GP Services (Tower Hamlets)

Rushanara Ali Excerpts

Tuesday 13th May 2014 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair this afternoon, Mr Streeter. I am grateful to Mr Speaker for affording me the opportunity to hold this debate, to the Minister for being here to listen and respond and to my parliamentary neighbour, my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali), for taking an interest and supporting the debate.

My remarks are designed to defend Tower Hamlets GP services. I am a great admirer of all that they have achieved, especially over the past 15 years. I called for this debate for three reasons. The first is to find out more about the nature of the problem facing GP services in Tower Hamlets. The second is to determine whether the Government accept that there is a problem. The third is, hopefully, to identify a solution.

The picture is confused and many aspects must be considered, but the real concern is that primary care budgets are being cut, and not only in Tower Hamlets. In response to my written question about average annual changes to GP income in Tower Hamlets, the Minister stated that there would be

“a decrease of £184,000 spread across 21 GMS practices.”—[Official Report, 6 May 2014; Vol. 580, c. 126W.]

However, The Guardian has reported that the Jubilee Street practice alone

“will be down £77,263 by the end of 2014-15”

and that it had “already lost £30,000 QOF”—quality and outcomes framework—

“income last year and will lose its £219,508 a year MPIG allocation incrementally over the next seven years—the accumulated loss due to MPIG alone amounting to over £903,000.”

The figures do not add up.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

As well as the Jubilee Street surgery, four other practices in Tower Hamlets are reported to be part of the 98 surgeries facing closure, but we do not know where they are. Will the Minister commit to publish a list of those surgeries and to place that list in the House of Commons Library?

[Jim Fitzpatrick]

I am grateful to my hon. Friend for asking the Minister that question and look forward to his response.

The Jubilee Street and St Katharine Docks practices are the two main affected surgeries in my constituency. They are professional, efficient and well-loved and respected by patients. Jubilee Street says that if its proposals to solve the dilemma are not addressed and no agreement is reached, it will have to give notice of closure by October this year.

Today, I accompanied my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall), my colleagues in the shadow health team, on a visit to Jubilee Street to see first hand the problem. At the same time, we launched Labour’s NHS pledge on GP appointments within 48 hours, which I am sure the Minister has noted. What is causing the problem? I will be grateful for the Minister’s views. Is it the shift from deprivation indices to age in the new allocation funding formula from 2012? Is it the elimination of a percentage of the QOF indicators? Is it the seven-year phase out of the minimum income practice guarantee?

--- Later in debate ---

[Jim Fitzpatrick]

I had just asked the Minister three questions relating to what he thinks might be causing the problems confronting our GP practices. The fourth is whether it is because of the range of different contracts negotiated over the past decade, awarding different levels of funding for numbers of patients to different practices; and the fifth is whether it is because there is a shift of funding away from primary care, and, if so, where the money is going. Some 90% of NHS contact with patients is through primary care, but it receives less than 10% of the NHS spend, a point I will come back to later.

I would also be grateful if the Minister indicated who makes the decisions. Practices, in discussion with the local clinical commissioning group and NHS England, have been unable to identify exactly who determines the funding levels. Obviously, it is NHS England that implements ministerial policy, which is why I have an outstanding request to speak to the Minister responsible, who I understand is the noble Earl Howe. I have briefly mentioned that request to the Minister, who kindly said that he would pass on the message and reinforce the request that we have made directly to his office. I would like to have that meeting, and would be accompanied by clinicians and practice managers from Tower Hamlets to put the case.

Tower Hamlets primary care has much to be proud of in the past 15 years; at one point it was the fastest improving primary care trust in the UK. Practices such as Jubilee Street have cupboards full of awards. When I was first elected in 1997, complaints about NHS services and GP practices were numerous and regular, but they disappeared due to the investment by the Labour Government over many years and the dedication and professionalism of clinicians and staff in primary and secondary care.

My own GP practice in Ettrick street on the Aberfeldy estate in E14 is a great example of that first-class service and improvement; I thought that I had better mention it, because if the staff there knew that I was complimenting other practices but left out Dr Phillip Bennett-Richards, Dr Sarah Pitkanen and their colleagues, they would be mightily disappointed.

The local worry is that all that is about to change. Not only have Labour stalwarts such as London assembly member John Biggs—our mayoral candidate—and Councillor Rachael Saunders been on the issue, but local Conservative councillors have been expressing concerns, so the issue is not party political in that sense. I attended a meeting last week at the Mile End hospital with nearly 100 people and many GPs in attendance. I have had numerous e-mails from constituents concerned about what is going on, and I know that my hon. Friend the Member for Bethnal Green and Bow has, too. There are petitions with hundreds and hundreds of signatures springing up all over Tower Hamlets.

All that is against the background of increased pressure. The British Medical Association has said:

“It is estimated that 340 million consultations are undertaken every year. This is up 40 million since 2008.”

As I mentioned, it also said:

“Over 90% of all contacts with the NHS occur in general practice.”

The then-chair of the Royal College of General Practitioners, Dr Clare Gerada, called for

“an urgent increase in general practice’s share of the NHS budget from 9% to 10% so that 10,000 more GPs could be hired, in order to make GPs’ work loads sustainable.”

[Rushanara Ali]

Does my hon. Friend agree that, in a borough such as Tower Hamlets, with high levels of health inequalities, the fact that people cannot get GP appointments for days on end is scandalous? It will devastate people’s lives further and actually cost more, particularly by putting pressure on accident and emergency services while we are having an A and E crisis.

[Jim Fitzpatrick]

I agree entirely with my hon. Friend, and I am sure that the Minister also agrees that if we can treat people in general practice and prevent them from going to A and E, that is a much more efficient use of NHS resources. Her point is valid.

The House of Commons Library has produced for me a table of data on GP funding, which

“shows a shift on the share of funding for general practice from 10% in 2005-06 to 8.3% in 2012-13. The real terms change in spending over the past three years shows a fall of £432 million”.

At the same time, there has been an equivalent

“annual percentage decrease of 2.1% per year”

in GPs’ salaries through the same period.

So there we have it. There has been a 40 million increase in appointments but cuts in the share of the NHS budget; a significant real-terms fall in salaries; huge variation in funding at local level; and crises affecting many local practices in my constituency—some looking at closure, which would be a disaster for some of the most vulnerable people in our country.

I want not just to return to the Jubilee Street practice but to take the issue wider. The NHS deputy head of primary care for north central and east London, Rylla Baker, recently wrote:

“The situation has, unfortunately, developed further and we met with the Jubilee street practice earlier this week. Although the situation with the loss of MPIG”—

the minimum practice income guarantee—

“is, for most practices manageable, when the practices take into account other changes in funding that impact on them, the cumulative impact is significantly greater and practices such as Jubilee Street have said that if there is no mitigation against the loss the practice will not be viable… I have copied in Neil Roberts, Head of Primary Care for North Central and East London and Jane Milligan from the CCG as discussions are ongoing about the best way forward. It is also relevant to point out that this is an issue that is not limited to Tower Hamlets.”

We are hearing of numbers of practices in Hackney and Newham, two other impoverished boroughs, that are facing similar problems.

The Royal College of General Practitioners has said:

“In total, the phasing out of a key NHS funding stream called the Minimum Practice Income Guarantee…could affect a total 1,700 practices with the care of 12.2 m patients potentially under serious threat.”

I know that the Minister is deputising for his colleague Earl Howe—that is why I would like a face-to-face meeting with Earl Howe, or indeed with the Secretary of State—but I am keen to hear his response to the points I have raised. I am sure he has some information and data for us.

In Tower Hamlets, we have some of the poorest and most vulnerable people in the United Kingdom. There is the lowest life expectancy, on average, of anywhere in the UK. It is estimated that between 10% and 12% of residents are not registered on GP lists. Now, this crisis is coming to a head. I look forward to the Minister’s response, but I look forward more to a proper meeting with Earl Howe or with the Secretary of State, and I look forward most to arriving at a solution for the patients, the staff and the clinicians, so that we can protect and continue to provide first-class primary care services in Tower Hamlets.