GP Recruitment and Retention

Ross Thomson Excerpts

Wednesday 28th March 2018 Westminster Hall

[Bridget Phillipson]

I will touch on all the points the hon. Lady raises as I continue through my contribution.

I am clear that addressing the housing crisis in our country should be an absolute priority for the Government, but I argue that building thousands of new homes without ensuring that the necessary infrastructure is in place to meet increased demand on health, transport and education services would be a recipe for disaster. Poorly planned housing developments that do not take account of local need will only undermine public confidence in supporting a housing revolution in this country.

It is not just our constituents who are concerned about the deteriorating state of general practice in the north-east. Just over 18 months ago I was contacted by the Sunderland local medical committee about the findings of a confidential survey of local GPs and practice managers, which showed that almost half of those surveyed had seen a large increase in their workload and a further 31% reported an increase to unsustainable levels. Although two thirds of practices had attempted to recruit new family doctors, many had found recruitment difficult, and a majority reported that patient care had been adversely affected by the failure to recruit and retain GPs, the increasing workload that imposed on existing GPs and the significant reduction in core funding allocated to their practices. As a result, 60% of Sunderland GPs and practice managers said that their practice was viable only for between one and three years, with many local doctors considering early retirement or a career change.

That survey highlighted the profound problems at the heart of general practice in Sunderland, further evidence of which was laid bare in statistics I requested from the Department of Health later in 2016. Those figures showed not only a shocking 25% reduction in the number of full-time equivalent GPs in the NHS Sunderland clinical commissioning group area between 2013 and 2015 but also an accelerating rate of decline from one year to the next. The way in which full-time equivalent GP numbers were measured changed in 2015, but the new methodology shows a continued decline of 9% in the Sunderland CCG area between September 2015 and December 2017.

I am sorry to say that the most recent figures for other parts of the north-east make for even more painful reading. In the Hartlepool and Stockton-on-Tees CCG area there was a 15% drop in numbers over the last two years. In the South Tees CCG area it was 14.9%. In the Darlington CCG area it was 13%, and in the Durham Dales, Easington and Sedgefield CCG area it was also 13%. I could go on, but it is obvious that the exodus of family doctors from the profession is having a serious impact on the number of hours being made available for general practice in our region.

As a result, the demand on family doctors who continue to soldier on is intensifying. Not one practice in my area has a lower ratio of patients to full-time equivalent GPs than the England average of 1,738:1. In fact, each and every practice is consistently and significantly above that. The situation will be similar, if not worse, in other parts of the north-east.

Coupled with the plummeting number of full-time equivalent GPs is the similarly concerning decline in the number of GP practices in the area, from 53 in 2013 to just 40 today. I accept that there are merits to the argument that consolidating practices makes them more sustainable in the long term by creating larger patient lists. However, it is really important to remember that practice closures can leave behind big holes in communities.

[Ross Thomson (Aberdeen South) (Con)]

In Scotland we face a shortage of 1,000 GPs by 2021. Torry medical practice in my constituency has really struggled to fill vacancies and decided to end its contract with the NHS at the end of July. The practice is vital to the area, and thousands of my constituents rely on its services. Does the hon. Lady agree that the Scottish Government should seriously consider ways in which they can attract more medical students to Scotland?

[Bridget Phillipson]

Attracting medical students to areas of the country with the greatest need is important. That is something I have been seeking to do, and I am sure the hon. Gentleman will continue to make that case as well.

--- Later in debate ---

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

It is a pleasure to speak under your chairmanship, Mrs Moon. I compliment the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on a real tour de force around the issues before us today. Like the hon. Member for Strangford (Jim Shannon), I will dwell on an aspect of the issue that affects a constituency that is part of a devolved Administration. I hope that what I am about to say will be helpful at the UK level and possibly at the Scottish Government level.

I come from the basic premise that no matter where someone lives they have an equality of right to decent health services. I represent the second biggest constituency in the UK, and there is a particular challenge in the north of Scotland in terms of access to GPs and other medical services. In that context, within the past few days a big issue has developed—it has been fairly well reported in one of Scotland’s main newspapers. In the Caithness part of my constituency, in the top right- hand corner of Scotland, GP provision and access to other health professionals is not what it should be, notwithstanding the best efforts of the professionals that we do have. In no way do I want anything I say to denigrate their efforts because they work exceedingly hard, but the issue is a big concern for my constituents, and they raise it with me repeatedly.

Out of fairness to the Scottish National party represented here, the matter is devolved, but I hope that what I suggest will be helpful. A group called the Caithness Health Action Team has been formed and it outlines the problem on its Facebook page probably more succinctly and better than I can during the brief time available to me. I give credit to the fact that the group is campaigning in a constructive way to try to help matters.

NHS Highland has recently admitted that the recruitment and retention of GPs and similar professionals in other branches of medicine is proving a real challenge in that remote area. It really prompts the question of whether we say there is nothing we can do about it. Do we have to walk away and accept that some parts of the UK or Scotland will not have equality of provision, or do we say we will roll up our sleeves and tackle it? In my book, the answer is the latter.

Before I return to recruitment specifically, one of the most irritating things, or perhaps encouraging things, is that when we recruit a health professional in somewhere like my part of the world—although I daresay it is also true of Plymouth—after a while they begin to love it. There is every chance they might settle and their children be educated locally, and that is good for the community. That is a prize worth remembering.

I want to mention two specific points. Several Members have already mentioned a kind of bursary, a cash incentive to encourage someone to do GP training. We all know how expensive medicine is, how student debt can be built up and the length of time it takes to qualify. This is just a suggestion and it might not be possible within UK recruitment law—I am prepared to be corrected—but I am keenly aware that the armed forces can offer a bursary to go to college or university to be trained, but part of the deal is that when the person graduates the armed forces can send them to where they are needed most. I have a daughter who is serving in the armed forces and she knew right from the start that that was part of the deal. Whether that can be done within UK law, I do not know, but it might be worth looking at. A given health authority could help someone through their five years of GP training, but then have the right to say that for the next two or three years they will be placed in Plymouth, Wick or wherever in the UK. I think a cross-border UK-wide solution is best in that respect.

My second point is an old one. I remember that when I was a kid the nurse got a house. There were doctors’ houses, and that made a difference in recruiting people. As far as I am aware, the nurses’ houses have all gone and no longer exist, but it was part of the local authority’s responsibility to allocate such housing.

The answer in the Scottish context is for NHS Highland and probably the Scottish Government to take a co-ordinated and targeted approach to a specific problem in a specific part of the highlands. I think the willingness is probably there, to give credit where it is due. As and when a solution is found as to how we get people into the area, that experience could be useful to UK Government Ministers as well. There is everything to be learnt from each other. Should the Minister or the UK Government find a way to deal with these problems before the Scottish Government do—

[Ross Thomson]

As a constituency MP, the hon. Gentleman has no doubt had the same correspondence that I have had from Scottish students who have been denied access to Scottish medical school. I do not know whether he shares my concern that the current cap by the Scottish Government on Scottish domiciled student places means that only 51% of current medical places at university are filled by Scots.

[Jamie Stone]

That is a relevant point, and I share that experience. I do not want to go into the specifics, but within the past two days I have encountered the case of a sixth-year pupil at a school in my constituency who, because of the curriculum limitations in the sixth year, will be unable to pursue the tertiary education in the medical field that she would like to. It is a worry, but I shall take that up with the director of education.

The matter we are debating is a big issue in my constituency. It is particularly acute because of the distances involved, and it is at the forefront of my constituents’ concerns. I accept that it is devolved, but I feel duty-bound to air the matter in this place.