, but we are taking it extremely seriously.

In the few minutes that I have left, I want to say that there are two main issues here. There is the short-term covid issue, which has seen a tsunami of patients whom we need to support as we come out of the covid period. There is the £250 million winter package, and there is support around opening up community pharmacies and enabling other healthcare professionals to see patients, which will take some of the bureaucracy away from GPs while we support them to get through the period. However, there are some longer-term solutions as well. General practice and primary care were creaking before covid, and we need to ensure that they are supported in the long term going forward.

I thank my hon. Friend the Member for Beaconsfield for securing this afternoon’s debate. She has raised some really important points. On Thursday, I am holding a cross-party call for MPs to raise some of their constituency GP issues. I urge them to feed back to me as the Minister where it is working well, because there are some brilliant examples out there. Where it is not working so well, it is not the fault of GPs. There are some fundamental solutions that we can help them with, but it is important that we hear about the problems so that we can support them. If Members have specific issues from their constituencies, they should join the call. We are hoping to hold such calls on a regular basis, if that is needed by colleagues, and I am keen to work with everyone across the House to support general practice, because that is the only way we will support patients in the end.