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Primary Care: Targets

Volume 765: debated on Tuesday 13 October 2015


Asked by

To ask Her Majesty’s Government whether they will encourage general practitioners’ practices to employ nurse prescribers, nurse practitioners and pharmacists in order to achieve their seven day target for primary care.

My Lords, broadening the skill mix within general practice is an important part of improving access for patients. General practices are including nurse prescribers, nurse practitioners and clinical pharmacists in their multi-disciplinary teams and experience suggests that this results in significant benefits for patients. Earlier this year, NHS England launched a £15 million scheme to fund, recruit and employ clinical pharmacists in GP surgeries.

I thank the Minister for that reply, but is he aware that the GP shortage is made worse by the fact that a declining number of young doctors want to go into GP practice for various reasons, including pay, working hours and the volume of consultations? At the same time, we have a surplus of excellent young pharmacy graduates looking for jobs who would be very happy to go into clinical general practice. Is it not time for a new initiative to bring these two things together and ensure that doctors get the assistance of all these excellent young graduates?

The noble Baroness makes a very good point. There is plenty of evidence to suggest that where general practices employ clinical pharmacists, it relieves GPs of a considerable burden. Interestingly, the NHS Alliance produced a report last week called Making Time In General Practice. It identified that up to one in six patients seen by GPs could in fact be seen by someone from a broader skill mix within general practice, so what the noble Baroness says makes a lot of sense.

My Lords, while one may applaud the intention of the 24/7 NHS service, does the Minister agree that the Government are potentially raising public expectations that are just not going to be achievable, given the deficit of nearly £1 billion that we have seen in the first quarter of this year alone?

My Lords, the deficit in the first quarter is indeed a matter of huge concern—I am not going to pretend otherwise—but the Government are wholly committed to seven-day services both within hospitals and in general practice. We are committed to investing £10 billion extra in the NHS over the next five years, and ensuring that we have enough GPs and enough support for them is a key priority.

My Lords, does the Minister agree that, before anybody is qualified to prescribe, the important part is that the correct diagnosis is made before the prescription is given? Having said that, does he think that qualified high-street pharmacists may have a role in prescribing, apart from the clinical pharmacists who are attached to general practitioners?

I fully accept, of course, that diagnosis is extremely important but I think that advanced nurse practitioners can play a role in diagnosis, as well as in treatment, as can physician associates, given that both are supervised by GPs. I believe that high-street or community pharmacists can play a big part in supporting the role of clinical pharmacists.

The noble Lord will recall yesterday’s discussion about how the integration of care is crucial. I am absolutely in agreement with the noble Baroness, Lady Walmsley—this is what integration in the health service really means. Providing the opportunity for pharmacists in hospitals to work in those practices should be encouraged.

I completely agree with those comments. Over the next five years, we will see much greater integration of acute hospitals and primary care and community care.

My Lords, the suggestion has been made that nurses from overseas who are not earning £35,000 after five years will be deported. Does this mean that the Government are going to think again on this issue?

This raises an important point—that we ought to train our own nurses. Relying on recruitment from overseas is not a viable long-term strategy and we must increase the number of training places in the UK.

My Lords, in seeking to broaden the skills base in general practice, as the Minister has just said he wishes to do, will he consider encouraging GP practices to employ artists? Is he aware of the excellent outcomes for patients in GP practices that have an artist in residence?

My Lords, the short answer is no. I do not think that I could stand here and promise funding for artists in GP surgeries, but I do have an open mind. If the noble Lord would like to talk to me about it outside the Chamber, I would be very happy to do so.

My Lords, as the NHS has a problem with its cost base, rather than load GP practices with even more overheads, would it not be wiser to follow what a number of us experience in our own practices: much closer liaison between GP practices and local chemists, which account for only a partial amount of the NHS’s overheads?

My noble friend makes a very good point. There is an increasing and important role for high-street and community pharmacists in delivering healthcare.

My Lords, I declare my interests as chairman of UCL Partners and as UK Business Ambassador for Healthcare and Life Sciences. What strategy do Her Majesty’s Government have to ensure that NHS prescribers can continue to provide innovative therapies and interventions for their patients?

The noble Lord makes an interesting point. I do not have an answer to give him today, but perhaps I may reflect on that and come back to him.

My Lords, clearly the role of community pharmacists could be enormous in the future, but in the end we still need more GPs. I have yet to be convinced that the Government really do have a programme that will effectively make sure that current GPs stay in the profession and that new GPs enter it. Can the Minister confirm that a number of the seven-day working pilots involving primary care have had to be cut back because of a shortage of GPs?

I cannot confirm that a number of the pilots have been cut back because of a shortage of GPs. I assure the noble Lord that we are committed to having an additional 5,000 doctors and a further 5,000 professionals working in general practice by 2020. That is a key priority for the Government.

My Lords, the number of 80 year-olds today—3 million—is estimated to double by 2030. According to the King’s Fund, this will be the biggest challenge facing society. In particular, the issue of caring for frail, vulnerable adults with complex needs is crying out for attention. What future planning will the Government do to address this human bombshell?

The noble Lord makes a very perceptive point. Demography is driving healthcare. The whole thrust of government policy is to treat as many people as possible outside acute hospital settings. Over the next five, 10, 20 years, I expect to see a far greater share of the health budget going to primary and community care, and a lower percentage to acute care.

My Lords, in view of the massive costs of agency staff working in the NHS, could not the Government consider setting up their own agency?

My Lords, it is our intention —for all kinds of reasons; cost, safety and quality of care—to reduce our dependence upon staffing provided by agencies. We would much rather see staff employed on a permanent basis or through hospital banks.