Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

Richard Fuller Excerpts

Wednesday 22nd May 2024 Westminster Hall

[Andrew Selous]

I agree with the hon. Lady, and I have experience of assisting constituents through the PIP process, which is tortuous for those with EDS so I am very grateful to her for putting that important point on the record.

The 13th type of EDS is not rare and cannot be tested for, which is really significant. Recent studies have shown that the diagnosed prevalence of the most common type can be as high as one in 227 people, although most are not diagnosed. Those with the most common type are twice as likely to use hospital services, and there is evidence that the cost of secondary care for them is an additional 29%. This places a significant burden on the NHS, so if we understood and could diagnose it earlier, we could take some of the strain off hospitals. That is another important reason why we must make progress.

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

I thank my hon. Friend for giving voice in Parliament to those suffering from this disease. We have heard from a number of fellow MPs about their constituents. A constituent has contacted me to say that she, her mother and her children all suffer from this condition. She is so grateful that Parliament is finally taking some notice of it, and a daughter of a very close friend of mine is also affected.

The fact that this condition is not diagnosed early leaves parents scared—petrified about what is happening to their loved one and not knowing what the answer is. Does my hon. Friend agree, and perhaps the Minister will also talk about this, that progress in analysing health service data about certain conditions—so-called big data and AI—could play a role in assisting doctors? As my hon. Friend has said, doctors cannot learn everything during their training, so maybe technology can provide them with some assistance.

[Andrew Selous]

I am not surprised that my hon. Friend and county neighbour makes such an astute point. He is absolutely right about the power of technology to help the NHS get this right, and I am grateful to him for putting that on the record.

Ehlers-Danlos Support UK, a wonderful charity that we are so lucky to have, called on the Government last year to provide urgently needed NHS services for those with the most common type of EDS and HSD. Its petition secured 28,700 signatures in England, although I have to say that it was disappointed by the response from the Government:

“There are no plans for a national service for diagnosis or treatment of hEDS and HSD. Our plans for musculoskeletal conditions will be outlined in the major conditions strategy.”

The draft strategy stated that people will be supported in primary care and that

“GPs and expert physiotherapists…are being empowered to identify and diagnose hEDS and HSD through the use of validated approved clinical guidelines and toolkits.”

When the Minister responds, perhaps he will tell us a bit more about what “empowered” means in this context. The only toolkit for diagnosing and managing hypermobile EDS is the one created by Ehlers-Danlos Support UK. There are no validated and approved clinical guidelines or genetic tests to use to diagnose, and in the past EDS UK has always been told that physiotherapists cannot diagnose EDS or HSD.

We need to do better. We need a proper multidisciplinary approach to diagnosing and managing hEDS and HSD, for two reasons. First, hEDS is a common type of EDS —it is the most prevalent—and is therefore not covered by the rare diseases action plan. Secondly, it does not fit solely into the category of musculoskeletal conditions and accordingly will not be covered by the major conditions strategy.

Like virtually all hon. Members in the Chamber, I am grateful to my constituents, one of whom, Alex Akitici, is here with us this afternoon. She has been to see me a number of times, and when she came to my constituency advice surgery in January, I could tell that something was not right. The colour of her face was giving me cause for concern, and when she got up at the end of the meeting, she collapsed flat on the floor and fainted in front of me. That was just a small example of what this group of people, whom we are all here this afternoon trying to help, have to deal with.

This is not just a musculoskeletal condition, because musculoskeletal conditions do not necessarily cause people to faint, but that is what happened to my constituent Alex. She has had to pay privately for a diagnosis—not everyone can afford to do that—and for her treatment and care. She and her husband have had to spend money adapting their home to make it safe as her collapses are frequent and unanticipated, as I witnessed. She lives in constant pain and has had an issue with personal independence payments, which were raised by the hon. Member for Blaydon (Liz Twist).

My constituent’s experience is common. Many people with EDS are also fighting to stay in work, but due to delays in diagnosis and a lack of appropriate care, they end up in a position where they can no longer stay in work.

I want to mention some people with EDS who are constituents of MPs who cannot be here today. As Under-Secretary of State for Culture, Media and Sport, my right hon. Friend the Member for Pudsey (Stuart Andrew) is not allowed to speak in this debate, but he contacted me ahead of it to tell me about his constituent Fran Heley, who has a connective tissue disorder. She has had to spend thousands of pounds on private healthcare, and she walked from Leeds to Parliament to draw attention to the condition. She has also undertaken a coast-to-coast walk across the north to raise awareness of the condition. What a brave campaigning lady! I thank her.

My right hon. Friend the Member for Calder Valley (Craig Whittaker) asked me to give a shout-out to his constituent Karen Huntley from Healthwatch Calderdale and Huddersfield, who works tirelessly to highlight the need for a Government strategy. I thank Karen Huntley for what she does.

The hon. Member for North Shropshire (Helen Morgan) contacted me before the debate with details of her constituent who has just had a battle royal to deal with her condition and get appropriate care and recognition for it. And one of my constituents contacted me earlier this week and said:

“Both my daughters and grandson have the condition”,

but they did not realise until the older daughter was “quite old”. Other hon. Members have made exactly that point. So we can see that the condition is widespread across the UK and that the same issues come up time and again.

I want to draw the Minister’s attention to what is happening across the United Kingdom. In Wales, Members of the Senedd have resolved as follows:

“The National Clinical Lead for Musculoskeletal Conditions is working with EDS UK and Community Health Pathways to develop a nationally agreed pathway for hypermobility in children and adults. This will support healthcare professionals to have informed conversations with patients and to provide access to the right specialist teams.”

That is a major step forward. If it is good enough for the Welsh, it is good enough for the English.

I am told that in the Scottish Parliament there will be a roundtable debate at the end of this month, which, by the way, is Ehlers-Danlos Syndromes Awareness Month. In Scotland, they want to try to understand how they can improve diagnosis and care there. A recent study launched in Holyrood included a recommendation to develop a pathway and NICE guidelines—a request I made to the Minister earlier—with lived experience as evidence of the need.

I hope that the Minister will reassure us that he and his officials are looking around the world at best practice, the best research and the best care. I stumbled across the Ehlers-Danlos Society of the United States of America today. Lots of clinicians involved in that do a lot on research. I hope that we are up on what is happening globally, so that we do not miss out here. Departments needs to look internationally to get best practice in the United Kingdom.

On Ehlers-Danlos support, I mentioned the four points: the pathway for diagnosis; NICE guidelines; a co-ordinated multidisciplinary approach; and support and training for healthcare professionals. I ask the Minister to really push for that in the Department. I know that he is a good man and that he has to get that through NHS England, but, frankly, the time really has come to make progress. I would like a meeting, if possible, with him and Ehlers-Danlos Support UK, which does so much in this space, so that we can take the matter forward.

I am grateful to colleagues who have attended the debate. With your permission, Mr Dowd, I am happy for my hon. Friend the Member for Watford (Dean Russell) to speak briefly.

Draft Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024

Richard Fuller Excerpts

Tuesday 21st May 2024 General Committees

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

I beg to move,

That the Committee has considered the draft Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024.

It is a pleasure to serve under your chairmanship, Mr Hollobone. The Government are proposing changes that would improve patient access to medicines in both dental practices and pharmacies.

First, hon. Members will know the vital role that pharmacies play in communities across our country, and I am sure that they will join me in expressing enormous gratitude and appreciation for the incredible work of brilliant pharmacists up and down the country. Of course, pharmacists dispense prescription medicines to the public, but for many people they are also the first port of call for healthcare advice. Pharmacies can provide a number of different services, including vaccinations, blood pressure checks and contraception, and that takes pressure off hospitals and GPs while playing an essential role in safeguarding the nation’s health. Pharmacists are fully trained and qualified, and pharmacies in hospitals are a key source of advice for doctors, nurses and other clinical staff. As well as supplying basic healthcare products, they support the management of complex medication regimes.

Pharmacies are a priority for this Government, and of course for the Prime Minister personally. Indeed, I do believe that the Prime Minister’s own mother was a pharmacist—colleagues may have heard that. [Interruption.] Have they? I think they have. I thank her for her lifetime of service, and pay tribute to every pharmacist who is helping us to deliver for the British people by taking NHS appointments, day in and day out. In recognition of the clinical expertise and knowledge that pharmacists have to offer, this Government have invested in pharmacy as part of our primary care recovery plan. We have made significant funding available for more blood pressure checks and more contraception consultations, as well as for Pharmacy First, which launched in January 2024, enabling community pharmacies to supply prescription-only medicines for seven common conditions without a prescription from a GP. Together with the investment in more blood pressure checks and oral contraception consultations, Pharmacy First will save around 10 million GP appointments once fully rolled out. The sector has embraced Pharmacy First, with over 125,000 consultations delivered in February, which was the first month of the service. Data on Pharmacy First delivery will start to be published from the end of this month.

Secondly, hon. Members will be only too aware of how important dental practices are in local communities. Dentistry is a top priority for this Government, and that is why we published our dental recovery plan in February. I am delighted that the plan is already delivering results on the ground, with nearly 500 more dental practices now open to new NHS patients. Dentists not only deal with emergencies, of course, but play a critical role in prevention.

Although the draft statutory instrument covers two very distinct professions, it will enable both to use their full range of skills to supply patients with the medicines they need in a timely manner. Legislation already allows some registered healthcare professionals to supply or administer certain medicines as part of their usual clinical practice. These are called exemptions. Our proposed changes will put exemptions in place for dental therapists and dental hygienists to supply or administer a range of medicines that are already a part of their day-to-day jobs. The changes will mean that they can supply or administer those medicines to patients without first having to refer to a dentist, so that they can deliver care without the need to organise additional appointments or interrupt dental colleagues who are already busy with other patients. These sensible, common-sense measures will free up precious time for clinicians and patients alike. The medicines are listed in the draft regulations. Seven of them are topical or local anaesthetics, three are fluoride products, and there is one antibiotic gel and one antifungal medicine.

Healthcare professionals have a responsibility to carry out care only where it is safe to do so and they are competent to do so. Many already have extensive experience of using these medicines, but of course we will not be compromising on safety one inch. Dental practices will continue to be responsible for making sure that clinicians undertaking the procedures have the knowledge, qualifications and skills to carry them out safely, and training will be made available for all those who want to make use of the exemptions. That will help dental practices to safely deliver more care for their patients as part of our dental recovery plan.

Our proposals will allow pharmacy technicians to supply or administer medicines to patients using mechanisms called patient group directions, or PGDs, which are written instructions that allow some healthcare professionals to supply or administer specified medicines to patients with certain conditions, without the need for a prescription. They are developed by experts from a range of fields, who thoroughly kick the tyres of every PGD before they are passed. Pharmacy technicians will be responsible for assessing whether patients fit the criteria. Once implemented, PGDs are carefully monitored to check they are being used appropriately on the ground. It is up to local healthcare organisations to decide, following national guidelines, whether a PGD route is appropriate for a clinical service. Local clinical managers are responsible for permitting healthcare professionals to work under PGDs, while making sure they are trained to use them safely.

Hon. Members might have come across pharmacy technicians in their local hospitals without necessarily realising who they are or what they do. However, pharmacy technicians are well placed to take on these roles. In fact, they already carry out a wide range of tasks in many healthcare settings, including hospital and community pharmacies, GP practices, care homes, prisons, our armed forces and the pharmaceutical industry. In recent years, their roles have given them opportunities to work face to face with patients, making them highly adept at answering questions about medicines.

We are making changes to training for pharmacists that will soon mean they can graduate as fully qualified prescribers.

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

I fully support what the Minister proposes, but I have a maths question for her. I know that she did not prepare the impact assessment herself, but she probably reviewed it. It states:

“We have discounted benefits to patient health and the NHS at 1.5% per annum and all other benefits at 3.5% per annum.”

Of course, that lower discount rate has the effect of making the later benefits look better—they are not discounted to a lower level now, so we can spend more money for the same amount of benefits later on. Is the Minister comfortable with those discount rates? Given where interest rates are now, will she put some questions to the people who made the impact assessment about why those particular discount rates were used?

[Dame Andrea Leadsom]

As always, my hon. Friend makes a very good point about the finances. I cannot answer his question immediately—I would have to refer back to the impact assessment—but perhaps I can write to him on that point. It is vital that we look at the longer-term impact of any change that we make. Without addressing his specific point, I can say more generally that in introducing these further flexibilities for pharmacy technicians, we are increasing capacity in the very important sectors of dentistry and pharmacy, and doing so will benefit patients and the national health service alike.

Let me conclude by pointing out that, together with the proposals we are debating, all these measures will expand capacity in pharmacies for the prescribing, supply and administration of medicines, providing patients with access to a wider range of clinical services delivered by healthcare professionals with the right skills, at the right time. That supports the Government’s ambition to improve outcomes for patients while reducing demand on other parts of the service. I commend the regulations to the Committee.

Cass Review

Richard Fuller Excerpts

Monday 15th April 2024 Commons Chamber

[Victoria Atkins]

I thank the hon. Lady for her thoughtful question, because she rightly lists some of the mental health conditions that both Dr Cass and professionals in this area have realised can be part of the complex needs of children and young people who are asking questions of their identity and about their path in life. On funding, the financial value of the contract last year with the Tavistock was £9.3 million, but for this financial year NHS England has committed some £17.1 million for the two new hubs for gender services. Of course, they will keep this under review as we build up the services across the country in the ways envisaged in the report.

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

Let me add my thanks to Dr Hilary Cass for her review. Having listened to this Secretary of State today, I am confident that young people in this situation are in safe hands as she implements the recommendations. However, I wish to ask her about accountability, because what we have seen in the NHS with previous scandals, be it the contaminated blood scandal or Mid Staffordshire, is that accountability is a little slippery. Accountability is not just about lessons being learnt; it is about people being held to account for what they have done. So will my right hon. Friend be looking at ways in which there is room for people to be struck off if found to be wrong, for managers to be sacked and, in certain circumstances, for legal action to be taken?

[Victoria Atkins]

I completely understand my hon. Friend’s desire for accountability. I just remind us all that some clinicians have acted in a morally exemplary way, trying to blow the whistle on practices they observe. He and I, and, I hope, others, want to ensure that clinicians who have not acted in accordance with their professional duties are held to account. As I say, ongoing conversations are taking place with the independent regulators, but I suspect that they have very much understood the way in which the House is viewing this and the seriousness with which we view clinicians who have not abided by their professional duties in this regard.

Oral Answers to Questions

Richard Fuller Excerpts

Tuesday 5th December 2023 Commons Chamber

[Maria Caulfield]

I attended the National Farmers Union session in Westminster just before the launch of our suicide prevention strategy. We recognise that isolation and loneliness in rural communities is an issue. I am happy to meet any hon. Members who wish to discuss how we can better support farmers, improve their mental health and reduce suicide rates.

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

Will the primary care Minister join me in congratulating the Conservative Mayor of Bedford borough for proposing council money to invest in primary care facilities in Great Barford, Wootton, Wixams and Kempston? Will she condemn Labour and Liberal Democrat councils for voting it down?

[Dame Andrea Leadsom]

I am glad that my hon. Friend has raised this issue. He is absolutely right; in local authorities we need mayors and integrated care boards supporting primary care and not listening to the Opposition, who talk it down the whole time. The 50 million more GP appointments is something to celebrate.

Building an NHS Fit for the Future

Richard Fuller Excerpts

Monday 13th November 2023 Commons Chamber

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

May I join my right hon. Friend the Prime Minister in thanking His Majesty for his Gracious Speech, as there was much in it to commend? As this issue is dear to my heart and the hearts of many councillors in Bedford borough, let me thank the Government for saying that they will introduce changes on estate management charges to homeowners. Those charges affect perhaps 1 million homeowners across the country and this is an unregulated area. It is important that those people have improved rights to challenge and I look forward to seeing what the Government come forward with.

Let me also say what a pleasure it is to follow the hon. Member for Salford and Eccles (Rebecca Long Bailey). Like many of her colleagues, she bemoaned the fact that the King’s Speech contained so few Bills and that the Government were not trying to do more. Let me make a counter point: many people think that the Government are already trying to do too much. These people are fed up with their businesses and lives being too regulated, and their taxes being too high. They are fed up with being told what they can and cannot say, and when they can and cannot demonstrate. People want to be free to live their lives. Government can play an important enabling role, but I say to her that the most important thing is the quality of the legislation proposed, which we all have a role in forming, rather than the quantity.

The topic of today’s debate is an NHS fit for the future. When I became the MP for North East Bedfordshire, it was clear that growth in population and in housing was driving many of the issues that affected my generally rural constituency. That is why “infrastructure first”, whereby we get the infrastructure in place before putting in more housing, was important for the future, while recognising that the growth over the previous two decades had had a significant impact, most importantly on primary care.

I have visited literally every GP practice in my constituency and spent an hour there, with one exception—it is still to come. I have found out about discrete issues that are important in how local residents feel about their GP services, including the choice of phone system. I think that the move to the cloud-based phone system by the NHS is welcome. I found out how people feel about the skills mix, where we have more non-GPs. Some parts of the community find that making the transition from seeing their normal GP to seeing another differently qualified member of staff creates problems, but in the long term it is useful. I found out that the different methodologies for accessing primary care—not just walking in or getting an appointment by phone, but getting access through email, the net or an app—have created extra pressures on primary care doctors. However, they are there to see it through to the end and they think it will have long-term benefits.

I thank all my local GPs across the constituency. A couple had particular difficulties, but I am pleased to say that progress in those two practices has been substantial since changes have been made. Despite the fact that all Members here feel that primary care has gone through quite a difficult process after the covid experience, in my constituency we have made progress, although there is still more to be made. It is a shame to see my hon. Friend the Member for Harborough (Neil O’Brien) moving from his role in primary care, not least because I had just arranged a meeting with him and the leader of Central Bedfordshire Council to discuss the Biggleswade health hub. May I make a quick plea to those on the Front Bench that that meeting should be put back on the schedule as soon as possible?

Social prescribing was mentioned by the Minister in her opening remarks and it is a positive initiative. I visited the Bedfordshire Rural Communities Charity, which has taken on that responsibility. What a great form of outreach that charity and its volunteers and recruits have taken on with this role of social prescribing. In addition, there is a bit of pressure on local pharmacies, with some of the national changes altering their strategies. Others, however, are coming forward with positive initiatives, including Jardines pharmacy in Biggleswade, which has just launched its out-of-hours, Amazon box-type option for people to get their prescriptions.

In discussing improvement, I wish to mention four areas where there is change. On capital for the NHS, the issue is not primarily one of needing more money. Capital for the NHS in this five-year period will be 60% greater than it was in the previous five-year period. The issue is the process by which that capital is allocated and the choices that are made. We are also seeing people coming forward to help with capital. We recently had a change in the elected mayoralty in Bedford, with the replacement of a Liberal Democrat Mayor by a Conservative one, Tom Wootton. I am delighted that as one of his first measures, he has provided capital from the council’s budget to bring forward the provision of primary care services in the constituency and the rest of the borough. I look forward to those improvements being made in Great Barford and in other constituencies—I know it is happening in Wixams and Wootton. I commend an elected Conservative Mayor as the way to get local primary NHS facilities improved. Well done, Mayor Tom Wootton.

We need to provide more access for private capital if we are to enable a range of diagnostic centres across the country. I think that people are prepared to put private capital in place, but decision rights on how we all access diagnostics need to be given to us, not held by the NHS. Because of the limitations on time, I will mention compensation briefly. How on earth did we end up with a GP pay system that means that those who choose their hours and do not take on the responsibility of being a partner end up getting paid more lucratively than those who are full time or who are partner GPs? We need to reinforce the partner GP model, not turn our back on it.

I know that the Government are in discussion with junior doctors about this, but the circumstances in which we train our doctors has changed substantially. There is much greater global competition, both in terms of trying to bring people to the UK—the NHS brand is not as strong as it used to be—and in what people will do when they leave their training, such as moving to the middle east or to other health markets. We also need to recognise that many of our junior doctors now carry student debt, which the original model did not anticipate that they would have, and therefore the charging of ongoing fees for annual training is important. We must also recognise that junior doctors want to spend most of their time training and being with patients. The Government should look acutely at ways they can reduce the admin burden.

On decision authorities, it seems odd to have a system where integrated care boards bring together local councils and the local NHS—my area has a £2 billion annual budget—yet local people who understand local health needs have almost zero decision rights over how that money is spent. I do not see how the future of the NHS in the long term can be such a top-down, budget-driven system with so little local discretion if it is to succeed.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a real pleasure to close this important debate and to follow my hon. Friends the Members for North Tyneside (Mary Glindon) and for City of Durham (Mary Kelly Foy) who spoke powerfully about the need to take more action to help people quit smoking and not take up smoking in the first place. As a former smoker myself, I wish to goodness that I had never ever taken it up, and I can reassure Members that a Labour Government would do everything within our power to take further action in this area.

My right hon. Friends the Members for North Durham (Mr Jones) and for Walsall South (Valerie Vaz), and my hon. Friends the Members for Tooting (Dr Allin-Khan) and for Putney (Fleur Anderson) rightly held the Government to account for once again failing to bring forward legislation to reform the Mental Health Act 2007, despite all the serious problems that need addressing, all the promises that have already been made and the cross-party agreement that there is on the need to act.

My hon. Friends the Members for Blaydon (Liz Twist) and for Liverpool, Wavertree (Paula Barker) talked about the importance of reforming social care—another area where promises have repeatedly been made and repeatedly been broken—and the real importance of giving older and disabled people more support in the community, rather than their ending up in hospital, which is worse for them and worse for taxpayers.

My hon. Friends the Members for Ellesmere Port and Neston (Justin Madders) and for Ealing North (James Murray) rightly talked about the desperate need to build more affordable housing, including social housing, to tackle problems in the private rented sector, and to reform leasehold. Those are huge issues in my constituency. My hon. Friend the Member for Nottingham South (Lilian Greenwood) talked about the terrible problems of people waiting in huge pain and distress in ambulances or on trolleys in A&E, and many hon. Members talked about the need to improve GP access and dentistry care.

Last but by no means least was my hon. Friend the Member for Luton South (Rachel Hopkins), who talked about the fantastic work her council is doing to tackle health inequalities, and the need to understand that a good job is part of a healthy life, and good health is vital to getting a job.

The point that I wish to make today is that the health of our nation is critical to the health of our economy and that, after 13 years of the Conservatives, both are in a perilous state. There was nothing in the King’s Speech to address these problems or meet the scale of the challenge we face. But Labour has a plan: to improve the health of the nation; to get Britain working again; and to give our country its future back.

Ministers repeatedly attempt to claim that everything in the garden is rosy when it comes to the state of our economy and to employment, but the truth is that we are the only country in the G7 with an employment rate that still has not returned to pre-pandemic levels. The underlying reason for that is the increasing number of people out of work due to long-term sickness. Some 2.6 million people are now shut out of the labour market due to ill health, which is the highest number ever. Frankly, that is a scandal in what is still, despite all our problems, one of the richest countries in the world. Around half of this group are more than 50 years old—that is more than double that of any other age group—and musculoskeletal problems, such as bad hips, knees, backs and other joints, are the most common problem.

Many of the over-50s are also caring for elderly, sick or disabled loved ones, for which there is precious little help and support. Women are consistently more likely to be workless due to long-term sickness than men. Indeed, women account for more than two thirds of the increase that we have seen over the past decade. But the rise in worklessness due to long-term sickness is not just an issue for older people; there has been a sharp and hugely worrying increase in the number of young people not working due to ill health, predominantly driven by mental health problems—an issue that many of my colleagues have raised. The number of 18 to 24-year-olds who are workless due to ill health has doubled in the last decade, while the number of 24 to 35-year-olds has almost trebled. Those problems are even more likely for young people who lack basic qualifications and who live in parts of the country that are struggling economically, often outside our big cities in towns and rural and coastal areas.

The fact that such problems are more likely to affect certain parts of the country in the midlands and the north comes as no surprise to Opposition Members. In Conservative Britain, people are twice as likely to be out of work due to ill health if they live in one of the most deprived areas in England than if they live in the least deprived areas, with rates of economic inactivity due to long-term sickness in the north-east and midlands almost double that of London and the south-east.

That really matters to families, to our economy and to wider society. Being shut out of work because of poor health is terrible for individuals, especially during a cost of living crisis. It is bad for businesses, which need to draw on the skills and talents of all our population if they are to grow, expand and thrive. It is also bad for taxpayers, who are now paying an extra £15.7 billion a year in lost tax revenues and higher benefits bills, compared with before the pandemic. The Office for Budget Responsibility says that the rise in health-related economic inactivity poses a significant risk to our fiscal sustainability, because it reduces our prospects for growth, reduces tax receipts and puts ever-increasing pressure on health and welfare spending.

Yet despite all that, we have not seen a plan from Conservative Members that is anywhere near serious enough to get Britain working again. No doubt, when he rises to speak, the Secretary of State for Work and Pensions will tell us about work coaches and health MOTs for the over-50s. I am not against those measures—I support them; I have met work coaches in my own jobcentre, and I know how hard they are working to try to support people back into work—but they are nowhere near big or fundamental enough to get to grips with the root causes of worklessness, or to reform the way the system runs.

Britain deserves so much better, and that is what Labour will deliver. Our top priority will be to ensure that everyone who can work does work. We believe that the benefits of work go beyond a payslip to the dignity and self-respect that good work bring. We will tear down the barriers to success, tackle the root causes of worklessness and get Britain working again.

Our long-term plan for the NHS will invest an extra £1.1 billion a year, paid for by abolishing the non-dom tax status to provide 2 million more appointments a year and clear the NHS backlog—[Interruption.] The hon. Member for North West Norfolk (James Wild) laughs, but I say to him: if you were a woman stuck on a waiting list, waiting for help and treatment for your hips, for your knees, for your back, you would not be laughing. We will recruit 8,500 more mental health staff, with support in every school and every community to tackle mental health problems in young people early on.

But that is not all. We will transform jobcentres so that they provide personalised help and support, work in genuine partnership with local employers and services, and help people not just to get work, but to get on in their work, with all the benefits that progression from low pay brings. That is an issue that the Government’s own review said they needed to tackle, but they have completely failed to act on it.

[Richard Fuller]

For a shadow spokesperson, the hon. Lady is making some good points, but she has just raised the interaction of the non-dom status and the health service. As she will be aware, the General Medical Council said today how important it was that we continue to attract doctors from overseas, but many would be impacted by a change in the non-dom status. How will Labour’s policy affect our ability to recruit people from overseas for our health service?

[Liz Kendall]

I have spoken to many doctors who come to work in the hospitals in my constituency—

NHS Long-term Workforce Plan

Richard Fuller Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

I think there is actually a lot of agreement between the hon. Lady and I. She talked about the plan, and having read it a number of times—that is part of my role—I know that childcare is specifically referred to in the summary, no less, in terms of the key issues that it goes on to set out. It goes into detail about our proposals, including linking up to the NHS people plan and greater flexibility in terms of roles and people retiring. One aspect of the NHS Staff Council deal is the expansion of pension abatement rules. So there is a huge amount.

The hon. Lady calls for more flexibility. I set out a number of the areas, and she does not seem to realise that there are three sections to the plan, with the second being all about giving greater flexibility to help retain our staff. So the plan addresses the points she raises; that just does not seem to be the answer she wants to hear. As for flexibility being important to mums, yes it is, and the NHS has a largely female workforce, but it is also important to dads. It is important to all NHS staff that we have that flexibility.

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

The NHS today, at 1.4 million employees, is the fifth-largest employer in the world, and if the ambitions in this welcome plan are met, it will be the largest employer in the world. That raises the question of how effective the management of those human resources is. It is a little disappointing that there is so little commentary in the plan on two important management issues: the ambitions on improving the quality of management systems, and particularly clarification of decision rights and responsibilities; and the quality of accounting control systems and how the NHS seeks to improve them. Will my right hon. Friend ensure that the NHS looks at those two important matters?

[Steve Barclay]

Those are both fair points. I know that my hon. Friend comes at this with great commercial experience, and I hope he knows that I have an interest in those issues. Just to reassure him, the plan is iterative; it is not a one-off. It is a framework from which we will do further work. Indeed, one of the areas that I am often criticised for is my interest in data and variation in data across the NHS—he and I probably agree on that more than some of those who are critical. That speaks to his point—the Chair of the Health and Social Care Committee’s point relates to this—that in a system the size of the NHS, data on the performance of the integrated care boards and their role in terms of the workforce is one area that the House will want to return to.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

GPs and Primary Care (North East Bedfordshire)

Richard Fuller Excerpts

Tuesday 7th June 2022 Westminster Hall

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

I beg to move,

That this House has considered access to GPs and primary care in North East Bedfordshire.

It is a pleasure to serve under your chairmanship, Mr Betts, and to welcome the Minister to her place. The reasons for this debate are, in essence, two of the main commitments that I made when standing for election in 2019: to promote access to local services; and to maintain the rural character of North East Bedfordshire, in the light of high levels of persistent housing development stretching back over a number of years. Those issues are related, but each of them also has certain distinct resolutions.

What has informed me, in calling for the debate, is that over the past six months I have spent a considerable amount of time speaking to GPs and primary care staff across my constituency. I have listened to their points of view and analysed information from their practices. I commend the work of our GPs and their staff, most particularly in the period through covid. I will touch on some of my concerns about how GPs were feeling and about morale over that period when I talk a bit about the responses I have had from constituents in my email inbox.

The debate is also informed by previous debates about the impact of development and of population on access to health services, such as GPs and dentists, although the latter are not my primary focus today—I have participated in debates led by my hon. Friends the Members for Waveney (Peter Aldous) and for South West Bedfordshire (Andrew Selous). My inbox, however, has been full of emails from constituents on the issue of access to GPs.

This will be known to the Minister, but I always think it is useful for Ministers to hear directly from constituents, so I will briefly quote three of mine. One wrote:

“My wife is 75 and in acute pain. She can barely walk. Several days last week and yesterday she has been attempting to see a GP…she phones at 8 am and eventually gets through some 2 hours later. She is then told there are no appointments remaining that day!, and that she should phone the next day at 8 am to try again. This same pattern is repeated day after day. Hours and hours spent listening to a recorded message with zero result.”

Another constituent wrote:

“I am writing to you about the absolute terrible Healthcare Centre… I’ve phoned the surgery 3 times last week to be told they have no appointments…this is disgraceful. I rang again today to be told no appointments available again today and to phone 111. Apparently they have to hold appointments for 111 to allocate. The lady from 111…told me to go to A&E to sit there for hours on end to see a doctor”.

The third constituent wrote:

“I have tried phoning the practice at 8 am as told to in order to arrange a telephone conversation. For about 50 minutes the dialling tone cut off with a message saying the line was overloaded. Thus, redialling over and over again was necessary (not something it is pleasant to do when feeling unwell). Eventually you may get through to be told you are in a queue. When you finally get through to a receptionist you are told that GPs are only taking emergency calls. When querying what I should do now, I was told to try again tomorrow at 8 am.”

Such issues are, to a certain extent, part of the recovery from covid and of the post-covid period, but they also highlight issues of concern more generally. The Minister must recognise the irritation of my constituents at the requirement to repeat and repeat a process in order to do something as simple as seeing someone in primary care for their health needs. Further irritation comes from the pressure on the ability to find an appointment within a reasonable amount of time.

That also has a significant impact on the morale of staff in GP practices. Given people’s problems getting through, they are naturally at a rather heightened level of irritation, and that has often spilled over into abuse of staff. The Minister will agree that there is never a rationale or reason for any of us to be abusive towards staff who are trying to do their best.

I will share with the Minister some data on my area. As of April 2021, the patient-to-GP ratio of my clinical commissioning group area, which covers Bedfordshire, Luton and Milton Keynes, was ranked eighth highest of 106 clinical commissioning groups, with 2,169 patients per GP, against last year’s average of 1,772 patients per GP. I have looked at the data running back to 2014—I am grateful to the local medical council for helping me with it. From 2014 to 2022, the list size for GPs in my constituency—a subset of the clinical commissioning group area—grew by 13%, compared with national growth of 8%, so it is growing considerably faster than in other areas of the country.

Let us look now at personnel. For the same period of 2014 to 2022, the total headcount of qualified GPs grew by 2.1% nationally but fell by 2.2% in North East Bedfordshire. Over that eight-year period, the number of GP partners fell by more than a quarter. Those staffing numbers are troubling. The CCG area has 2,169 patients per GP, but for practices that serve my constituents the number is 2,482 patients per GP— up 28% in eight years. I point out to the Minister that housing growth in my constituency is already three times the national average. That problem will not go away, and nor will it stay the same; it is going to get worse.

I will go through some specific findings from my discussions with GPs. The first is fairly obvious: GPs—and I and my constituents—think that primary care in North East Bedfordshire is under severe strain. One GP told me:

“The vulnerability of the service provided by GPs in my area was off the scale large”.

I believe that my constituency is actually a test case for our Conservative manifesto commitment to infrastructure first. I will raise some points about that in a minute.

In my view, and in the view of the GPs with whom I have spoken, remuneration systems provide insufficient incentives for GP partners to take on additional responsibilities. If we wish to stem the decline in GP partners, the Government have to show by words, actions and remuneration that they value the additional work that partners take on to enable broader provision of primary care in their local practices. More generally, pay systems provide more reward, rather than less, for GPs who pick and choose their hours rather than work full time. On the issue of locums versus salaried GPs versus partners, what is the Government’s strategy and what is their preference? My view is that the partner model has worked well historically and is the best model for the future, and even if the Minister agrees, there should be some substantial changes to how the remuneration systems work.

The NHS provides practices with payments based on hitting specific targets set at a national level, or sometimes a local level, such as the qualities and outcomes framework and the investment and impact fund. I hear that some of those targets can be onerous and the benefit is outweighed by the bureaucratic cost of achieving them. I worry that there is a tendency to prioritise bureaucratic target setting and undermine the professionalism, integrity and insight of GPs. We have to recognise that GP partners are some of the best qualified people in the country. To drive them to little target boxes that they have to check is in some ways a little bit demeaning to what a GP thinks is best for their patient. I can see that there is a need, but I think that perhaps the Government are overdoing the balance, towards bureaucracy.

This is perhaps a very minor point, but to me it sounds quite significant if it is true. I was intrigued when I learnt that GPs cannot create a corporate shield against personal liability when they wish to become a leaseholder of property. Normally, if someone is in business, for example, and they are a director or chief executive, their personal liability is not put on the line for a lease that they sign. I was given this impression, and perhaps the Minister can write to me with an answer to this question: is it right that there is no personal liability shield on this issue? That seems to me an unnecessary disincentive to becoming a GP partner.

Increasing the pathways to contact GPs is significantly under way. These range from face-to-face consultations, to e-consultations, to phone consultations. This is currently adding to the frustrations both of my constituents and of some of my local GPs, but there are signs and reasons for hope that the change can be for the better. Some constituents greatly prefer the opportunity to have a phone consultation. Although 50% of phone consultations require a face-to-face follow-up, 50% do not. That creates opportunities for scale economies in telemedicine. One practice that tracks those changes very carefully has been positively encouraged by the reduction in missed appointments for face-to-face consultation, which is a real saving of GP time. I would encourage the Minister to pursue further those efforts for new pathways but to recognise that there will be teething problems as we broaden things out.

Similarly, the broadening out of clinical roles—particularly those of paramedics, nursing roles and other direct patient care positions—in primary care is generally welcomed by GPs, but they would make the point, and I make it to the Minister, that there remains patient resistance to seeing someone other than “my GP”, even if seeing them is not required, and that it can remain a bottleneck. Also, that will not be a full answer to the issue of GP access, even in the long term.

I also heard that the relationship between primary care and secondary care has become a little fraught post covid. I am not sure that it has always been the most harmonious, if I am being honest. But will the Minister look or has she looked at the additional roles that GPs took on during covid to relieve pressure on hospitals, to see whether the balance is right and whether the remuneration is still right or whether there needs to be some clarification on those roles?

Similarly, there is the issue of the relationship between GPs and pharmacies, specifically as regards regulatory intrusion on efficient communication and simple processes such as the issuing of prescriptions. I know that the Minister and Government are looking at that, but it seems to me, from what I have heard, that more progress can be made. That could have significant benefit in broadening the ways in which people can access primary care.

Customer service attitudes and procedures, particularly post covid, created widely different outcomes between practices. This was one of my two most significant findings. It really matters how the practice manager and the receptionist interact with the patients when they arrive or when they get through on the phone. It is interesting how some practices have done a fantastic job and some have fallen short—there is such a wide variety. I wondered whether there was training and protocols about that human interaction, to ensure that standards were kept up. A similar thing—this is the other thing that is most important—is phone systems. Who would have thought that a GP’s choice of phone system would be a critical factor in patient satisfaction with the service that they get? In my own constituency, there is one particular practice whose choice of system A rather than system B has created for it an enormously larger problem with its patients than other practices have.

The rate of population growth in North East Bedfordshire has been so high for so long, and I am afraid to report that I believe that the NHS has failed to keep pace with regard to the modernisation of premises, particularly ones that bring individual practices together. This will be my final and key point as part of my asks of the Minister. The slow pace of NHS performance has been further frustrated by inefficiencies of section 106 and community infrastructure levy payments. That is most vividly highlighted in my constituency by the plans for a new surgery to serve the villages of Biddenham and Bromham. The land was promised years ago, all the houses have been built and yet the building of the new practice has not begun. That is a crucial “infrastructure first” test case for the future.

North East Bedfordshire is already near to the top of ratios, and population growth at three times the national average means that, without action, the situation will get worse. I ask the Department to look at North East Bedfordshire as a test case for our manifesto commitment on “infrastructure first”; to go back over the past eight years, to identify lessons learned from the inability to keep pace in personnel, processes and facilities; and to map out what could have been done and what could now be done to improve the situation. I am asking for a specific test for my constituency for that historical analysis, and I hope the Minister will agree to that today.

Practically speaking, I also ask the Minister to get her Department to look at unblocking the jam on the hospital site in Biggleswade. It appears that Treasury restrictions, which are legitimate but causing a problem here, are blocking the transfer of facilities so that it can provide GP services in one of the fastest growing towns in my constituency. I have spoken with Central Bedfordshire Council, which is willing to fund the rebuild, but it needs more reassurance and flexibility on long-term use. Will the Minister please talk with her Treasury colleagues to enable progress, as that would be a vital element in relieving the strain?

There are similar issues at Great Barford surgery, which is still located in cramped facilities. Right across the road there is an available facility, which everyone knows is the right one and has been talked about for years. I ask the Minister to look at that issue and see whether it has to be resolved locally, between the council and the local clinical commissioning group, or whether the Department can assist. In closing, I am grateful to our GPs, who have worked, sometimes with hostility from their patients, exceptionally hard in my constituency in difficult circumstances. I am very grateful to them and their staff.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for North East Bedfordshire (Richard Fuller) for securing the debate and raising important points about the good work that is happening, as well as the substantial issues facing his GPs and constituents. I will not stand here and pretend everything is rosy: I want to work with him to address a number of the issues that he raised.

I start by thanking GPs, general practices and primary care for all their work during the pandemic, and for the work they are doing now, increasing their workload, such as dealing with people on elective waiting lists who need care because they are not able to get procedures done as quickly as normal, or helping with the covid vaccination booster. They are dealing with almost a tsunami of patients who are now coming forward to seek help, after we advised them to stay away and protect the NHS during the covid pandemic. We are seeing almost 11,000 cancer referrals a day, for example, and each one comes through a GP. On average, there are 1.6 million appointments nationally per working day, which is an increase of 5.3% on April last year, and 62.5 million covid vaccinations have been delivered by general practices.

That gives the scale of the work that has gone on, but I do recognise some of the issues raised. To reassure my hon. Friend, GPs—whether they are salaried or partners—are generally not directly employed by the NHS. They are independent practitioners who have a business of their own and have a contract to deliver NHS care. Some of those historical arrangements limit the interventions we can make, and some GPs want more integration than others—we have to be flexible in the support that we give.

My hon. Friend the Member for North East Bedfordshire is quite right to identify the issue of telephone access. I know from my own constituents that getting through to the GP is half the battle; once they have got through they usually have a positive experience seeing the GP, or other healthcare professional in primary care. We tried to help with this in autumn last year with the winter access fund. Part of that help meant that practices could bid for funding to introduce cloud-based telephony systems, which can transform the way that appointments can be made. My hon. Friend highlighted systems where GPs can see how many people are waiting on the line and how long they have been waiting for, and can divert resources to get calls answered quicker, even doing so remotely, with receptionists not having to work directly in the surgery to answer the phone, book appointments or organise prescriptions.

Cloud-based telephony is really transforming access to GPs. Unfortunately, some GPs are already signed up to contracts with other telephone providers that they cannot get out of, and some have signed up with other cloud-based telephony systems that are not as good as others, as my hon. Friend pointed out. NHS Improvement is working with GPs to drive full adoption of cloud-based telephony across the system. We are working with surgeries and sharing best practice of what really works. He is quite right that when patients are frustrated about not being able to get through they take it out on staff and GPs. To deal with the telephone access issue and make it easier to get through will transform the lives of both patients and staff.

We must also bust the myth around the 48-hour appointment model, which was in place under previous Governments, where patients had to be given an appointment within 48 hours. Patients had to phone up every morning and could only get an appointment within that 48-hour window. There is no need for that, and we are trying to say to GP practices that that is a historical model—they do not need to stick to it. Very often, a patient will be happy with an appointment next week, rather than having to phone up on the Tuesday, the Wednesday and the Thursday but still not get an appointment. There is a lot of work around practice management, and the systems in individual practices, that we are happy to help GPs with.

We are also working on the pharmacy consultation service, which has been used very successfully during the pandemic. If a patient phones 111, or the GP practice, there is a range of minor ailments that a pharmacy can deal with face-to-face, quickly and expertly. Those ailments, which range from sprains to colds and flu—even those patients with long-term conditions and on long-term medications, such as some diabetics or those with high blood pressure—can be well managed by a pharmacist. We want to go further with that and introduce more services provided by community pharmacists. We are in negotiations with pharmacy teams to see if we can do that. Scotland and Wales have a pharmacy-first system that works extraordinarily well; we are keen that patients in England have access to similar support.

We are introducing changes to the GP contract this year—some of those are more popular than others. For patients, one of the key elements is about extending opening times to evenings and Saturday mornings, to make it easier for patients to be able to see their GP if they need to. That comes on top of the point that my hon. Friend made about other healthcare professionals working in primary care. Primary care is changing dramatically. We have already recruited over 18,000 additional primary care professionals, such as nurses, physios, pharmacists and paramedics, who are often better placed than the GP to provide the care and support a patient needs. My hon. Friend is quite right that there is sometimes a reluctance from patients—a feeling that they are being palmed off on someone else rather than seeing the GP. However, we are finding that once they have seen the paramedic or the physio, they are very pleased to see that professional the next time an appointment is offered. We are hoping that the take up of that will improve.

We have a commitment to recruit 26,000 more healthcare professionals by 2023-24 in addition to the GPs. We are on track to meet that, so that primary care becomes a multidisciplinary experience for patients, and it is not always the GP who they need to see first. However, as my hon. Friend says, we do need more GPs, and a record number of 4,000 doctors have taken up GP training posts this year, which is a real boost to the numbers, but I recognise that they will take several years to be trained and to come through.

Although my hon. Friend speaks well about the pressure on whole-time equivalents, his local clinical commissioning group allows GP registrars to see patients, which boosts patient appointments and capacity in the local area. He will be pleased to note on housing—again, my constituency in the south-east has similar problems, where housing developments are in their thousands rather than their hundreds and spring up overnight with no consultation with the local GP, who then has to take those patients on—that I am meeting the Housing Minister, my right hon. Friend the Member for Pudsey (Stuart Andrew), this month to discuss the very issues my hon. Friend raises about primary care being a key feature during planning and when things such as section 106 and community infrastructure levy money is being allocated. As he rightly says, the health centres need to be built first before the housing.

[Richard Fuller]

I am delighted that the Minister is taking such an active interest in the impact of development on access to services. In my speech, I requested that, ahead of my meeting with the Secretary of State, the Department look back at that history in my constituency as a test case to see what could have been done differently and what might be done now. Will she commit to that being done ahead of my meeting with the Secretary of State?

[Maria Caulfield]

I am not sure when my hon. Friend’s meeting is—I think it is fairly soon.

[Richard Fuller]

July.

[Maria Caulfield]

It is in July. We can certainly look at that, because we need to look at the lessons learned if we are to make progress going forward. The Housing Minister is keen to address this problem, so it is good to look at what has not happened in the past that should have, so we can take that forward. I cannot commit 100% to that being ready for my hon. Friend’s meeting, but we can certainly look at it.

The final point was on the GP partner model and support for GPs in their role and in some of the challenges they face, whether that is taking on premises or taking on liability. There is definitely a trend where partnership numbers are going down, but salaried GP numbers are going up. That is because younger GPs coming forward often do not want to take on the responsibility of being a partner and everything that entails, but partners feel that being bought into the practice gives them a huge amount of additional investment in terms of time and finance, as well as guidance, development and support for patients.

The Secretary of State has instigated the Fuller review—that is not my hon. Friend, obviously, but a GP—around the future models of GP practice, and whether that is partnership or salaried or whether there are different models available. We will take a good look at those recommendations because there may not be a one-size-fits-all solution. Some partners have a definite view of where they want to go; others are struggling and need support and help. I do not think it will be that one size fits all, but the Fuller review will certainly make some strong recommendations.

I hope in the short time we have had that I have been able to acknowledge the main challenges my hon. Friend’s constituents and GPs are facing and have outlined some of the measures we are taking to support primary care and enable patients to see their GPs more quickly and easily, whether that is virtually or face to face.

Question put and agreed to.

Access to NHS Dentistry

Richard Fuller Excerpts

Thursday 10th February 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Efford, and to follow the hon. Member for Ealing, Southall (Mr Sharma), although I did not agree with the premise of his argument. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. He and other hon. Members have mentioned a number of problems. I do not mean to reiterate any, but I will add one issue for consideration by the Minister: infrastructure first, and the pressure of additional housing development. House building in my constituency is at five times the national average. That is not only disruptive to our natural environment but means that people cannot access their GP, a school place or a dentist. Maybe she can address that.

I wanted to speak for a number of reasons. One thing I put on the record—many colleagues will have had this—is that a number of dentists contacted me through lockdown desperately wanting to serve and provide services. They found it exceptionally difficult to be able to do that. They literally knew that there was a growing problem, and they wanted to serve. I thank dentists in my constituency, as I am sure do all Members, for their efforts during the period of covid. In addition to infrastructure first, I would like to hear from the Minister specifically how we are going to address the difference between registration for a service and actually accessing a service. It seems that there is a problem in the contracting around that at the moment.

Where I perhaps disagree with the hon. Member for Ealing, Southall, who just left his place, is that I think we have to control taxpayer support for dentistry. Public finances are stretched and have been for considerable time—in my time as a Member of Parliament, both currently and during my time as the Member for Bedford. We have tried to deal with some aspects of excessive public expenditure. We have record debt. We have record levels of taxation. It is a fantasy for Members of Parliament to come here or to the Chamber time after time and say how wonderful it would be to spend more money on whatever is the topic of the day. In that way lies financial ruin. The Labour party has no answer to that. We need to find creative solutions to use existing levels of expenditure more wisely than currently.

On the way dentistry contracts work, as the British Dental Association and others have shown, there is plenty of scope for spending existing resources more efficiently and more effectively, by looking at a better form of contract than drill and fill or by looking at preventive dentistry, rather than reacting once problems have occurred. I was amazed to see—I do not know whether other colleagues have seen this; I am not sure I read it right—that one of the main reasons for young people ending up in A&E right now is tooth decay. How on earth did we get into that situation? There must be a better way for us to spend resources if that is the result those resources are having.

May I also make a point about recruiting people into dentistry? I supported Brexit and I support the Home Secretary’s points-based immigration system. What on earth are we doing to ensure that we have an adequate supply of people from across the world? My hon. Friend the Member for Waveney talked about people coming from the Commonwealth. I do not mind where they come from. I want the best and brightest to come to this country. How can we eliminate some of the restrictive practices to ensure that we make that an interesting and attractive option?

Finally, I will make a point about the contract. One issue in our health services is that most contracting is done, in essence, through what I would call production contracts between a producer and the state for how taxpayers’ money should be allocated. However, there are other ways to do that, such as by putting the power of the money with the consumer. We started to do that in elder care through personal budgets, and I know that the Opposition spokesperson, the hon. Member for Bristol South (Karin Smyth), has a lot of experience in care, so she might address that issue, too.

Can we find a new way to contract with our dentists that empowers consumers with the financial resources that are to be spent, so that they can choose where to use the money? They could have competitive pricing from dentists, rather than every particular production item in dentistry having a particular price, with all the frailties mentioned by my hon. Friend the Member for Worthing West (Sir Peter Bottomley), the Father of the House, with one filling versus the whole thing ending up at the same production price. If we empower people through the budget, that might be a better way to approach any change to our contracts, rather than just rehashing another producer contract for dentistry.

Integration White Paper

Richard Fuller Excerpts

Wednesday 9th February 2022 Commons Chamber

[Edward Argar]

I am grateful to the hon. Lady, although I am not entirely convinced on her point about the absence of Government action. Yes, co-operation has been happening organically from the ground up, but that has been encouraged and supported by Government action—including various pots of funding, for example relating to discharge during the pandemic—driving that activity and helping to foster that culture of co-operation. She highlights the importance of the workforce and the need for increasing numbers. That is a point I have already acknowledged. I have made clear that the Government have a plan and are already delivering increases in the workforce.

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

I welcome the White Paper, not least because we have had to put through a very painful tax increase and want the Government to get on with things, but also because the Minister faces considerable challenges, including demoralising intransigence between competing bureaucracies, a hugely complex task of integrating information systems, and the need to rip up and replace the truly horrendous workforce planning system for change of pay and other conditions, as other Members have said. All those things are going to bog the Minister down, so will he do two things? First, will he set up a special taskforce to look at quick wins to start to deliver improvements? Secondly, reinforcing what my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee said, will the Minister agree to put control of, and full information about, patient records in the hands of patients, so that they can use effective choice?

[Edward Argar]

My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve.

On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.