Primary Care: Plymouth

Debate between Seema Kennedy and Luke Pollard

Wednesday 10th April 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) for securing this important debate and for his kind words. I wish him a very happy birthday.

The hon. Gentleman spoke passionately about his constituency, as he always does, and he raised a number of pressing issues related to GP provision in Plymouth. I join him in thanking GPs and all the 1.3 million dedicated NHS staff for how they coped with increased demand on services over a challenging winter. The Government will continue to give the NHS all the additional support it needs over winter to ensure that patients continue to receive high-quality care.

The Government recognise the vital role primary care plays at the heart of our NHS, but a growing and ageing population, and increasing numbers of patients with long-term conditions, are putting strain on the system and adding to the challenges we face in recruiting and retaining GPs. Those real pressures can affect the quality of care that patients receive. We fully recognise those huge challenges, which is why we have made primary care a clear priority.

I will set out the significant measures that we are taking to support and reinvigorate general practice, which will improve GP services for patients across England, including the hon. Gentleman’s constituents. In 2015, we set an ambitious target to recruit 5,000 more GPs. That is challenging, but it is vital to ensure that we have more GPs in the NHS, so we remain committed to delivering that commitment as soon as possible. The NHS long-term plan, which was published in January, made a clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion more a year in real terms by 2023-24.

In January, we launched the new five-year GP contract, which was agreed with and widely welcomed by the profession. It will see billions of pounds of extra investment for improved access, expanded services at local practices, and longer appointments for patients who need them. We have listened to GPs about the biggest pressures they face and where we must focus to deliver reform of general practice. GPs have told us that one of the biggest pressures they face is an often unsustainable workload, which is a key reason why many dedicated GPs leave the national health service. Our new GP contract seeks to address the workload pressures that have resulted from a workforce shortfall. NHS England has committed to further expanding community-based multi-disciplinary teams and will provide funding for up to 20,000 other staff, such as physician associates and social prescribers, in primary care networks by 2023-24. Those bigger teams of staff will provide a wider range of care options for patients and free up more time for GPs to focus on their true passion—treating patients.

Another huge cause of concern for GPs has been professional indemnity. In recent years, the spiralling cost of purchasing professional indemnity cover has been a major source of stress and financial burden for GPs. That is why we addressed it in the GP contract and why just last week, on 1 April, we launched the new state-backed clinical negligence scheme for general practice. That brings a permanent solution for indemnity costs and coverage and includes all staff delivering primary medical services, including out of hours. It will remove a huge cause of worry for GPs, which will help with the recruitment and retention of GPs.

As the hon. Gentleman mentioned, we are looking at how to make the general practice partnership model fit for GPs working in the NHS in the 21st century. We recognise the huge contribution that the partnership model has made over the last 70 years of the NHS, but we know that it faces huge challenges, because many GPs, like other NHS doctors, want more flexible and varied portfolio careers; perhaps they do not want the long-term financial and geographical commitments of joining a GP partnership. That is why we commissioned Dr Nigel Watson to lead an independent review of the partnership model to understand those challenges.

As part of that review, Dr Watson visited more than 25 practices around the country, some of them small and some super-partnerships. As the hon. Gentleman alluded to, Dr Watson visited areas that are experiencing the greatest difficulty in recruiting GPs, including meeting some in Plymouth. Those visits played a key role in informing the work of the review, which reported in January and made seven key recommendations about workforce, business models and risk. We are grateful to Dr Watson for his important work, and we will respond to his recommendations in due course, with a view to reinvigorating the partnership model and making it fit for the 21st century.

I have set out that general practice is a priority for the Government, but what does that mean for Plymouth, and the hon. Gentleman’s constituents? GPs know the needs of their patients best, which is why the long-term plan seeks to change the balance of how the NHS works by shifting more activity into primary and community care. That will be enabled by expanding multidisciplinary teams working within general practice.

In Plymouth, the funding linked to the new GP contract will create extra capacity, with a 25% increase in staff numbers expected over the next five years across Devon as primary care networks employ pharmacists, physician assistants, physiotherapists, paramedics and social prescribers. I commend the valuable work being undertaken in Plymouth to open a network of local wellbeing hubs, aimed at giving residents easier and earlier access to health advice and support.

I understand that in a meeting with the former Health Minister, my right hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), there was a specific proposal for funding to develop a hub in Plymouth city centre. I understand that following that discussion the clinical commissioning group has undertaken further work on the case for investment with the local sustainability and transformation partnership, in anticipation of the next capital funding bidding process.

I am encouraged by the number of promising local recruitment schemes that Devon CCG has put in place both to recruit more GPs and to retain those already in the workforce. I am very happy to meet the hon. Gentleman, hopefully along with my hon. Friends the Members for South West Devon (Sir Gary Streeter) and for Plymouth, Moor View (Johnny Mercer), and some GPs. Other schemes include investment in portfolio careers for GPs, supported by funding from NHS England; investment in GP coaching to support retention, and a scheme to entice those who have left the primary care workforce to return to the profession, which will launch this year. It will also offer flexible working and alternative employment arrangements.

[Luke Pollard]

Flexible working is a huge opportunity. May I ask the Minister to look also at whether flexible working schemes with acute hospital trusts, such as part-time GPs and part-time acute hospital doctors, could be included in that scheme? I think there is real merit in that.

[Seema Kennedy]

I will take that salient point away and write to the hon. Gentleman.

The CCG is also working closely with the Devon Community Education Provider Network and Health Education England to develop primary care training hubs to support GP training, as well as the broader primary care workforce. Furthermore, the targeted enhanced recruitment scheme in England—an initiative that offers a one-off payment of £20,000 to GP trainees for committing to work in a specific area—has offered 24 places in Plymouth from August 2019. I am delighted to tell the House that 22 of the 24 places have been filled ahead of schedule, which is excellent news for Plymouth. It is the second highest number of places for any one area in England.

It is important to note that, despite the difficulties that the hon. Gentleman has raised, primary care in Plymouth is improving. Provision has been reviewed by the local authority’s health scrutiny committee regularly over the last five years. Most recently, the committee concluded that it was assured that the system in Plymouth—in particular, general practice—had made substantial improvements since its last review, and that although the system was fragile, significant work was under way to address recruitment issues.

I hope that I have made it clear what an absolute priority supporting and reinvigorating primary care is for the Government. We know that there are challenges with GP recruitment and retention, and other important issues facing general practice as the hon. Gentleman has outlined. However, the commitments made in the NHS long-term plan and the significant extra funding to back them up mean that we are well placed to address them. We can anticipate real improvement and reform of general practice, ensuring better access and improved services for patients in Plymouth and across England. It is such an exciting time for me as the new Minister responsible for primary care to come in and see those new commitments begin to be put into effect, and to ensure that they are delivered. I thank the hon. Gentleman for bringing such an important matter for debate, and I wish him a very happy birthday.

Question put and agreed to.