Access to GP Appointments

Debate between Theresa Villiers and Damien Moore

Wednesday 12th January 2022 Westminster Hall

[Theresa Villiers]

I agree that we need more general practice capacity and I will come on to explain how we could do that.

There can be no doubt that GP surgeries are under immense pressure. The Royal College of General Practitioners says that the workload has never been greater. A GP in my constituency told me that as well as colleagues leaving the profession, it has become increasingly difficult to recruit new doctors. He said:

“Those of us left behind feel that we are holding up a broken system.”

In GP surgeries, as is the case across the NHS, demand has spiralled partly because, as we grow older as a population, we have greater healthcare need, partly because of pent-up demand from people who felt reluctant to seek help during the pandemic, but also partly because the decision by NHS leaders to push a range of treatments out from secondary to primary care has left GPs dealing with more serious and complex cases than in the past. As a result, one High Barnet GP told me that primary care was in a precarious position even before the pandemic. Of course, delays in accessing GP appointments have been an issue for some years in many areas, including my Chipping Barnet constituency. My concern has been intensified by the predatory demands of developers seeking to build blocks of flats in multiple locations in my constituency. The Mayor of London wants to see over 23,500 new homes built in Barnet over 10 years. That is a massive increase in population, yet GPs are struggling to serve the population we already have.

We have seen the number of doctors in hospitals increase to record levels—and that is a great achievement—but the same cannot yet be said of GPs. I have been campaigning to expand GP capacity in Barnet as part of the Government’s wider commitment to boost primary care. I very much welcome the £250 million announced in October to tackle immediate pressures on the system. This promised new cloud-based phone systems, a reduction in routine paperwork such as sick notes and Driver and Vehicle Licensing Agency checks, and additional staff to support GPs. Well, I think we probably all know that better phone systems are urgently needed in many practices, but the need to reduce unnecessary bureaucracy is also pretty obvious.

[Damien Moore (Southport) (Con)]

My right hon. Friend is making an excellent speech. On patients phoning up trying to get an appointment, does she agree that there needs to be more capacity in phone systems so that people are not waiting on the phone for hours on end to get an appointment with a GP?

[Theresa Villiers]

I think that is right, which is why it was a good decision in the Government’s October announcement to focus on an upgrade to phone systems. I really hope that the Minister will update us on how that is going and when it will be delivered, so that our constituents can experience it directly.

Returning to the issue of GP paperwork, a Barnet GP told me that

“the amount of bureaucracy and red tape has increased exponentially despite various assurances that this would be cut. Increased regulation and monitoring, whilst important from a governance point of view, seems to have generated endless form filling, policy updating, mandatory training, appraisals and paper chasing.”

When this issue was debated in this Chamber last October, the Minister repeated promises that paperwork and form filling would be reduced. Has that happened? If not, why not? It is far better for a GP to spend time with patients, rather than writing sick notes or ticking boxes.

The third element of the Government’s plan seeks to strengthen the multi-disciplinary teams in general practice, so that, where appropriate, patients can seek other professionals such as nurses, pharmacists or physiotherapists. This is intended to free up GP time for them to see sicker patients. I welcome the fact that 10,000 new staff have been recruited of the 26,000 promised in the Conservative manifesto, and I commend the work of North Central London clinical commissioning group, which is due to recruit 177 more primary care staff under the programme. However, more could be done, for example, to enable pharmacists to take a bigger role, including in prescribing. We must also ensure that GPs have a strong voice in the new integrated care boards, so that primary care is at the heart of NHS decision making. It is vital that part of the massive capital investment that the Government have promised for the NHS goes into improving GP surgery premises, which in some instances are just not fit for purpose or not physically large enough to cope with increased healthcare demand.

[Theresa Villiers]

I agree that we need action now to make it easier to get GP appointments, and we also need action for the longer term. Even if everything that I have spoken about is delivered, and the October package is delivered in its entirety, we still need more GPs—it is as simple as that.

It is really welcome that this year more people have entered training to become GPs than ever before, because the Health Committee identified workforce shortages as the “key limiting factor” in tackling the covid backlog successfully. In its annual report on the state of health and social care in England, the Care Quality Commission concluded that by mid-2021 there were likely to be fewer full-time equivalent GPs in total per 100,000 patients than there were in 2017.

In July 2021, the then Care Minister commissioned Health Education England to review long-term strategic trends for the health and social care workforce. That review is very welcome, but we need to see it deliver results. As the Health Committee has called for, we need an objective, transparent and independently audited annual report on workforce projections that cover the next five, 10 and 20 years, including an assessment of whether sufficient numbers of staff are being trained.

[Damien Moore]

My right hon. Friend is being very kind in sharing her time. Does she agree that universities that have medical placements and more capacity should be allowed to extend that capacity, so that we can train more people and have more people entering the profession?

[Theresa Villiers]

It is essential that we expand the capacity of training places for GPs, and I welcome the new medical schools and the progress that has been made. However, because it takes years to train up a professional, the effect of those developments is not yet being felt in local surgeries.

We need to ensure that the NHS visa scheme is used effectively to recruit skilled GPs from around the world in order to meet immediate pressures, and we have to get better at retaining the GPs that we have. A vital first step in doing that is to implement measures to relieve the stresses on GPs that I have spoken about and to address spiralling workloads.

An effective workforce strategy also needs a better plan to encourage women to stay in the profession. We need to give more thought to how we persuade women who might have chosen to work part-time while caring for children to consider coming back to work full-time.

Also, what about all those retired or non-practising GPs out there? At the start of the pandemic, the Government rushed through legislation to enable retired professionals to return to the workforce to help battle that first covid wave. Clearing the covid backlog and expanding GP services is another great national challenge and we really should try to do more to enlist the talent of doctors who have retired or moved on to other careers.

[Damien Moore]

Will my right hon. Friend give way?

[Theresa Villiers]

I will just make a little progress now, because I want to give the Minister time to respond.

That means fixing the problem with doctors’ pensions. I know that efforts have been made in that regard. However, it is still worrying that it seems that once a doctor has been in practice for many years, they can face a big tax bill for their pensions. Of course, the last thing we should do is push GPs into early retirement because of punitive pension taxes. We want them to stay in practice and not retire.

In conclusion, pressure on GP surgeries is leading to appointment delays, which will only generate yet higher numbers of people showing up at accident and emergency departments that are already busier than at any time in the history of our national health service, as graphically shown on Sky News in relation to Barnet Hospital just a week or so ago.

GP services are a crucial gateway to treatment by other parts of the health service. If this gateway gets blocked up, the consequence will be that lives are lost, for example to cancer, because symptoms were not picked up early enough. So this matter is not just one of convenience; it is a matter of ensuring that we are doing everything we can to deliver the best healthcare.

The Government rightly promised 50 million more appointments in GP surgeries every year. It is essential that we deliver on that promise, so that my constituents can get the care they need within a reasonable timeframe. We must see the NHS long-term plan and the Government’s record £33 billion investment in the NHS deliver more GPs in local surgeries in places such as Barnet. It is as simple as that. We cannot carry on as we are. When he recently gave evidence to the Health and Social Care Committee, the Health Secretary said that plans to recruit 6,000 additional GPs by 2024 are not on track. I appeal to the Government to get them on track and to do all they can to expand capacity in GP practices in my constituency and across the country.