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NHS: GP Vacancies

Volume 806: debated on Thursday 8 October 2020


Asked by

To ask Her Majesty’s Government how many vacancies there were for general practitioners in the National Health Service for England in July; and what were the comparable figures in (1) 2015, and (2) 2010.

My Lords, in 2018-19, 1,398 practices reported 652 vacancies in the NHS Digital GP workforce data collection. Fewer than a third of practices submit data to the NHS Digital collection each year, and it is not possible to make estimates for practices that did not submit data, therefore a comparison between years cannot be made.

I thank the noble Baroness for her Answer. This small reduction in the number of GPs covers huge differences across the country. Can the Minister explain, for example, why there is such a shortage of GPs in parts of Cumbria, where there are even discussions on closing the purpose-built surgery in Windermere, the largest town in the national park, which would leave in excess of 5,500 locals and literally millions of tourists without any primary care cover?

My Lords, the closure of an individual practice is not something the central Government take charge of. However, the noble Lord is right that there are areas of the country where it can be hard both to recruit and retain doctors in general practice and other specialities. That is why the Government have put in place a programme of £20,000 one-off payments to recruit doctors in areas where recruitment is hard. The number of placements available under that scheme is increasing this year, next year and the year after.

It is clear that virtual and telephone appointments enable more consultations to the hour and are, in that sense, more efficient. However, a doctor told me recently that he hoped virtual appointments would not become the norm after the pandemic, as in his view it was essential for a doctor to have face-to-face consultation and examination where possible. Will the Government encourage physical consultations again after the pandemic has passed?

My Lords, the shift to virtual consultations and, in particular, virtual triaging, has been a positive development in the NHS. However, for many patients, a face-to-face appointment may be most appropriate. So, I say to the noble Lord that we do encourage digital working; it can be more efficient, and it protects both GPs and patients from potential infection. But face-to-face appointments can be incredibly important and should take place where needed.

My Lords, like everyone in the NHS, GPs have had to work extremely hard during the pandemic. I wonder whether my noble friend could enlighten us on what support the Government are giving front-line practitioners for their mental health. I note that the Government recently—Matt Hancock is to be congratulated on this—set up the National Academy for Social Prescribing, recognising, at last, the crucial role the arts play in supporting people’s mental health, particularly those in the health service.

My Lords, for GPs, NHS England and the Royal College of General Practitioners have launched the Looking After You Too service, which is there to provide mental health services to all primary care workers in the NHS. On social prescribing, that is an incredibly welcome development. The Government’s loneliness strategy, launched in 2019, committed to every eligible patient having access to a social prescribing connector scheme by 2023, and we look forward to delivering that.

My Lords, from my personal experience, waiting times to see a GP have always been long, and appointments limited to five or six minutes only. Now, it is even worse, with many appointments by phone, denying patients the proper medical care they urgently need. I believe the situation is mainly due to shortages of doctors and nurses. I also realise that the Government are committed to filling the vacancies as soon as possible. Could the Minister say how and when these vacancies will be filled so that GPs are able to provide a better and more comprehensive service?

My Lords, the noble Lord is correct that the Government are committed to increasing the number of doctors working in general practice. It is about not only increased recruitment—that is why we are increasing training places to 4,000 next year—but increased retention, which is incredibly important. A number of new retention schemes, which were included in the updated GP contract, have now been launched.

My Lords, will the Minister concede that, in spite of the much-vaunted promises by Tory election manifestos, the actual number of GPs has decreased for the first time since the 1960s. Does she not find explaining the difference between rhetoric and reality somewhat embarrassing?

My Lords, the noble Lord is correct that the number of GPs is down by 600 on last year. My understanding is that a number of factors have impacted this, including foundation doctors on placement in general practice being redeployed to secondary care during the Covid crisis; GPs working in NHS 111 during the Covid crisis; and the quality and completeness of data being impacted by Covid. But he is right: we need to do more. We have increased recruitment, and our emphasis is also on increasing retainment so that we can increase the number of GPs.

My Lords, data from a 2018 survey in Pulse magazine showed that during the six years between 2012 and 2018, 565 GP practices closed. What plans have the Government put in place to alleviate the intense pressure on the remaining general practices in the areas most affected, such as the north-east, given that 1.7 million people were left without a GP?

One aspect of our response is to increase the number of GPs, but there is also an important role for other healthcare professionals working in primary care. Those numbers increased last year—both the number of nurses working in primary care and the number of other workers, such as physiotherapists and social prescribing link workers. A more diverse workforce and a better mix can free up GP time to focus on those with the highest clinical need.

My Lords, there are complications in calculating the number of general practitioners, because a large number of them do variable numbers of sessions—some do four, five, six, seven, eight and so on. The size of the general practice workforce is often calculated in terms of whole-time equivalence, but this is unlikely to be accurate because there are GPs who are paid for five or six sessions but do many more. Is this taken into account when calculating these numbers?

The noble Lord is correct that the numbers are calculated at full-time equivalence. There may be more individual GPs working, because one trend we have seen is that with increased workload, people with families to look after, or who are either at the end or the start of their career, are choosing not to work full-time. With the retention programme, we are looking at both freeing up time and workload pressures on those GPs and providing specific support with childcare and costs to those looking to join or return to general practice.

My Lords, analysis by the Health Foundation think tank has found that people in the most deprived communities are less well served by GPs, who are struggling to cope with shortages of doctors and receive less funding per patient than those in more affluent areas, despite the fact that people living in poorer areas have greater healthcare needs. What action are the Government taking to tackle the lack of doctors and the funding disparity between poorer and wealthier communities? Is not addressing the inequalities of provision in general practice the key to tackling health inequalities, which have worsened because of the coronavirus pandemic?

As I said to noble Lords before, one of the initiatives the Government are undertaking is providing extra funding to doctors to train in those hard-to-recruit areas, to increase provision there. The noble Baroness is right to say that equality of provision is an important part of the NHS, and it is something that we strive to deliver.

My Lords, it is worrying that the situation has changed so much, and that two-thirds of GP consultations now have to be done by telephone, as time and practical access to surgeries are so limited, and it is no longer possible just to walk in. In those circumstances, it is difficult to know whether a case of obesity, for example, is getting worse or improving. Seeing patients personally is much to be preferred. But when they ring the doorbell they have to be let in, they can only be spaced in a certain number of chairs, and everything has to be cleaned after each patient leaves. It really is difficult. As for the shortage of GPs, I wonder whether we might get some from Commonwealth countries—as I came, years ago, when there was such a shortage of dental practitioners. There may now be surplus doctors in some other countries, who we could ask to help us out.

The noble Baroness is correct in her references to the measures taken in GP surgeries to control infection. Those are incredibly important during a pandemic. However, telephone and video consultations can be a triaging process to allow people to have face-to-face consultations for the appropriate amount of time with the appropriate primary care worker.

My Lords, the time allowed for this Question has elapsed. I apologise to the noble Lord, Lord Hunt, and the noble Baroness, Lady Altmann, who have not been able to put their questions.