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House of Lords Hansard
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25 June 2015
Volume 762

Question

Asked by

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To ask Her Majesty’s Government whether they will provide an annual report to Parliament regarding the operation of seven-day opening of general practitioner clinics.

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My Lords, we are committed to seven-day GP access. We have already invested £175 million in 57 schemes covering 2,500 practices, offering improved access including evening and weekend appointments. The 2016-17 mandate to NHS England, to be published later this year, is expected to reflect Government commitments, including on access. The Government hold NHS England to account for progress against these objectives and publish an annual assessment of NHS England, including progress in delivering the mandate.

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My Lords, I am grateful to the Minister for the information he has just given. Will he recall that earlier in the week, in reply to a Question about the number of GPs in practices, he said that the general practice model “is largely broken”? His second statement was that it “is probably broken”. In the light of that expression of his concerns about what was happening in GP practices, I presume that he was associating himself with those millions of NHS patients who increasingly find it difficult to see a GP within the time they want, or to see a GP of their choice. If so, can he say whether moving from what is broadly a five and a half-day weekly GP practice to seven days for all will improve matters for those patients or make matters worse, especially as it is being done on a broken model, to use his own words? In those circumstances—

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Too long!

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In those circumstances will he say what the new model will be, spell it out to the public and say how many GP practices will have to close?

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The noble Lord makes a number of interesting points. One of the leaders of the BMA talked yesterday about the need for a renaissance in general practice, which was about the only thing in that speech that I agreed with. We need a renaissance and a complete transformation in general practice because the structure of primary care is largely unchanged since being set up in 1947, and the population’s requirements have changed fundamentally. So over the next five years, I expect primary care to go through a renaissance and be transformed from the bottom up.

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My Lords, the Minister referred to a renaissance of general practice. Given that about 30% of GPs are expected to retire in the next five years and even the most popular training schemes cannot find anyone to come and train—I should not say “anyone”; however, Winchester has six people but places for 16—what sort of renaissance will it be? We actually need GPs, so perhaps the Minister can explain.

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The noble Baroness is quite right. We do need GPs, and they will be at the heart of the renaissance in general practice. The Government are committed to recruiting an extra 5,000 GPs into general practice over the next five years—that figure is net of people retiring. We accept entirely the noble Baroness’s proposition that we must persuade more newly qualified junior doctors to opt for general practice rather than for working in hospitals.

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My Lords, what discussions have the Government had with the Royal College of Emergency Medicine about the idea of collocating GP clinics in A&E departments? Surely such a strategy has the potential for killing two birds with one stone.

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I agree with the sentiments of the noble Baroness. There are indeed many GP practices that are collocating outside or very close to A&E departments. For example, I saw one at the Royal Free only last week. It is one of a number of new models of care that we should be exploring.

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My Lords, may I press the Minister a little more on recruitment? In an answer to me earlier in the week, he made the same reply—that the Government were committed to recruiting more GPs—but he has not yet told us what incentives would make a newly qualified doctor wish to go into general practice, and whether those incentives are financial or otherwise. In particular, the idea that part of your commitment would be to a seven-day week is possibly not quite as alluring as he would like it to appear.

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The right answer to the noble Baroness is twofold. First, we have to paint a picture that inspires young doctors to go into general practice. There is no doubt in my mind that the solution to the health needs of today’s population depends on a different model of general practice. We can paint that picture, and I hope that leaders of the BMA might wish to help paint it as well. Secondly, on the seven-day week issue, we are living in 2015 and people expect to be able to see GPs at the weekend. People get ill at weekends, and if we want good quality of care, we have to provide that care seven days a week. If we wish people to be treated outside hospitals, we have to provide good access seven days a week in primary care.

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Will my noble friend make it easier for GPs who have retired to come back to work in part-time practice? I am told this is extremely difficult at the moment.

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My noble friend makes a very good point. Health Education England and NHS England have a return-to-practice scheme precisely to do as he suggests, making it easier for those who have temporarily left practice by going overseas, or taken time out, to come back to practice.

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How does the Minister see the plans for seven-day working going forward in the light of recent data showing that there is growing pressure on surgeries and that practice closures have resulted in one in four GPs now working as locums, who are increasingly forming an integral part of practice teams? Does the Minister see the new models of care and the transformation he refers to embracing these new forms of working, together with partnered and salaried GPs? We often hear the view that local and part-time working, particularly for women GPs, is one of the major causes of GP shortages.

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The noble Baroness makes a good point. The old model, based largely around partners, often in small practices, is the one that I think will evolve over the next five years. We will certainly see many more salaried GPs coming into the workforce. The fact that there are now many more women doctors, who will wish to take time out to look after their children or for maternity leave and the like, means that the structure of general practice will change fundamentally. It may also mean more locums. I do not have a view on that particular aspect of the noble Baroness’s question.

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My Lords, if the Minister believes that we have had the same model since 1948, what was the House doing taking through during the last Session the health legislation that changed the structure so that the business model was around GP practices? Many GPs find that extremely onerous. They want to be doctors, not business managers. There has been significant change and not necessarily for the better. Would the Minister not agree?

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The noble Baroness—

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Has a very good point.

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The main thrust of the legislation was to put GPs more in control of the delivery and structuring of local healthcare.