General Practitioners: Appointments

Viscount Bridgeman Excerpts

Thursday 17th March 2016 Grand Committee

[Viscount Bridgeman (Con)]

My Lords, I, too, thank my noble friend Lord Attlee for initiating this debate. We heard from him that in his view the conduct of the practice of which he is now a patient leaves something to be desired. He has also been good enough to indicate that I might be able to sketch out for your Lordships a somewhat contrasting view. These two interventions, from my noble friend and myself, have not been co-ordinated; we only exchanged views two days ago.

I and my family are fortunate to be patients of a practice in central London which tells a different story. This practice has a walk-in surgery open for an hour and a quarter in the morning and two and a half hours in the evening Monday to Friday, with the exception of Wednesday evenings. I have never had to wait more than 20 minutes to see a GP. The practice has first-class support in practice nurses and receptionists. Repeat prescriptions can be requested online—this is now fairly common among GP practices. Significantly, and in many ways this is the acid test, the practice has some of the lowest referral rates to A&E in central London. In other words, more patients can be treated for minor ailments in the surgery without going to A&E. The cost of an A&E admission is approximately £80. Your GP is paid that same sum to have you for one year, so if you go to A&E for a runny nose that is the same money paid out again.

In 2006, under the GP settlement, practices could opt for PMS premium status where for extra work undertaken they received extra pay. On the whole the more enterprising practices—including the one where I am a patient—took advantage of this offer. Now I understand that the latest proposal from NHS England is for this premium to be substantially reduced or eliminated over a period of four years to bring the funding of PMS practices in line with the GMS practices that did not take advantage of the 2006 premium. It would be interesting to know if my noble friend Lord Attlee’s practice is one of the latter. It is policy to recycle the resultant savings thus made back to CCGs and through them to the practices within their groups. Where PMS practices are in a group with a substantial number of other PMS practices, the clawback available to CCGs will be considerable and as I understand it there will be significant funding available for improved services and financial support. However, PMS practices that stand virtually alone within their groups will not enjoy the same level of support. Note also that all funding deriving from the cutback to PMSs will be available to both PMS and GMS practices—a further subtle discrimination against the former.

Let me attempt to be constructive with three examples of welcome initiatives instituted by NHS England. The first is integrated care: a structuring for the patient to formulate with his GP a health plan. In my case, this involved an hour-plus session with the doctor—just think of that length of time being made available in an NHS practice. As I understand it, that model draws on experience in the US and elsewhere where patients with planned maintenance prove to be much less of a demand on healthcare services. This is being funded by CCGs, which are investing very considerably in it. It is a nation-wide initiative and much to be welcomed.

Another development in our part of London is the rapid response teams under the control of local health trusts but funded by CCGs. These consist of doctors, nurses and paramedics and I understand they are extremely effective in saving GPs in practice from having to leave their surgeries to answer emergency calls. The noble Lord, Lord Turnberg, suggested the damage caused by such calls in terms of the time of doctors in small practices.

Thirdly, I draw attention to the development of GP federations, where GPs join together in a unique and largely unprecedented way. These are set up as limited companies and their mission is to bid for services that hospitals may wish to contract out. Examples I know about are smoking cessation clinics, cardiograms, testing patients on warfarin for anti-coagulation and looking after airways disease—in short, widely disparate procedures. I think we can assume that in all cases there will be cost savings for NHS England and any profits made by the federations will be available to their GP shareholders.

I revert to the subject of my noble friend’s debate. My question for the Minister is how NHS England is to reconcile the very different standards that are emerging from this short debate. The challenge for NHS England is how to bring the less adventurous practices up to an acceptable standard without effectively dumbing down the forward-looking practices which, as I have tried to illustrate, have the potential to introduce new, co-operative practices with a substantial contribution to cost savings.

My own NHS practice reckons it will lose around £400,000, resulting in a cutback to the PMS premium over four years. From the resulting benefits that are to be made available by the CCGs to the practice, and I have given three examples, it is estimated that the practice will reduce the loss to about £200,000. Why should any loss be acceptable in this of all branches of healthcare? This is one branch of healthcare which is showing real initiative, particularly in regard to enterprise and its financial viability. Surely the NHS is in danger of killing the goose that lays the golden egg. I shall very much welcome my noble friend the Minister’s comments on that. I am in danger of mixing my metaphors, but general practice is one of the jewels in the NHS, which has been made clear by all the speakers today. Let the entrepreneurial practices not only be an example to their less-motivated colleagues but also lead the way in taking advantage of the imaginative developments that NHS England has initiated—but free from the financial penalisation that many practices are now facing.