Skip to main content

Primary Care: Quality and Access Improvements

Volume 823: debated on Thursday 21 July 2022


Asked by

To ask Her Majesty’s Government what assessment they have made of the variations in the quality of primary care across England, including access to GP services; and what plans they have to improve quality and access.

My Lords, we are working to expand and diversify the general practice workforce to create an additional 50 million appointments a year, which should improve access for patients across England. NHS England continues to provide support to practices working in the most challenging circumstances in order to provide better access to patients via its accelerated access improvement programme.

My Lords, clearly the Government have no chance of meeting their target of 6,000 additional MPs, or rather, GPs—they might be happy with that at the other end—by 2024, when this month the BMA is reporting that there are over 1,700 fewer GPs. More GPs are seeking to leave, the population is growing and, as we know, health problems are ever more complex. In the light of this, will the Government review the numbers of promised GPs? What urgent and specific action can the Minister offer to those who cannot get an appointment, particularly in the more deprived areas and those places identified for levelling-up support?

My Lords, we have 1,400 more full-time equivalent doctors working in general practice compared with March 2019. But the noble Baroness is right that we must do even more to expand the numbers. We have a record 4,000 trainees who have accepted a place on GP training this year. Another element is the wider primary care workforce, where we are on track to meet our commitment of 26,000 additional patient care staff working in primary care. The most deprived areas are being targeted for the accelerated access improvement programme, which is providing tailored support to practices in those areas to improve access.

My Lords, in a recent inquiry by the House of Commons Health and Social Care Committee, the Minister in the Commons was asked whether he thought that general practice was in crisis. He disagreed but did agree that there were some serious challenges to be faced. Can the Minister say what the Government think that these challenges are in the short term and how they intend to address them? Furthermore, the long-term sustainability of primary care and community care will require some reforms, as suggested by two recent reports: the Policy Exchange report and the report by Claire Fuller, a practising general practitioner. I will be glad if the Minister can answer.

My Lords, I absolutely recognise the pressure that GP practices are under. To name just two of the factors, we have seen increased demand on the practices, which are seeing more patients than ever before, but we also have reports of people struggling to get access. There are workload pressures on those working in those practices and the need to increase staffing numbers, not just of GPs but those wider primary care staff. In terms of reform, I have not seen those specific reports, but the noble Lord will know through the Health and Social Care Act that was passed recently that the creation of integrated care boards and integrated care systems will, I hope, bring primary and secondary care closer together and enable local areas to design care that is meeting the needs of their populations better.

My Lords, I declare my interests with the Dispensing Doctors’ Association, based in North Yorkshire. Will my noble friend restore the funding to general practice of 11% of the overall health budget? Will she immediately allocate £1 billion of that to primary care networks, for the reasons that the noble Baroness opposite gave?

My Lords, we have increased funding to general practice and primary care to address some of the pressures that they have faced. In addition to funding, we are seeking to give greater support to those practices in the most challenged areas to improve their ways of working; for example, with their telephony systems, to ensure that patients can get through to their practices and book the appointments that they need.

My Lords, traditionally general practice has been one of the most satisfactory things for many doctors, who have been very proud of being GPs. The current crisis is critical. Just two weeks ago, the noble Lord, Lord Patel, suggested that we might have a Select Committee to look at why there is so much dissatisfaction now among general practitioners. I am sure there would be broad consideration of that across the House if it were something that the Government were interested in trying to promote. What message can the Minister take back to the Department of Health about this?

The Department of Health and Social Care is cognisant of the pressures on GPs and is looking at improving the retention as well as the recruitment of GPs to increase their numbers. A number of programmes are in place looking at tailored solutions in certain areas to see why GPs are leaving the profession. We continue to work with the NHS and the profession to understand how we can help GPs and improve their working environment.

I understand that we do not yet have enough UK-qualified clinicians. Is the Minister confident that trained practitioners from the rest of the world wishing to work here will be welcomed by both the Department of Health and Social Care and the Home Office?

In terms of GPs specifically, my understanding is that because general practice is quite unique to the UK, we have a large number of people who have done their basic training elsewhere and then come to the UK to do their general practice training. That is something that we continue to support and encourage. With regard to trained people in general practice, that training tends to happen only in the UK so we do not tend to have a great number of people coming in at that level.

My Lords, the Carr-Hill funding formula is based primarily on ageing, not need. The RCGP and NHS England have called for this to be reviewed. We saw during the pandemic how outcomes can vary due to inequalities. What is the Government’s view on reforming that funding formula?

I am afraid I do not have the specific details of that funding formula to hand so I will write to my noble friend.

My Lords, how much infection control is taking place in the community now that testing for the coronavirus is no longer free? Are there effective vaccines for the most recent variants of Covid-19, and is there sufficient vaccine for the monkeypox?

On infection control, the NHS continues to keep in place the right infection control measures proportionate to the risk. While free testing is not available to the general population, tests are still available where they may be needed. On the vaccine, my understanding is that it continues to be effective against the variants, and last Friday we announced our acceptance of the JCVI recommendation that all over-50s be offered a booster this year. We will also continue to keep in place the extended flu vaccine eligibility that we had last year.

My Lords, is it not the case that this crisis has been made worse by the changes to the pension scheme for GPs? What are the Government going to do about that?

My Lords, the Government have taken action in terms of the annual pension allowance. We are also aware of the issue of the lifetime allowance for GPs. However, it is generally still in the interests of GPs to stay in the profession even when they hit their lifetime allowance. The NHS is working to raise awareness of pensions and the true value of the pension reward package. We know that the lifetime allowance is not the only driver for early retirement. Last year’s GP Worklife Survey reported that the most considerable job stressor is GPs’ increasing workloads, which is why we are so focused on increasing the number of staff in those practices to help deal with that workload.

My Lords, would the Minister be kind enough to address the question asked by my noble friend Lord Winston, which was specifically whether or not the Government support a Select Committee being established to look at the current difficulties for GPs? That was the specific point put, and maybe she would be kind enough to answer it.

My understanding is that the establishment of Select Committees is a question for Parliament, not the Government.

Is it possible to look at the fact that 50% of the people who present in the NHS are suffering from food poverty? Of those suffering from cardiac arrest, for example, 50% are to do with food poverty. When are we going to address the long-term overriding problem of poverty, which destroys our NHS?

I am not aware of the specific statistic that the noble Lord refers to but we are doing a huge amount to support people, particularly during this difficult economic time. People are facing increased costs, which is why we have put in £37 billion worth of support this year, focused on the most vulnerable and those on the lowest incomes.