GP Services

Stella Creasy Excerpts

Thursday 5th February 2015 Commons Chamber

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing what, for me, is an incredibly important debate. I am pleased to follow the hon. Member for Henley (John Howell), because he and I have probably been doing the same thing in going to talk to people in our local community about local health care. I must say that my experience is of a very different health care system—one that is under real pressure and, frankly, very much in danger in my local community.

I wanted to speak in this debate to put my concerns on the record and to ask the Minister and officials at the Department of Health to look at my area, because I am so worried about these issues. As an MP, I see it as my job first and foremost to help the patients of Walthamstow—my neighbours, as well as my family and friends in the area—who can see how our services are falling apart. As their MP, my very real worry is that, as much as I have tried to raise such concerns, all I hear is that those problems are for someone else or for some other organisation to resolve. I want to put on the record some of the issues, and to explain the situation in our local community and how it is having an impact on doctors. By doing so, I hope to convince the Minister to pay special attention to Waltham Forest.

There are 45 GP member practices in Waltham Forest CCG. We have one of the fastest growing populations in the country, but many of the practices are in poorly maintained buildings and are single-handed. They serve a community that has a very high incidence of what we might call lifestyle diseases—diabetes, heart disease, cancer—and GP access is absolutely critical to the outcomes achieved for patients.

[Mr George Howarth (Knowsley) (Lab)]

Will my hon. Friend be a bit more specific? Type 2 diabetes is lifestyle-related, but type 1 is not.

[Stella Creasy]

I apologise for using shorthand. My right hon. Friend is completely right. I am talking about type 2 diabetes. For example, many people from the south Asian community in my constituency have type 2 diabetes.

We are told that our local GP work force needs to grow by 40% by the end of the next Parliament if it is to serve the community I represent. However, I can already see very real problems with our local community service, and that is bad for the patients and for the rest of the NHS. We know how difficult it is to recruit and retain doctors, but in my part of town, with the high cost of living in London, it will get even harder.

Since 2011, complaints about GP access have rolled into my constituency office. Let me give the Minister some examples. Just the other day, a resident rang me and said: “Look, the receptionists were perfectly polite. They said call at 9 o’clock or queue up before the surgery opens to get an appointment, but the line was constantly engaged from 9 o’clock. My phone shows I called 28 times between 9 am and 9.30 am, and I could not get through. When I did get through, it was only to be told that there were no more appointments left.” That is not unusual in my community.

Little wonder that residents in Walthamstow routinely report that it takes two weeks to get an appointment with a doctor. Nationally, we know that one in four people wait a week or more. The problem—this is why I disagree with the hon. Gentleman—is that it is very hard for people to know whether or not they need to see a doctor, especially if they are worried about a child.

Let me give another example of a complaint I received just the other day: “I have had constant problems trying to get a GP appointment for my 13-month-old daughter since she was born. A couple of times, even only last week, I was asked by reception staff at the doctors why I hadn’t gone to A and E.” That is the constant question for residents in my local community when they cannot get through to the surgery—should they wait or should they go to A and E?

I agree with the hon. Gentleman that not everybody needs to see a doctor, but another resident told me: “I fell and cut my hand deeply on glass. I went to the doctors to ask if a nurse could check that there was no glass left in. They told me to go to hospital. The cut was really not that bad. But they said they don’t have any nurses on a Friday and I would have to make an appointment to see a nurse—two weeks as usual, no doubt—so I just left it, as I do with most pains, coughs or small lumps, and hoped it would sort itself out. My hand is healing now and seems to be glass-free. I hope so anyway.” That is not unusual in my area. At least that elderly lady could have seen a nurse, but many constituents tell me that they do not bother to see a doctor because of how long that takes, and they take the risk of waiting.

[Douglas Carswell (Clacton) (UKIP)]

I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.

[Stella Creasy]

It is unusual for me to agree with the hon. Gentleman, but I agree that we need to look at how we can attract and retain doctors. We also need to look at what these problems do to the rest of the NHS.

Let me tell the hon. Gentleman about a constituent of mine who had a problem with his eyesight that was caused by high blood pressure. Because he could not get a doctor’s appointment, he left the condition alone. He has now gone blind in one eye and his other eye is at risk. His elderly wife came to me because she did not want to bother the doctor. We have to change that culture and to consider the consequences of not using our resources to deal with those early problems. When we leave somebody like that and they end up going blind, the cost to all of us to help them is much greater than if they had been able to access a GP. We must look at the terms of the job, but also at where the resources are not going. I have been raising those questions with local health care providers.

[Michael Fabricant]

I am very interested in what the hon. Lady has to say. She said that in her constituency—she must tell me if I have got this wrong—there are a large number of single-doctor practices. Does she not think that that is the cause of the problems, and that the Government should encourage practices to consist of a number of doctors working together?

[Stella Creasy]

Although I am a doctor, I am not a medical doctor, so I warn the hon. Gentleman that if he needs treatment, he should not come and see me. However, I could tell him why he has no friends—that is the sort of doctorate I have.

There are many issues and the number of single practices might be one of them. My point is that nobody has got a grip of this issue over the past couple of years, despite the fact that I, as the Member of Parliament, have raised concerns. In 2011, the complaints about access to GPs started coming in. I went to the primary care trust, but because of the reorganisation of the NHS, nobody was interested in the case that we were trying to make. The PCT said, “Wait until the CCG is organised.” I tried the new CCG, but six months after saying that it would look into the repeated complaints that I had raised, it said that this was not its issue and told me to go to NHS England.

Initially, NHS England told me that I could not raise the issues on behalf of patients because of patient confidentiality. It could not respond to any of the concerns that I was raising because they related to patient records. It then tried to say that unless the residents had complained to the GPs about GP access, it would not look into the issue, even though I had a binder full of complaints, which showed that it was a problem not just with an individual practice, but with many local practices in my local community. There was widespread concern. The problem continued and, eventually, NHS England came back to me and said, “It’s all right. We’ve spoken to the practices and they have said that if people want an appointment, they can ring up and get one.” It was a circular and deeply frustrating experience.

[Mr Bellingham]

Will the hon. Lady give way?

[Stella Creasy]

I will happily give way one last time, but then I want to get on.

[Mr Bellingham]

I understand the hon. Lady’s annoyance and frustration with her CCG and local health service. In my patch, the CCG is chaired by a GP. It has been incredibly responsive to my concerns and has worked with GP practices. I am just sorry that she has not found that in her patch.

[Stella Creasy]

I appreciate that that is the hon. Gentleman’s experience. This is precisely my point: why is nobody taking a strategic view of these issues?

I will give the hon. Gentleman an example and it goes to the heart of what the hon. Member for Henley was saying. One concern that people have raised is about missed appointments. The appointments that doctors give people do not always match the times when people need to see them. There is no recording of missed appointments because of the fragmentation of the NHS. Who should take responsibility for that?

A snapshot survey that my CCG did, possibly because of nagging from me, showed that on average 10% of appointments are missed in my local community. However, that is an average. In one surgery, 40% of appointments are missed and in another only 12% of pre-booked appointments are used. Irrespective of whether that is just because patients are missing appointments or because appointments are not at the right time, it is a waste of resources. Surely there is a public interest in having a central co-ordinating body that looks at these issues and at where there are problems in the NHS. It is a waste of money for everyone concerned. Crucially for my constituents, it means that they are not getting access to doctors, even though there may well be the facilities to see them.

Even if people can get access to a doctor, the quality of the practices in my local community is very poor. I know that other Member have raised similar concerns. That might be one reason why it is difficult to retain doctors. I have one practice that has been waiting 25 years to be rebuilt. It serves 12,000 patients. Because of the poor quality of the facilities, it cannot offer some basic services such as blood tests. It has not had central heating since January 2014. That is not an acceptable environment in which to provide a health care service.

The problems with GPs in Walthamstow are not just about the facilities. Since becoming an MP, I have worked with a group called WoWstow, which is a group of women who are fighting to get basic sexual health care services in Walthamstow, because we do not have them. When I talk about basic sexual health care services, I am talking about the provision of contraception, the provision of the coil and the provision of basic facilities to help women maintain their public health. We have doctors who refuse to prescribe such things, and then people wonder why my local area has a level of sexually transmitted diseases that is significantly worse than the national average.

There have been widespread complaints about other doctors, to the extent that the General Medical Council is involved. As far as I can see, there is little concern about how we deal with patients who are asked to go to doctors in respect of whom there are known to be concerns about the quality of care that they provide. Nobody is picking up the pieces. Nobody is gripping the issue to ensure that we do not see health care problems in my local community, which very much needs to be able to access GPs.

As my hon. Friend the Member for Halton has set out, all of this means that there are pressures on my local hospital, Whipps Cross university hospital. There are concerns about Whipps Cross itself. One resident wrote to me to say, “All I want is to be able to get an appointment for my child and not have to worry that if she or another member of my family ended up at Whipps I would have to fear for our lives, and that is not an exaggeration.” Barts Health, which runs my local hospital, is a large provider of acute services. It serves a population of 2.5 million in north-east London. The Care Quality Commission has taken enforcement action against it in the past couple of years because of the quality of care.

The CQC pointed out that if patients in my local community had access to an urgent care centre, they would be able to see somebody and it would improve the quality of care. However, I have just been told out of the blue that the commissioning process for more urgent care centres has been paused because of a lack of remaining bidders. Again, that is a separate part of the NHS from the GP surgeries and the hospitals that is also trying to deal with patients. The system is fragmented and piecemeal, and that is causing problems in a community that needs health care. Without the urgent care centres, there is a risk that many of the health care services in Walthamstow will simply collapse.

I have written to the Secretary of State about GP access. I have raised it with the CCG and NHS England. We have even organised local patients to act as mystery shoppers and go to doctors’ surgeries to ask to join their patient involvement groups. Not one of those people has been able to join a patient involvement group. That is a problem.

In 1958, Nye Bevan spoke in this place about the point of the NHS:

“Many people have died and many have suffered not because the knowledge was not there, but because they did not have access to it. To all the suffering which attends illness, there was always added the bitterness that, if the poor could have had access to the knowledge available, they might have been saved or, at least, might have been helped. It was this situation that the National Health Service was intended to put right.”—[Official Report, 30 July 1958; Vol. 592, c. 1383.]

Sixty-seven years later, the same concerns remain for a new generation of patients facing lifestyle diseases. I am making an open plea to Ministers at the Department of Health urgently to review the provision of health care in Waltham Forest. Please, let us not make early diagnosis a provision only for the rich in this country.

--- Later in debate ---

[Dr Poulter]

I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.

As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.

[Stella Creasy]

Will the Minister give way?

[Dr Poulter]

I will give way one last time, but then I will have to conclude.

[Stella Creasy]

In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?

[Dr Poulter]

I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.

Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.

In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.