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House of Lords Hansard
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General Practitioners
22 June 2015
Volume 762

Question

Asked by

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To ask Her Majesty’s Government what plans they have to increase the number of general practitioners.

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My Lords, my right honourable friend the Secretary of State for Health announced on Friday the first steps of a new deal for general practice. This includes working to increase the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice. We will do this through promoting general practice as a career, increasing training places, encouraging people to return and considering how best to retain staff.

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My Lords, first, I welcome the Minister to his first Questions in the House. I thank him for his response and for whatever role he played in bringing about Friday’s announcement, ready for this Question. The Health Education England incoming chair recently told the Guardian:

“GP recruitment is what keeps me awake at night”.

Under this new package, will he have to wait until 2020 to get a decent night’s sleep or will the Government take note of the urgent call from the Royal College of General Practitioners for a clear and costed plan, and a timescale for turning it all into reality, so that we can make progress from now onwards?

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The noble Baroness will know that NHS England recently published its Five Year Forward View, which is a five-year plan for the future. It will encourage much more care, delivered outside hospitals, in the community, and that will require larger input from general practice. I am very pleased to tell the noble Baroness that we are committed to 5,000 more doctors working in general practice.

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My Lords, I, too, welcome the Minister to the Dispatch Box. I wonder whether he agrees that the Government are being very complacent on this issue. I passed my GP surgery in a small ex-mining town in the north-east this weekend. On the door I read that there were 11 or 12 sessions in the next month when the GP practice would not be open—that is, from Monday to Friday. Is it not true that the model is broken and that young doctors coming into GP practice do not want to be partners and have the responsibility of running a small business as well? Is not the model broken? When we look at what is going on in areas where health outcomes are poorer, is it not urgent that the Government pay more serious attention to that?

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The noble Baroness speaks a good deal of truth. The model that we have been working with since 1948 in this country is largely broken. We have to deliver more care through vertically integrated units of care, not just independent hospitals. Over the next five to 10 years we will see a huge consolidation of primary care. The old cottage industry model of general practice is probably broken. The Five Year Forward View recognises that and the Government have committed £8 billion to see that forward view put into practice.

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My Lords, I do not know where the Minister spends his time, but where I come from, in the country, you have to travel 18 miles to a hospital or a GP practice at the weekend. That is very difficult when you have groups of elderly people. In the rest of the country—even in the city where I spend my city time—GPs are now saying that practices are to be closed and people are waiting three weeks for an ordinary assessment. Can the Minister tell us why the Government are not seeing what is happening on the ground and taking more urgent action?

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The Government are committed to seeing 5,000 new GPs. This is probably the biggest expansion of primary care that we have seen for many years. It is not just 5,000 GPs but a further 5,000 people working in primary care, including physician associates, practice nurses, physiotherapists and other allied health professionals.

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My Lords, is it not the case that, although the analysis that the noble Lord has given us is very accurate, the solutions that he seems to be putting forward are not very clear? Can he say what incentives he and his colleagues will offer young medical students beginning their training to encourage them to go into general practice? It is fine to say that we will train 5,000 more doctors, but we cannot force them into general practice if they do not want to go.

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The noble Baroness is quite right. After five years as a medical student, they then do two foundation years before making the choice whether to become a GP or to go into specialist medicine. That is a crucial time to persuade young doctors that there is a good, long-term career in general practice. Health Education England and NHS England are putting huge resources into persuading young doctors at that stage in their career that there is a good future in general practice. I say to the noble Baroness that there is no doubt at all in my mind that, if we run the clock forward five years, more care will be delivered in primary practice and in the community than in acute hospitals.

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My Lords, I declare inside information, in that my daughter is a trainee GP. I asked her about these issues last night. In Cheshire and Wirral there are vacant training places with no GP trainees to take them. On asking her why people did not want to go into general practice, she said that it is the growing burden of bureaucracy and administration. What do the Government plan to do about that?

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The right reverend Prelate is right. Many GPs are concerned about the level of bureaucracy in their practices. As he probably knows, we have reduced the number of QOF indicators by a third—that is, by 40—from a staggering 120. This is a big concern. NHS England is looking at other ways in which we can reduce the bureaucracy. If the right reverend Prelate’s daughter has any ideas, perhaps she will be kind enough to give me them.

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What is the position as regards assistants in surgeries? This morning, we heard about the shortage of nurses that we are going to have. The abolition of the SEN position has been fatal, as a lot of the right people who wanted to enter nursing have not done so because they do not have the necessary academic qualifications. However, would not these SENs now be extremely valuable in taking some of the workload, particularly form filling, off GPs, who are burdened with huge amounts of paperwork?

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My noble friend is quite right. We are looking carefully at introducing a new position of a qualified nurse who would not have to have the same academic qualifications as existing nurses. As she may know, we are also introducing a new position of physician associates, who will be able to take some of the burden off GPs.