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GP Services in Rural Areas

Volume 798: debated on Tuesday 2 July 2019


Asked by

To ask Her Majesty’s Government what measures they propose to take to ensure that there is adequate provision of GP services in rural areas.

I beg leave to ask the Question standing in my name on the Order Paper and in doing so refer to my interests declared in the register.

My Lords, primary and community care will receive at least £4.5 billion more a year by 2023-24. Incentives have been in place since 2016 to attract GP training to hard-to-recruit areas, including rural areas. NHS England is consulting on allowing digital-first practices to be set up in under-doctored areas and everyone will have the right to digital-first primary care by April 2021, which will provide another way for patients in rural areas to access services.

I thank my noble friend for that Answer. She might be aware of last week’s Telegraph report, which shows that almost 2,000 villages are at least three miles from their nearest GP practice. That figure would be higher were it not for the fact that rural practices can dispense medicine where community pharmacies are inviable. Will my noble friend take this opportunity to commit today to specific support for rural general practices over and above what is already in the NHS long-term plan, which has a particularly urban-centric focus? I remind my noble friend that we in rural areas are struggling to get 4G, let alone access to digital medicine.

I know that my noble friend, who comes from a family of GPs, has personal experience of this. She raises an important point. We are encouraged that, in the last year, 300 more doctors, 300 more nurses and 700 more staff with direct patient care responsibilities working in general practice have been recruited. HEE has recruited record numbers of doctors into GP training, but we recognise the challenge of recruiting in hard-to-reach areas. That is why we have put in place the targeted enhanced recruitment scheme and we are identifying ways to improve this, such as the under-doctored digital-first practice. We recognise that we need to do more, however, and I would be very happy to meet my noble friend to discuss ways in which we can do that.

My Lords, the noble Baroness is aware that Cumbria is one of the blackspots for recruitment of GPs, with, in many cases, surgeries completely dependent on the odd locum and the good will of the general nursing practitioners. Bearing in mind that there are 19 million visitors a year to the Lake District and the national park, as well as the resident population, this is not a satisfactory situation. Is she prepared to look into the particular problems of GPs in Cumbria?

I am definitely happy to look into the situation in Cumbria, but this is one reason we have increased the funding specifically to primary and community care above the rate of the general increase to the NHS. It is also why we are bringing in incentives for GPs to work together at scale through the primary care networks and why there will be seven new service specifications for this. They will include enhanced healthcare in care homes, personalised care and supporting early care diagnosis, but also local action to tackle inequalities. This will be one of the specific areas for ICSs, which will lead the way we improve social care, as my noble friend Lord Young pointed out in his earlier answer.

My Lords, does the Minister expect there to be at least one doctor in each digital-first centre? If not, how do the Government expect patients to be examined when they need an examination? I do not think a machine will be able to do that.

The noble Baroness is quite right. The digital-first proposals have been launched as a consultation so that we can work out the funding and contract changes to ensure that we get digital-first primary care right. It can mean telephone as well as video consultations, but there would also have to be physical premises in the area to provide face-to-face consultations where necessary.

My Lords, I speak as a co-chair of the All-Party Parliamentary Group on Rural Health and Social Care. Living now in a city, I know the challenge of rural health provision, but GP services are not just about doctors. They are also about nurses and community workers. Can the Minister comment on the possibility of developing direct access training for district nurses and health visitors?

The right reverend Prelate is quite right. We need to expand the wider workforce to support GPs. One reason this has been such a challenge is the shortage of the wider workforce. That is why there was a commitment in the people plan to recruit 20,000 extra staff—such as physiotherapists, pharmacists and nurses—for GP practices, to ensure that we can provide the support staff for sustainable community services. There is an emphasis on moving towards more community care. That is why the funding has been provided, and why there is such an emphasis on that part of the service.

My Lords, I live in a very rural part of Cornwall. My GP practice is 18 miles away. It struggles to recruit GPs and then to keep them. The proportion of the English population who live in rural areas is 19%—the equivalent of the population of London. Can the Minister explain why very few NHS plans consider rurality, with its high levels of deprivation and loneliness and their associated diseases? Might that be one reason why GPs choose not to work there, or why they do not stay for long?

The noble Baroness is very lucky to live in such a beautiful part of the country, but she is right that rurality has a significant impact on health outcomes. It is considered as part of a number of plans. As for recruitment and retention, these have been part of the plans that the NHS has brought in, particularly for GPs. That is why we have had the recruitment and retention plan for hard-to-reach areas for GPs since 2016. We are evaluating that programme and are still considering it.

May I press the Minister, following the earlier Question on housing, on the need for her department to talk to the MHCLG, to ensure that when new-build housing developments come in, there is enough tie-in between health provision and housing? My understanding is that unless the number of houses is more than a certain amount, there will not be any new GP practices, thereby putting much more pressure on existing ones.

My noble friend is right; infrastructure must be in place before there is an expansion of development. NHS England is accountable for ensuring that patients have access to a GP practice, although the commissioning of general practices is delegated to local CCGs. It is an important planning consideration, and must be taken into account when new developments occur.