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Access to GP Appointments

Volume 706: debated on Wednesday 12 January 2022

[Relevant document: e-petition 587701, Create a legal right for patients to receive timely face-to-face GP appointments.]

I beg to move,

That this House has considered access to GP appointments.

It is a pleasure to serve under your chairmanship, Mr Robertson.

GPs are at the heart of our health service and our communities, and I thank them all for their dedicated work. They have been at the frontline of one of the most successful vaccination programmes in the world, thanks to which we have some of the lightest covid restrictions and one of the most open economies. Family doctors have also delivered an incredibly rapid adoption of new digital means to interact with patients when lockdown meant that it was vital to be able to give health advice without vulnerable patients having to visit a surgery. This is quite a switch for a health service that just a few years ago was still using about 9,000 fax machines.

Phone or digital consultations are here to stay, and for many they are a great way to get help from their GP, but not for everyone. In particular, many elderly people, people with learning disabilities or other cognitive impairments and those with language barriers may not be able to cope easily with digital communication. They may find anything other than a face-to-face meeting difficult. It is vital that these vulnerable people can still see their doctor, and there has been some real progress in recent months. There are now more appointments in general practice than there were before the pandemic, and, judging by the latest figures, about 65% of those were face to face.

I was interested when I saw this issue on the agenda for Westminster Hall. I am interested in lots of things that are debated in Westminster Hall, but this is one in which I have a particular interest. Does the right hon. Lady agree that for many people who are not comfortable about describing their symptoms over the phone, or eloquent enough to do so, it is essential that they can request to see their GP without having to prove to the receptionist the reason why they need to?

That is of course correct. Phone calls are important in triaging and assessing the extent to which a face-to-face meeting with a doctor is appropriate, but it is essential that those who need face-to-face appointments are given them.

We are seeing some progress, and this has been delivered at the same time as millions of booster jabs. I give credit to GPs, NHS England and Ministers for that recovery in general practice, but it remains the case that many of us will have heard from constituents about problems in getting in to see their GP. I thank the 19,302 people who signed the online petition on Parliament’s website expressing concern about this.

The right hon. Lady makes a really important point about constituents trying to get in contact with GP surgeries. I have the same issue with one of my constituents who tried to get in contact with her surgery and had to call every day for three weeks in order to get an appointment. By the time she did get an appointment, she experienced delays in accessing the treatment she needed. Does the right hon. Lady agree that further action is desperately needed to ensure that we have a plan in place to address staff shortages and resource shortages across our NHS and across our GP surgeries so that our GPs can continue to provide the healthcare that is needed?

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.

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?

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.

Many of my constituents, and constituents across the country, are concerned about how quickly they can get face-to-face appointments, especially those mentioned earlier: the vulnerable, the elderly, and those who cannot do online or telephone appointments. The investment in surgeries is most welcome, but we need immediate action to address the shortfall in patients being seen by doctors where they need to attend a face-to-face surgery.

During covid-19, elected Members received an uplift to our budgets to help us to deal with our constituents. The same needs to be done for GPs, who are under huge pressure to deliver services, and that needs to happen now rather than later, because such investment can take time to come through and we do not have time.

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.

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?

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.

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.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) for bringing the debate to the Chamber. I echo much of what she says, and the Government are delivering on much of it, so perhaps this is an opportune moment to update Members on the progress we are making.

We owe a huge amount of gratitude to general practice staff for their efforts throughout the pandemic, stepping up to run vaccination programmes, continuing with flu vaccinations, looking after house-bound patients and continuing their day-to-day work. They have been absolutely outstanding. Since 30 November last year, more than 52 million covid vaccinations have been delivered by general practice, which is an amazing achievement. They are incredibly busy and have been throughout the pandemic, as reflected in appointment data. In November, general practice delivered an average of 1.39 million appointments nationally per working day, an increase of 6% compared with November 2019. Once covid vaccination appointments are factored in, the increase is greater than 20%. GPs and their teams have been working incredibly hard.

The focus on the booster programme has meant some patients experiencing delays in getting an appointment, but that does not mean that general practice has been closed. GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams. It is important that people do not delay coming forward. We saw patients stay away during the first lockdown, and so unfortunately there was a delay in starting some of their treatment, so it is important that we all get out the message that GP practices are open for business. In my right hon. Friend’s constituency, under North Central London CCG, excluding covid-19 vaccinations, approximately 16% more appointments took place in November last year compared with November 2019, of which 57% were face to face. The crux of the matter that we hear from many constituents is around face-to-face appointments. That is why, in October, the Secretary of State launched the winter support package to tackle many issues my right hon. Friend mentioned. I will just touch on several.

First, we are improving telephone access, because sometimes the problem is that patients cannot get through by phone, rather than their not being able to see a GP. My hon. Friend the Member for Southport (Damien Moore) touched on that. Part of the package is a cloud-based telephony system to help increase that capacity for GPs, who may only have one or two receptionists and a couple of phone lines that get busy pretty quickly as soon as 8 o’clock hits. The improved functionality has the potential to free up existing telephone lines for incoming calls and will be available at no additional cost to practices. We will require GP practices to sign up to this cloud-based telephony system, which will be up and running pretty soon. All those that expressed an interest have been contacted, and we expect many to go live fairly soon. Some practices are already tied into existing contracts, so there may be a slightly delay in roll-out there, but where we can get them up and running, we absolutely will.

Secondly, we are encouraging GPs to offer face-to-face appointments. However, it will not always be a GP that a patient sees. There are a range of healthcare professionals in primary care, from nurses—they do an amazing job, if I say so myself—to paramedics, pharmacists and physios, and the GP is not always the best person for a patient to see. Face-to-face appointments are available, and our message to patients is that they will not always see the GP face to face, but that does not take away from the care that they receive.

On finance, £250 million was announced in the winter support package, which can be used by GPs in a range of ways—whatever suits their local area. For some, it will be a physical expansion of their practice so that they can see more patients. For others, it may be to take on locums, where they are available—that is also a pressure point—or other healthcare professionals or an extra receptionist, or to extend opening times. The money can be used on whatever will help GPs to expand their ability to see patients.

My right hon. Friend touched on bureaucracy and red tape, which is a massive ask for GPs. We have made some temporary changes during the omicron vaccine roll-out period to free up capacity, including extending the sickness self-certification period for people accessing statutory sick pay and suspending requests for medical information from bodies such as the Driver and Vehicle Licensing Agency. We are bringing forth secondary legislation to allow other healthcare professionals to do some of those checks—statutory instruments are going through the system as we speak—and having discussions with other Departments about moving away from always expecting GPs to do medical reports, whether for the Department for Work and Pensions, the Department for Transport or for schools. Patients can do a lot for themselves and a medical report from a GP will not always be required. We are also improving digital technology so that handwritten letters and reports, which take so much time for GPs, can be digitised and made much easier.

One of the most exciting innovations in the package is the promotion of pharmacists, which my right hon. Friend touched on. We have a community pharmacist consultation service whereby patients who phone 111 or contact their GP can be referred direct to pharmacists, who are taking on prescribing skills so that they can prescribe as well as dispense. We are looking towards a more pharmacy-first model as in Scotland and Wales, where patients can go direct to pharmacists without necessarily going first to the GP, opening up primary care and making it much more accessible. I hope that, through a number of the points that I have addressed, it can be seen that we are moving at pace.

Workforce was touched on, and I am pleased that we are making progress on that. We have already recruited 10,000 of an additional 26,000 staff who will be working in general practice by the end of 2023-24. In the North Central London CCG area, 327 additional staff have been recruited to date, with a further 114 anticipated.

I congratulate my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) on bringing the debate to the Chamber and draw attention to my entry in the Register of Members’ Financial Interests as a practising NHS doctor. In 2015, the then Secretary of State said that we would recruit an extra 5,000 GPs to the workforce. Can the Minister update us on how many extra full-time equivalent GPs are working in the NHS?

Pensions is also a real issue that is stopping the current workforce extending their careers as they face punitive tax penalties. Will she please commit to addressing that and raising it with the Treasury?

Absolutely. I was going to come to the number of GPs. I am pleased, as is my right hon. Friend the Member for Chipping Barnet, that we have 4,000 doctors in GP training places this year, which is an increase from 2,671 back in 2014. We are getting more GPs through the training process. However, in terms of GPs in place, there were 1,841 more full-time equivalents in September 2021 compared with September 2019, so we are seeing increases coming through.

However, there are issues with retention as well as recruitment. I think my right hon. Friend touched on issues with the Home Office and GP trainees once their visas expire. We met Home Office officials just before Christmas and there is better working now between the NHS and the Home Office to help facilitate those who come on a visa and need help to get into the workforce, get their visas extended or their training finished before their visa expires.

My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) made a very valid point about GP pensions. We have discussed that, and we are setting up a meeting with Treasury teams to look at that in more depth. There is no doubt that that is a disincentive to stay in practice, and we will certainly be looking at that further.

I will finish by asking all colleagues to support local GPs. They have had a very tough time. We are taking a zero-tolerance approach to any abuse they receive. That also applies to pharmacists. They have had a difficult time and continued to stay open during the pandemic. Face-to-face appointments were a challenge. We are doing everything we can to support them with the asks to break down some of those barriers. I am optimistic that we will see progress and that patients, who are the most important people in this debate, will see improved access to services in primary care.

Question put and agreed to.