GP Services

Simon Burns Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

I cannot answer the hon. Lady’s question because I do not have those figures in front of me. I am sure that if she talks to the Royal College of General Practitioners or the BMA she will be able to find all those figures. I am sure she understands that I represent one of the most deprived urban constituencies in the country and so I am going to focus on that, as I am sure she would focus on her constituency.

Let me re-emphasise a point I made earlier: whoever forms the Government after 7 May, they will have to come forward with solutions to the mounting pressure on general practice and the NHS overall. There needs to be long-term, sustainable investment in GP services in order to attract, retain and expand the number of GPs. Retention is just as important as recruitment—a point made in the comments about GPs retiring early.

[Mr Simon Burns (Chelmsford) (Con)]

The hon. Gentleman raises an important issue. A significant amount of house building is going on and will be needed in the near future. Does he agree that to encourage people into general practice and to minimise the pressures, planning for any significant amounts of new housing should include health centres and facilities for GP practices, so as to make it easier for GP practices to be able to go to such places?

[Derek Twigg]

The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.

I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.

As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.

This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to

“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”

How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.

The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.

Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.

The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:

“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”

Those words are not mine but those of a GP: NHS 111 has caused some real concerns.

The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.

My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a time to care fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.

In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.

One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.

--- Later in debate ---

[John Howell]

I completely agree. If I manage to get through my speech, I will say a few words about that.

The way forward is for patients to take responsibility for their own health, but there is a basic education point that stands in the way. I have a minor condition that requires my blood pressure to be monitored. I do that myself at home, and then send the results remotely to the surgery. We then have a conversation about it remotely, hopefully by e-mail. It is ironic that the internet is increasingly used by the over-50s, but the view of GPs providing a public service stands in the way of, and even contradicts, the over-50s being able to use the internet to achieve that result.

[Mr Simon Burns]

Is there not also a problem with some patients using the internet to self-diagnose, as there can sometimes be unpleasantness and arguments when GPs do not agree?

[John Howell]

That risk does exist, but I am talking about a treatment regime that I have agreed with my local practice, and this is the best way of dealing with it.

I have discussed the impact of no-shows with local practices. No-shows can affect surgeries by denying appointments that are the equivalent of up to one doctor each week. We looked with patient groups at various ways of dealing with that, including a ring-back system that allows surgeries to send text messages to remind patients not to forget an appointment the following day. What is missing, though, is an ability for the patient to ring back and say, “Yes, I’m coming”, or “No, I’m not coming.” I understand that the scheme that was going to put that in place centrally has been cancelled, and I ask the Minister to look at that carefully. Some practices use no-shows positively as a potential indication of symptoms; if someone is a consistent no-show, that might be a sign of dementia or something else. When I discussed charging for no-shows with patient groups, there was great hostility to this, tempered by the admission that it was administratively impossible and raised too many issues about access to services.

The hon. Member for Halton talked about the role of GPs in planning locally. I have asked about this in my area, where a whole lot of places are going for neighbourhood plans. I fully support them in doing that. It is the first time that communities have had the ability to determine where houses will go—and, indeed, what they will look like, because there is a very important design element. When I asked GPs what role they had in the neighbourhood planning process, the answer, basically, was none at all; they had not participated in the discussions. I sent them back to have those discussions with the people putting the neighbourhood plan together. This cannot be left to the CCG to determine for GP practices; GP practices have to do it themselves. The risk is that if they do not have their wish-list regarding what is to be done, they will lose out in the allocation of community infrastructure levy money that will eventually come through.