Access to GP Services and NHS Dentistry

Richard Fuller Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with the hon. Gentleman’s point about the importance of looking at primary care as a whole and the really powerful and valuable contribution that community pharmacies can make, alleviating pressures on other parts of the primary care system, particularly general practice.

Communities across the country are experiencing those problems; let me take one place at random to illustrate the scale of the challenge. Today, after a decade of Conservative mismanagement, the city of Wakefield has 16 fewer GPs than in 2013. In fact, Wakefield has not seen a single additional GP since the Prime Minister promised 6,000 more at the last election, and since Wakefield has been served by a Conservative MP—albeit, thankfully, no longer—it has seen three GP practices close, with some surgeries so short-staffed that 2,600 patients are left to fight over one family doctor. Last month, patients in Wakefield were able to book 25,000 fewer GP appointments than in November 2019, the last month in which they were served by a Labour MP. The only good news for general practice in Wakefield in recent years has been that Simon Lightwood, an NHS worker and brilliant candidate in Thursday’s by-election, has successfully campaigned to save the King Street walk-in centre. [Interruption.] They don’t like it. Conservative Members shout in protest and point the finger at us, but they have been in government for 12 years.

[Richard Fuller (North East Bedfordshire) (Con)]

The hon. Gentleman is talking about problems, but his motion does not include one solution. He has now been speaking for 20 minutes, and he has not outlined one solution. If he wishes to be taken seriously as a politician, will he now turn to some solutions to the problems he has outlined?

[Wes Streeting]

It is certainly true that I am saving the best until last in my speech, but the hon. Gentleman may have missed the point I have made repeatedly, which is that the NHS—an organisation that employs more than 1.2 million people—needs a workforce strategy. It needs a proper analysis of what its workforce needs are today, the workforce needs of tomorrow, and the future shape of the workforce. We gave Government Members the opportunity to vote for that; the hon. Gentleman voted against it, and he wants to lecture me about being taken seriously as a politician. Who is he trying to kid? I do not know how the hon. Gentleman voted, because it was a secret ballot, but the fact that a majority of Government Members voted to keep the current Prime Minister in office means that they are not in any position at all to lecture anyone else on who is and is not a serious politician.

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[Sajid Javid]

I will, and I will get back to my hon. Friend on that issue with more detail. I hope he welcomes the investment we are seeing and the record numbers of doctors and GPs in training.

[Richard Fuller]

I know my right hon. Friend is coming on with some more ideas, but from talking to GPs across my constituency, one of the issues I have found is that, as we have diversified primary care staff beyond GPs to paramedics and others, the role of what might be called receptionists and telephonists has moved far more into triage. It is now a more complicated role. Is he attracted to the idea in the Policy Exchange document of creating an NHS gateway to provide more medically qualified staff at that first point of entry to GPs, but on a nationalised basis, available via internet, telephony and the cloud?

[Sajid Javid]

Yes, I am. I have seen the report my hon. Friend refers to and have discussed aspects of it with its authors, so the short answer is yes.

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[Richard Fuller (North East Bedfordshire) (Con)]

It is a pleasure to follow the hon. Member for Liverpool, Wavertree (Paula Barker). My observations are based on having, in the past six months, spoken and spent mornings with the people at about 11 of the 13 GP networks in my constituency and on some of their observations, which I have shared with the Minister previously.

Part of the issue in my area is that the population has grown so significantly. Since 2000, the number of patients per GP has gone up by about 40% in the constituency, which puts on significant pressure, which GPs are responding to, primarily by recruiting other direct care professionals, such as paramedics and various qualified nurses. That has a role in providing support to deal with the problems, but it has not overcome them. Significant efforts are being made to enable my constituents to contact their GP. One interesting issue in those observations was that the practice’s choice of phone system had a significant effect. Practices that chose system A—I will call it that, as I do not want to say a bad word about a particular practice or phone system—would find that the response for the customers, the patients, was terrible. In effect, when 10 people were waiting, the 11th caller got a signal that the number was no longer obtainable. So they would then go to the practice. This was just after covid, so they would go to the practice, try to get in and there would be a big sign on the door saying, “No entry”. These very easy-to-understand problems cannot be solved by the Government but they have a direct impact on people’s experience of primary care.

However, there are aspects that can be affected by the Government. One of the biggest concerns in my area has been the level and pace of housing development and the absence of an infrastructure-first policy. Can the Minister update the House on her conversations with the Department for Levelling Up, Housing and Communities about implementing infrastructure-first? It means that, before a large housing development can take place, the GP services and the school places need to be there. We should not have people moving into their new houses on some of these estates and then finding that there are no GP places, school places and dentists. This was a manifesto commitment of my party and we should be putting it into law.

The comments by the hon. Member for Sheffield Central (Paul Blomfield) about dental contracts also go for GP contracts. There seems to confusion in the NHS—the Minister is clear that this is not really a Government responsibility—about whether there is value to the partner model among GPs, or whether we should be moving to a salary model and saying, essentially, that we are not going to pay extra for partners. This is an area where the Government need to set some direction of travel. It is an important direction to set for the NHS. I have my views, but I would be interested to hear whether the Minister believes that is something she can do.

Something that has been on my mind this week particularly has been the sclerotic process in NHS Estates and in other groups for getting primary care facilities built. The BBC’s “Look East” yesterday carried a story about the new primary care facility being built in Biddenham in my constituency. Eight years since it was first planned, we are hoping—fingers crossed, Madam Deputy Speaker—that that building will be commenced. That is because a lot of people had an interest. The GPs, the CCG, NHS Estates, the local authority, the housing developer and the developer of the facility all had an interest, but who was making the decision? The NHS needs to recognise that in the provision of services it has to be clear on who is saying yes, when, where and how.

I am grateful to the Minister for saying she will conduct a review of the impact, had infrastructure-first been in place. In my constituency, there is a cramped surgery in Great Barford that could move to a perfectly good, agreeable building opposite that would provide better facilities. Arlesey has had a significant increase in population. I visited its GP practice just two weeks ago. There is no air conditioning, and the doors mean someone could walk in on a GP during their session with a patient. The facility needs upgrading, so we need a decision. I am told that my local authority, Central Bedfordshire Council, has the money ready to convert a site in Biggleswade to primary care, yet the NHS decision process is not making that happen. These planning processes need urgent attention from the Government if change is to be made.

We have talked about the diversity of primary care roles, which is one of the Government’s positives, as they have said they will increase the number of roles such as emergency care nurses and other types of nurses and paramedics. We saw the Government’s “Data saves lives” paper this week, on how the better use of data can assist in providing solutions. I take the shadow Secretary of State’s criticism of the NHS app. I was going to say it is 19th century, but it is certainly 20th century in its user-friendliness. What is the plan not only to harness data but to make it accessible and to put power in the hands of the patient?

People can do things with their health information, such as tracking how many steps they take each day. Diabetics can track information on testing. This is a world of improvement that empowers individuals in primary care. The first port of call in primary care provision is each of us managing our own healthcare. What better way to do that than following examples from the rest of the world through NHS applications?

Will the Minister update the House on the use of artificial intelligence and big data, particularly when it comes to pre-emptive screening? The Government are making a welcome investment in screening centres, but how are we harnessing all this medical data to the task of improving healthcare at a preventive level, rather than later in the day?

My hon. Friend the Member for Winchester (Steve Brine) has left, but he is absolutely right that the Government are on the right course in opening up more points of presence for primary care by bringing in pharmacies and screening centres, so that each of us can choose where we want to go to get some of the services we want. It is important that legislation and regulation follow as permissive an approach as possible. Let us focus regulations on the patient and patient choice, not on the provider and provider restrictions.