GP Recruitment and Retention

Steve Brine Excerpts

Wednesday 28th March 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

It is a pleasure to see you on your throne this afternoon, Mrs Moon.

I have a lot of time and respect for my shadow, the hon. Member for Burnley (Julie Cooper), but what a counsel of despair that was. As the sun comes out after a day of rain in London, let me see if I can bring some sunshine to our proceedings.

I congratulate the hon. Member for Houghton and Sunderland South (Bridget Phillipson) on securing the debate. She spoke passionately, as always, about her constituents and her area. The hon. Member for Strangford (Jim Shannon) said that we are often in here together and share many of the same subjects. That is true but, to be fair, he is in here even more than I am.

I note the Prime Minister’s announcement yesterday that she intends to bring forward a long-term plan for the NHS with the Secretary of State, Ministers and our partners. That will build on our record of extra funding for the national health service in England year on year since 2010, to deliver a NHS that is fit for the future. I agree with the shadow Minister that this is about the wider NHS, and that we cannot see primary care in isolation. We are able to do what we have done for the past eight years because of the state of the economy, which we have got into a better place. When the economy fails, the NHS catches a cold or much worse, which is important.

[Jim Shannon]

rose—

[Steve Brine]

I will not give way at the moment.

As everybody has said, we recognise the importance of general practice as the heart not only of our NHS, but in many ways of the country. It is as much about prevention before people get into the NHS as it is a gateway to it. That point was made well by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the SNP. As others have kindly said, I am absolutely committed to ensuring that the NHS has the resources, workforce and Government backing to make it fit for the future.

As the hon. Lady said, it is a great success that we are living longer, but an ageing population and more people living with long-term conditions, or so-called comorbidities, means that general practice will become more important than ever in keeping well and living independently for longer. On Friday, I spent a morning sitting and observing—lucky patients—a general practitioner in Hampshire, not in but near my constituency. I watched him do his morning surgery. It was a brilliant thing to do as the Minister with responsibility for primary care, but I would recommend it to any Member who has that relationship with GPs in their area. By sitting and watching, it is possible to see what comes through the door and the pleasures of general practice, which is not dissimilar to the surgeries we hold as MPs.

The number of people over the ages of 60 and 85 is set to increase by about 25% between 2016 and 2030, and the number of people living with long-term conditions is increasing. In 2017, almost 40% of over-60s had at least one long-term condition. I am sure we can all think of people in our families who are in that position—I certainly can. We recognise that that places general practitioners in England under more pressure than ever before, and are taking comprehensive action to ensure that general practice can meet the demand.

The NHS set out its own plan for general practice in the general practice forward view. We have backed that with additional investment of £2.4 billion a year by 2020-21, from £9.6 billion in 2015-16 to more than £12 billion by 2020-21. That is a 14% increase in real terms. That is not made up—those are genuine figures, on the record. As has been said, we have also announced our ambition to grow the medical workforce to create an extra 5,000 doctors in general practice by 2020, as part of a wider increase to the total workforce in general practice of 10,000. We recognise that that is an ambitious target—it is double the growth rate of previous years—but it shows our commitment to growing a strong and sustainable general practice for the future.

This debate is about recruitment and retention, so let me break those down. NHS England, which we work with—it is approaching its fifth birthday—and Health Education England are working together with the profession to increase the GP workforce. That includes measures to boost recruitment, address the reasons why GPs are leaving the profession and encourage GPs to return to practice. We recognise that GPs are under more pressure than ever, but we want them to remain within the NHS and are supporting them to do so.

The hon. Member for Stroud (Dr Drew) made the point about recruiting and then following through. As I said at oral questions last week, there are things we can do, but there are things the profession can do too. If doctors in general practice are a counsel of despair, it is little wonder that people do not want to follow them. There are some good, positive voices in general practice, ably led by Helen Stokes-Lampard, who leads the Royal College of General Practitioners. She is a brilliant example of the cup being half full. That kind of positivity is very important—it is a partnership.

[Robert Courts (Witney) (Con)]

Will the Minister give way?

[Steve Brine]

I will, but just once.

[Robert Courts]

I am grateful to the Minister, because I am conscious of the time. He spoke about the support that can be given with regards to recruitment and retention. In my area, the cost of housing is part of the conundrum that we have to solve for everybody, but particularly for key workers. Does he agree that excellent, well-run district councils such as West Oxfordshire—ones that think creatively, outside the box, and help to provide affordable housing in a new way that is targeted at key workers—can be part of the solution to the recruitment and retention challenge?

[Steve Brine]

They can certainly be part of the attractiveness of coming to an area. My council in Winchester is one of the few authorities that is building new council houses—all power to it. My hon. Friend makes his point well, as always.

Increasing training in general practice is important. It is a top Government priority, which is why HEE has made 3,250 places in GP speciality training available every year since 2016. As a result, the number of doctors entering training has increased year on year. In 2017, a record 3,157 new starters were recruited to GP training posts.

The hon. Member for Houghton and Sunderland South spoke very well in introducing the debate, but hon. Members may not be aware that she asked me my first question as a Minister at Health questions in July. She said:

“Does the Minister accept that new medical school places should be created in areas such as Sunderland, where there is the greatest need to recruit and retain general practitioners?”—[Official Report, 4 July 2017; Vol. 626, c. 1008.]

All I can say is that we were listening. I did not say yes at the Dispatch Box, but we looked at the under-doctored areas and at the areas where it is hardest to recruit, which is why Sunderland’s bid was successful. I am glad she welcomed that.

The hon. Lady also welcomed the University of Sunderland putting that in place. As she said, the medical school will encourage general practice as a speciality after students have completed the two years of foundation training. It is envisioned that 50 new students will enrol in 2019 and 100 students in 2020. Experience tells us—this will be encouraging to the hon. Member for West Lancashire (Rosie Cooper), who is no longer in her place—that GPs tend to stay longer in the area where they train, so it is an exciting development for general practice in Sunderland. Once someone has gone there, why would they leave?

As we have heard, the Government have introduced the targeted enhanced recruitment scheme, which funds a £20,000 salary supplement for GP trainees who commit to work for three years in areas of the country where GP training places have been unfilled for a number of years. The hon. Member for West Lancashire is back in her place now—she missed her mention, but I am sure she will catch up on it. The scheme was launched as a one-year pilot in 2016. It was extended for a further year in 2017 and again in 2018. It is a positive innovation.

I am whipping through my brief because of the time. There are a lot of points to try to respond to, and if I do not respond to them all, I will write to hon. Members. A number of hon. Members asked about international recruitment. In August 2017, NHS England announced plans to accelerate its international recruitment to 2,000 GPs in the next three years.

A small number of pilot areas started recruitment last year. The next stage of the recruitment programme is on track to start at the end of the financial year as planned. The aim is to recruit 600 doctors by the end of March 2019 and the remainder by the end of March 2020. As the hon. Member for Houghton and Sunderland South said, that is part of the north-east and Cumbria submission to the national scheme, which runs from this year to source qualified GPs from abroad to work in England. She welcomed that, as do we.

On retention, in addition to our significant efforts to train and recruit more GPs, we want experienced GPs to stay in the NHS and are supporting them to do so. The GP retention scheme, which the hon. Lady mentioned, is a package of financial and educational support to help doctors who might otherwise leave the profession to remain in clinical general practice. It was launched to support GPs who cannot work more than four sessions per week and who cannot secure a suitable substantive post. In September, 218 GP retainers were working in general practice, which is a 40% increase on two years previously.

The induction and refresher scheme provides a safe, supported and direct route for qualified GPs to join or return to NHS general practice in England. By December, it had received 600 registrations. Of those, 368 GPs have completed or are progressing though the scheme back into general practice.

Several hon. Members rightly mentioned pensions. We need experienced GPs to stay. Pensions are an issue for them, alongside workload and indemnity. They are ultimately a matter for the Treasury—it would be a foolish junior Health Minister who wrote Budgets in Westminster Hall—but my hon. Friend the Member for South West Bedfordshire (Andrew Selous) recently made the point in Prime Minister’s questions—the Prime Minister assured him that the Chancellor was listening. He will also listen to hon. Members who have raised it today. We certainly need to address it. As the hon. Member for Central Ayrshire said, to have a full pension pot is a nice problem in some ways, but I take her caveat on board.

We recognise that indemnity is one of the challenges to people staying in the profession. It is a great source of concern to GPs and to me. We want to put in place a more stable and affordable system of indemnity for general practice. At the Royal College of General Practitioners conference in Liverpool in October, the Secretary of State announced that we would develop a state-backed indemnity scheme for general practice in England. We are working with GP representatives and those conversations are going very well. We expect to announce further details of the scheme in May, with the scheme going live in April next year.

Several hon. Members rightly mentioned the partnership model. The Secretary of State and I believe in the partnership model and that it has a role to play in the future of general practice, but times have changed, as the hon. Member for Stroud said in his first point. The Secretary of State announced at the RCGP earlier this year that we are setting up a review with the BMA and the RCGP to consider how it can be reinvigorated and sustained for the future. We hope to announce further details soon. I encourage hon. Members to engage with it.

I get excited about multidisciplinary teams and the wider workforce in primary care, because they are so important. They allow experienced GPs to deal with people with long-term conditions and comorbidities. Pharmacists working in general practice through the pharmacy integration fund, who will number 2,000 by 2020, are very important, as is community pharmacy. The hon. Member for Burnley is passionate about that, as am I. They are part of one NHS and are funded through public funds, so they should absolutely be part of sustainability and transformation partnership discussions. I discussed that with the Royal Pharmaceutical Society at the Department yesterday. The wider workforce is critical to us.

General practice is and always has been the heart of the NHS. GPs play a crucial role in our communities in terms of treatment and prevention. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) said that the majority of feedback that we get is negative—he mentioned the feedback from some of his GPs—but that is not what the GP patient survey says. In answer to his question, he should bring those GPs in. I would very much like to see them and I may even make them a cup of tea. He should contact me and I will do that.

I thank hon. Members for their contributions. A tremendous amount is going on, and we face a tremendous challenge, but good things are happening across the country and I am out and about visiting all the time. We have to take that best practice and not just share it, but implement it across the NHS in England to address many of our primary care challenges.