Face-to-face GP Appointments

Debate between Richard Tice and Lee Anderson

Thursday 20th March 2025 Commons Chamber

[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.

Immigration and Home Affairs

Debate between Richard Tice and Lee Anderson

Tuesday 23rd July 2024 Commons Chamber

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

May I congratulate the hon. Member for Darlington (Lola McEvoy), my hon. Friend the Member for Clacton (Nigel Farage) and others on their excellent maiden speeches?

It is a great honour to represent Boston and Skegness, which I believe is the most fertile constituency in the country. I refer of course to the productivity of the amazing agricultural farmland in the constituency. At the heart of it is Batemans Brewery, a fantastic family brewery launched in 1874.

[Lee Anderson (Ashfield) (Reform)]

Good beer.

[Richard Tice]

Good beer indeed. There is the extraordinary engineering feature of a lattice of ditches, dykes, drains, rivers and havens that ensure that the farmland is productive.

At the eastern end of this great constituency is sunny Skegness, where millions go for their holidays every year—the home of the first Butlin’s, in 1936—and where the fourth longest pier in the country was built in the late 1880s. It is an extraordinary and remarkable town. It has the benefit of producing what I think is possibly the best value, most delicious and greatest portions of ice cream, to which I am very partial.

If we head west from Skegness, over the farmland, we reach the historic market town of Boston. It has the tallest parish church tower in England—known as “the Stump”—built over 500 years ago. A couple of hundred years ago, Boston was the largest trading port outside London. Of course, it was Bostonians who, in 1630, left the Isle of Wight for north America, where they established Boston, Massachusetts. It is a remarkable constituency that I am proud to represent.

I pay tribute to my predecessor, Mr Matt Warman, who was the MP for nine years. His legacy is in healthcare in particular. We are building at the moment a £40 million accident and emergency facility—he played a role in that. He saved a children’s unit from closing, and he had a significant role in securing the diagnostics care unit that is under construction. Those are great achievements.

There is a reason I overturned the largest ever Conservative majority in the country. Despite the Jolly Fisherman being the symbol of Skegness, my constituents are not feeling very jolly at the moment. Seven out of 10 of them voted to leave the European Union. They trusted the previous Government—they took them at their word—but they now feel a sense of political betrayal in a number of areas.

The first people who are not very jolly are the fishermen themselves, who feel that various bureaucrats including the Environment Agency, Natural England and the Inshore Fisheries and Conservation Authorities are acting so as to try to suppress or destroy this great industry for our seafaring nation, one that produces food and generates great revenues. In addition, bureaucrats are making the issue of flooding a serious problem in my constituency. Thousands of homes have been flooded, and with a failure to properly maintain sea level defences, tens of thousands of homes are at risk, again because of bureaucracy and inertia. Another reason why my constituents are really quite grumpy is that the stupid net zero policies will result in hundreds of massive, ugly pylons blighting the environment and countryside of my constituency, as well as solar farms planned on incredibly productive agricultural farmland. It is absolute idiocy.

Then, of course, there is another big issue that is making my constituents very grumpy indeed. One of the slogans for leaving the European Union was to take back control. The previous Government promised it; do you remember that slogan? It was about money, laws and borders—yes, borders. It was about controlling immigration and having smart immigration—working, integrating and speaking the language—which we should all agree is a great thing. Instead, the previous Government opened the doors to mass immigration, with significant consequences for towns such as Boston and other towns up and down the country.

I will give Members an example. Every morning in the centre of Boston, dozens and dozens of east Europeans arrive in the marketplace with nothing to do. They have been hoofed out of the houses in multiple occupation where they are hot-bedding—two or three shifts a day on the same mattresses—because of mass, uncontrolled immigration. They have got nothing to do, and they have been aided and abetted in coming to the UK by false promises made by morally bankrupt businesses, which are helping them to get national insurance numbers for overseas persons under a scheme that we thought had closed.

We thought the EU settlement scheme had closed, but it turns out that it has not. If someone fibs about how much time they have spent here before 2020, they can still apply, so many are still arriving, and they are not integrating. They are not learning the language, and regrettably, it creates an intimidating atmosphere in the centre of the town—I know this goes on elsewhere. The implication is most seriously felt by women who work in the town centre, who feel unsafe leaving their place of work, and by constituents who do not want to go into the centre of this great market town at night because they fear, frankly, that it is not safe. When they go there at night, there is no chance of seeing any police whatsoever—I have been there on a number of occasions. What those people will see is drug dealers in the centre of the marketplace, plying their hideous, vile trade night in and night out. That is completely unacceptable.

During the election campaign, I went to numerous houses; for example, there was one where seven people were living in a house with two bedrooms. It was a Bulgarian family, and only one member of that family spoke any English at all. They said, “We’re here to claim benefits—your health benefits and housing benefits. We would prefer it in Bulgaria, but we want to take your benefits and then send the money home.” That is what is going on up and down the country, and it is completely unacceptable. [Interruption.] There is muttering—the truth hurts. The establishment do not want to talk about this, do they?