Face-to-face GP Appointments

Richard Tice Excerpts

Thursday 20th March 2025 Commons Chamber

[Richard Tice (Boston and Skegness) (Reform)]

It is a pleasure to hold this Adjournment debate on face-to-face appointments with GPs. I ask hon. Members listening and watching to go back to October 2023 and imagine that they have abdominal pain and some blood loss. They seek a GP appointment and they are given a telephone appointment. They are given a diagnosis of endometriosis and prescribed some painkillers. This diagnosis, sadly, turns out to be incorrect.

They then move forward, still in pain, to mid-December 2023. They receive a letter with a gynaecological appointment for the end of January 2024. But they are still in deep pain. The pain intensifies. Their husband rushes them to the urgent treatment centre at Pilgrim hospital, where a doctor sees them and reaffirms the diagnosis of endometriosis. The doctor says, “As you are being looked after by a GP, there’s nothing more I should do.”

Over the next two weeks, the pain intensifies, to the point where at the end of December 2023, they are rushed to A&E. It is just before new year. They are told to come back for tests on 2 January 2024. Those tests reveal some problems and some lesions around the liver. They are put on a two-week cancer pathway with more tests, CT scans, MRI scans and an endoscopy. On 2 February, they are given the results of those tests. Sadly, the cancer has spread to such a degree that nothing more can be done. Just three days later, they pass away.

It is impossible to imagine or to understand this, but it is the tragic story of Laura Barlow, aged just 33, the mother of three young daughters: Summer Skye, Bonnie Rae and Bella-Mia. Her husband Michael Barlow is here in the Gallery with friends. His campaign, after the tragic loss of his wife Laura, is for more face-to-face appointments, and for patients to have the right to one if they feel they need it.

It is worth looking at the context of face-to-face appointments in our healthcare system. Going back some six years to 2019, around 80% of all GP appointments were face to face. According to NHS England, for the last two months, the figure is just over 64%. How do we compare to other nations? In European nations with different healthcare systems, the average is 84% or 85%. We have some 20% fewer face-to-face appointments than some of our international peers.

I am just a layman, not a doctor, but it must be common sense that an experienced, highly skilled, professional GP looking a patient in the eye to physically assess them face to face must give patients the greatest chance of a correct diagnosis. Sometimes, a GP will spot something that the patient was not even aware of.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman on securing the debate. GP face-to-face appointments are a massive issue in my constituency, and you, Madam Deputy Speaker, are probably inundated with constituents asking about the same thing. People —more often than not, elderly people—phone the emergency number at half-past 8 in the morning and hold on till 5 past 9. After they have held the phone for 35 minutes, a voice says, “By the way, you’re too late.” The system is not working. To be fair to the Minister, I understand that changes are coming. We need to know what they are, and whether they will improve the system. If they do not do so to the satisfaction of the hon. Gentleman, my constituents and me, something is drastically wrong, and that needs to be addressed immediately.

[Richard Tice]

The hon. Member makes some excellent points. There is clearly a place for telephone appointments. When researching the topic in more detail, I was astonished to find that of the gap between the 64% or 65% of face-to-face appointments and 100%, telephone appointments represent some 25% and Zoom or Teams appointments are just 5% to 7%. I would have thought it would have been the opposite. Surely it is better if GPs can see the pain that might be etched on a patient’s face.

We can look at the broader context—at what is happening to our population, and to the number of GPs, and at the pressures on GPs—and ask: is that why the percentage of face-to-face appointments has collapsed so significantly? In England, there are 6.5 million more people than in 2015—an increase of some 17%. Interestingly, the number of GP appointments increased in that period by a similar percentage, give or take; it went from just over 300 million appointments to over 360 million appointments. In fairness, and with due credit, there has been a recent increase, month on month, in GP appointments, which is to be commended, but it seems strange that the number of full-time, fully qualified GPs has barely moved in those 10 years. It is true that there are more trainee doctors and trainee GPs in the system, but the number of fully qualified, full-time-equivalent GPs has basically stayed static. That means, of course, that the number of patients that a GP has on their books has increased significantly, from over 1,900 per GP to over 2,300 per GP. We can therefore understand the increase in pressure on them. Given those health needs, they will feel the need to see as many people as possible, so we can see the temptation to hold telephone or Zoom appointments.

[Lee Anderson (Ashfield) (Reform)]

My hon. Friend is making some excellent points. Does he agree that there is a place for telephone appointments if a GP is giving guidance and support, or making a referral, but that any diagnosis should be made face to face?

[Richard Tice]

I thank my hon. Friend for that excellent intervention. This comes back to the basic concept of common sense. It must be easier for a GP to make the correct diagnosis when seeing someone face to face. We all make mistakes, but when our medical professionals on the frontline, whom we all admire, are under pressure and tired, and they make mistakes, that can have devastating, life-changing consequences.

We will never know the difference it may have made if Laura had the correct diagnosis in October 2023, but it must be right to give all patients the best opportunity. I know that the Secretary of State for Health and Social Care, who I have interacted with in the Chamber, is absolutely determined to make reforms across the healthcare system. He has started actively, abolishing NHS England, making changes to the Department, and doing much more. That brings me to what else can be done.

We can look at the pressures on GPs. I was astonished to read that almost 50% of all GPs are thinking of retiring in the next five years. Almost 50% of them cite the increased pressure of bureaucracy, paperwork and administration. Surely we want our trained GPs in front of patients; we do not want their time being absorbed by unnecessary burdens and paperwork. If that is driving our GPs away from the noble profession of curing and helping people, we have to look again. I hope the Health Secretary, the Minister and colleagues will drive a change in processes.

When I was with people in my constituency of Boston and Skegness recently, doing more research, I was astonished by what I found when I spoke to a GP and liaised with her. She gave me some examples of bureaucracy clogging up the system. For example, if a GP refers a patient to a consultant in hospital, and the consultant says, “Yes, the patient needs this, but I also need to refer them to another speciality just down the corridor in the same hospital,” that cannot be done directly. The consultant has to write back to the GP. That letter goes through the post, with a hundred other letters a day. Then the GP has to refer the patient back to a different consultant, with that different speciality, down the corridor in the hospital. That lacks common sense.

It appears that if the consultant wants to prescribe medication to the patient who has been referred, they are unable to do that directly; they have to refer back to the GP, who has to spend more time providing the prescription. That appears to lack common sense. If the consultant wants to request blood tests, on many occasions that will have to be referred back to the GP, by letter or maybe by email, so that the GP can request those tests. All that leads not only to delay for the patient, and to time being consumed, but to more work for the GP, who we all surely want to see more patients face to face.

There are other situations that seem to be clogging up the system. Take our old friend GDPR. It is well-intentioned, but when I went to a pharmacy in Boston a few weeks back, the pharmacist said, “We have the same software system as the GP surgery, right next door to us in the same building, but because we have different modules, and because GDPR does not let the modules talk to each other, it leads to increased delays and a lack of productivity and, for patients, a lower-quality service.” They went on: “We could do so much more. We could relieve the GPs of some of the work they are doing, so that they could see the patient face to face.”

Then, a week later, I was in a care home in Boston, with carers and experts in the room. We were talking through the issues. They said, “There are processes and procedures that we can do that we are not allowed to do, so a GP has to do it; or we have to request an ambulance from the hospital, clogging up ambulance waiting lists or clogging up A&E corridors, when we could do those procedures.” Again, the great concept of common sense cannot be applied. I think we all know that we can do so much better than that.

Then there is the issue of referrals. When a GP makes a referral to a consultant, that referral often gets assessed by a non-clinician as to whether it is correct. I would have thought that we should be able to trust highly trained, highly skilled professional GPs and back their judgment on the frontline. If they think someone needs to be referred to a consultant, surely that does not need double or triple-checking. Again, that delays good patient care and causes more blockages for the GP, more admin and more paperwork.

Then there are our friends at the Care Quality Commission: an important supervisory process and concept. I hear about the processes, the box-ticking, the patient panels—all that is just more admin, more time and more resources consumed outside the core function of face-to-face treatment and care for patients. It therefore seems that this is not a party political issue, but one of driving continuous improvement in our healthcare system, and of the Department, as it moves forward with the reforms we all want to see, saying, “Actually, let’s look at all the processes. How do we reduce the blockages? How do we remove any unnecessary paperwork and burdens? How do we improve the technology?”

Indeed, artificial intelligence, which is so recent, is a huge opportunity for healthcare and technology in healthcare, and for GPs to, for example, double-check or triple-check their own diagnoses. These are great opportunities facing us, but most fundamental of all, we must give our GPs every support, every ease of progress and the right technological assistance behind the scenes in the back office, so they can face all of us when we are unwell and need treatment, because that is when they can use their experience, wisdom and knowledge to get to the right diagnosis.

It would be a tribute to Laura—it would be her legacy—for patients to have the right to see a GP face to face. Easing the processes would make life easier for GPs and would make them want to stay in the profession, because they know that face to face they will achieve a great and noble cause and good.

NHS England Update

Richard Tice Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

That is a great question from my hon. Friend. We have to give people the tools to do the job. The Prime Minister set me and my hon. Friends in the Department an enormous challenge on behalf of the public. In turn, I am setting an enormous challenge for NHS leaders at every level, but particularly for frontline NHS leaders. We have to give them the tools to do the job in terms of data platforms and the technology that they are given to work with, ensuring that they have access not just to cutting-edge treatments and medical technology, but to the back-office productivity support that can drive efficiency and improvement and, frankly, liberate managers and frontline staff from the arcane systems they are working with.

Some of the very best people I have met in the last few years, shadowing this portfolio and now holding it in government, are NHS leaders, especially on the frontline. It is my responsibility to give them the tools to do the job. That is not just about financial resources; it means bulldozing through some of the regulatory barriers and overcentralised instructions that stop them making decisions in the best interests of patients, in terms of clinical pathways and value for taxpayers. I have given them an undertaking that I will have their backs, both on the decisions that they will have to take on the frontline and on bulldozing through the national bureaucracy that is tying them up in knots when we need to set them free.

[Richard Tice (Boston and Skegness) (Reform)]

I congratulate the Secretary of State on the changes announced today to cut unnecessary waste and bureaucracy. We all know and agree that healthcare should remain free at the point of delivery and, of course, that the NHS needs reform. Just last Saturday, I was in a care home in Boston with a lady—an expert—who knows Melanie Weatherley, and she was telling me about the unnecessary processes within NHS England on the frontline that constrain good care in care homes, impose unnecessary constraints on ambulances and block A&E wards. Will the Secretary of State confirm that the changes and reforms will include unnecessary processes on the frontline in care homes?

[Wes Streeting]

I can certainly give the hon. Gentleman that assurance. We have to cut through the unnecessary red tape that ties leaders and frontline staff up in knots, and we are absolutely determined to do that. Regulatory reform will form a big part of this Department’s agenda and the wider Government’s agenda. As to an NHS free at the point of use, he almost said it with a straight face. I am sure that he meant every word he said. I think he might want to have a word with his party leader, who is his successor and—who knows?—perhaps his predecessor.

Health and Social Care: Winter Update

Richard Tice Excerpts

Wednesday 15th January 2025 Commons Chamber

[Wes Streeting]

When I was sitting on the Opposition Benches at the tail end of the last Parliament, I saw my predecessor at this Dispatch Box telling us all the wonderful things that she thought the Government were doing and achieving. It was like hearing about a completely different national health service and social care system in another country. I arrived in July and was honest on day one that the NHS is broken but not beaten, and that these are crises of historic proportions that we will never sweep under the carpet, nor will we hide problems to spare political blushes. In the coming months and years, I will continue to be honest about where we have not yet fixed problems, and clear about the action that we are taking to get the NHS back on its feet and fit for the future and to build a national care service worthy of the name.

[Richard Tice (Boston and Skegness) (Reform)]

I think we all share the Secretary of State’s aspiration to move healthcare out of hospitals and into the community. However, the two GP surgeries that I visited in Skegness just before Christmas are concerned that the impact of the national insurance increases on their staffing budgets will be around £100,000 per surgery, which will force them to reduce staffing capacity and, therefore, appointment capacity. What will the Secretary of State do to help those GP surgeries in that situation? There seems to be a conflict between the sensible aspiration and the practical reality.

[Wes Streeting]

There are 889 million reasons why GPs should be reassured about their financial sustainability for the year ahead—the £889 million allocation for general practice that I spelled out before Christmas, to provide reassurance to GPs when planning for the financial year ahead. I have been heartened by the response from GPs to that announcement, and I gently say to people who criticise the means of raising it that without the decisions that the Chancellor took in the Budget, we would not be able to invest £26 billion in our health and care services. We cannot have people welcoming the investment but criticising the means of raising it. If people do not support the Chancellor’s decision—a perfectly reasonable political position to take—they will have to spell out what services they would cut or what taxes they would raise.

Sepsis Awareness

Richard Tice Excerpts

Wednesday 9th October 2024 Westminster Hall

[Richard Tice (Boston and Skegness) (Reform)]

It is an honour to speak under your chairmanship, Sir Christopher, and I congratulate my hon. Friend the Member for Ashfield (Lee Anderson) on securing the debate.

These are extraordinary tales that we hear from loved ones and family. A very good friend of mine nearly died of sepsis seven years ago, but—I have to be honest—I had never heard of it until that moment when he nearly passed away. This could be one of the most extraordinary opportunities for our healthcare system to make a rapid difference.

Sepsis is so quick but so preventable. In the pressured environment of our hospitals and our GPs’ surgeries, it is so easy for healthcare professionals to miss it. If it becomes embedded in all of us through a major publicity campaign, which could be organised relatively quickly, to ask ourselves that simple question, “Could it be sepsis?”, in the same way that we often ask, “Could it be meningitis?”, and if we could help medical professionals by asking them that question too, we will have the ability to prevent death or major life-changing injuries and to save money for the NHS. It is a massive win-win, and I hope the Minister can rapidly respond both positively and appropriately.

NHS: Independent Investigation

Richard Tice Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

My hon. Friend is right, and at some point the Conservatives will have to take responsibility for it. We learned through bitter experience that if we did not change as a party, the country would not choose to change the Government. Long may the Conservatives continue, therefore, with their head in the sand, and long may we continue to get on with the job of clearing up their mess and building an NHS that is fit for the future.

The relationship between the NHS and local government, and between my Department and local government, is of particular importance in relation to social care, which is why I was especially delighted that the Prime Minister chose this week to appoint Tom Riordan, the chief executive of Leeds city council, as second permanent secretary. He is an outstanding public servant with a demonstrable record on health and care integration, public health and prevention. I look forward to having that local government perspective, and local community delivery perspective, at the heart of our Department.

[Richard Tice (Boston and Skegness) (Reform)]

I think the whole House agrees with what the Secretary of State said in his statement: the NHS needs reform. In reality, when I speak to people in the NHS, almost all of them say that this is not about a shortage of money, but about the legendary levels of waste, bureaucracy and mismanagement. Indeed, the report refers specifically to the huge number of regulators, accountants and bureaucrats from the top down. Is there recognition among the NHS senior leadership that management reform is a critical part of improving healthcare in the United Kingdom?

[Wes Streeting]

I welcome the hon. Member to his place and thank him for that question. I am always cynical about huge volumes of regulation. We reassure ourselves as legislators and regulators that putting regulations in place means that we have dealt with the issue. But the problem is that if we fail to deliver, we put another regulation in place, then another, and then more, and before we know it, we have drowned the people responsible for delivery in so much regulation that they cannot sort the wheat from the chaff or see the wood for the trees, compromising standards and patient safety. That is why I welcome the work that Penny Dash has done in relation to the Care Quality Commission, and we will continue to work with her to reduce the burden of regulation, focus on the things that really matter and free NHS staff from red tape. I hope that he finds that reassuring. I plead with him not to send his party leader to agree with me as well, or I really will be in trouble.