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General Practitioners: Shortage

Volume 823: debated on Tuesday 12 July 2022


Asked by

To ask Her Majesty’s Government what assessment they have made of the reported shortage of GPs in England; and what steps they will take in response.

I beg leave to ask the Question standing in my name on the Order Paper and declare my interest with the Dispensing Doctors’ Association.

The Government recognise that growing the GP workforce is challenging, particularly in light of pressures from the pandemic. There are over 1,400 more full-time equivalent doctors in general practice in March this year compared with March 2019, showing that there is some movement in the right direction. However, we need to go further, and we are working with NHS England and NHS Improvement, Health Education England and the profession to boost recruitment, address the reasons why doctors leave and encourage them to stay or return to practice.

I am grateful for that Answer, but my noble friend will be aware that by 2030, we will be facing an acute shortage of GPs as more doctors leave the profession than join. There are 9 million people living in remote rural, coastal and island communities, which is more than live in London. Will my noble friend ensure that all health policy is rural-proofed, and that those living in rural areas have equal access to healthcare to those living in urban areas?

My noble friend makes a very important point, and she referred continually throughout the passage of the Health and Care Act to practices in rural areas. We have looked at the challenges and have asked GPs about this in surveys, and we know that there are problems about the reduction of working hours, administrative burdens, some stress and burnout, and some issues about equitable distribution. One thing we do have is the Targeted Enhanced Recruitment Scheme launched in 2016, which has attracted hundreds of doctors to train in hard-to-recruit areas by providing a one-off financial incentive.

My Lords, in 2017, a House of Lords report recommended that the current small business model of primary care is not fit for purpose. The same has been said by the Royal College of General Practitioners, which produced a report; the British Medical Association; two think tanks, the Nuffield Trust and the King’s Fund; and, more recently, Policy Exchange, which produced a report on the model being fit for the future. Is it not time that the Government had plans to look at future models of delivering primary care? If they do not have such an intention, does the Minister agree that the House of Lords should set up a Select Committee to follow on from the excellent report produced on the NHS in 2017?

I thank the noble Lord for that question, but I should explain to him that I have been warned for exceeding my powers, as it were, in the past. I think setting up a Select Committee is a bit beyond my powers. The noble Lord and I, and many noble Lords across the House, including previous Health Ministers of all parties, have had this conversation, and we know that the old-fashioned model of a five to 10-minute appointment with your GP, only to be referred elsewhere and into secondary care, is broken in many ways. We need a much more modern model. We have seen primary care take on some of the functions of secondary care, but we have also seen, at the GP level, that the GP does not have to do everything, and that there are other workers such as nurses, physio- therapists and pharmacists who can do more of what the GP has done in the past.

My Lords, the figures show that more than half of GPs are considering retirement or are retiring before the age of 60. As the noble Lord has pointed out, there are lots of reasons for this, but he has not told us what he is doing about them. What is he doing constructively to change the attitudes and experience of GPs, which lead to this disillusionment among men who are at the highest point of their career, when they are the most useful to patients in primary care?

I assure the noble Lord that the Government are doing lots of things. Not only are we listening but we are looking at potential solutions and discussing them with the relevant bodies. For example, one of the pressures mentioned was the impact of the number of phone calls. There has been investment in handling them and getting them redirected appropriately, and GP practices have been offered money for that. The other issue is pensions: some GPs are worried about taking a hit on their pension if they come back to service. There are discussions about whether they are really worse off and how we can retain staff. Also, having other staff at the GP level who can take on some of those functions that GPs do not necessarily need to do could ease their workload. The administrative burden has added to this, but the digitisation of services should solve a lot of those problems.

My Lords, the Royal College of GPs reports that since 2019, GP clinical administration tasks have risen by a shocking 28%. GPs say that it would make a significant difference if hospital consultants could refer patients directly to other consultants, rather than patients having to come back to GPs and then be redirected. The back-office functions for repeat prescriptions take an ever-increasing amount of their time, and GPs are not in control of either of these processes. As a matter of urgency, will the Minister investigate how to reduce some of this bureaucracy so that GPs have more time to see their patients?

As part of the joint NHS England and NHS Improvement and DHSC bureaucracy review—there is such a thing—we have been working across government to reduce unnecessary bureaucratic burdens. There have been a number of key work streams, including a new appraisal process and digitisation of the signing of some notes, along with work to reform who can provide medical evidence and certificates and who can provide notes—nurses, occupational therapists, pharmacists and others. We are continuing to look through the process to engage with GPs to see how we can remove more such administrative burdens.

My Lords, looking at wider health workforce issues, I understand that we need another 2,000 radiologists in the next five years and that it is highly unlikely that we will be able to produce them. That is the pessimistic note. On an optimistic note, I heard recently that Apollo, the large healthcare provider in India, in partnership with the royal college and the GMC, has been training up 150 high-quality radiologists every year, some of whom are coming to this country. Does the Minister approve of such schemes, and is the department doing more work in places such as India where we can recruit high-quality medical staff?

I thank the noble Lord for his question, but also pay tribute to his commitment to tackling racism in our society.

We know that there are countries that train more people than they have places for in their country. They do that, first, to help those people get a better life elsewhere, but also because remittances are much better than foreign aid for many of those countries. I frequently mention the fact that it was immigrants from the Commonwealth who saved public services in this country after the war. We should remember that and continue to encourage people from the Commonwealth to come to this country. Sadly, for some reason, noble Lords quite often do not want them and make up all sorts of excuses for trying to block non-white people from outside Europe.

My Lords, one of the disincentives for both men and women GPs is the quality of accommodation. They are in overcrowded buildings. There is a good example from a care commissioning group in my area which spent £1 million planning a new centralised health centre, which would have provided top-of-the-range facilities and would have encouraged general practitioners to remain in practice. Will the Minister look at the quality of accommodation? What plans are there to introduce new buildings? That is a really important factor in dealing with the shortage of GPs.

The noble Lord makes the very important point that GP practices are evolving. Some are moving premises; some are merging in larger premises; some are moving into primary care centres, where they are able to offer not just traditional GP services but some of the services that secondary care currently offers. I am not entirely sure of the specific point that the noble Lord makes. He would be welcome to have a conversation so that I can follow it up with my department.

My Lords, does my noble friend agree that an increasing number of GPs prefer to work part-time because they face a marginal tax rate of 62% on earnings over £100,000? Will he consider discussions with his friends at Her Majesty’s Treasury to address those anomalies in the tax system?

There are a number of reasons why some GPs and other health professionals prefer to work part-time as opposed to full-time. Many people, especially given the stresses of the pandemic, want a better work/life balance. Some people have suggested in the past that we should focus on full-time equivalents. We should make sure that current staff who want to go from full-time to part-time can do so within the system, so that we can retain them, while tackling all the barriers to retention as well as recruiting more GPs.

My Lords, the appointments system is not working well for GPs or patients. Healthwatch England reports that complaints about GP services are rising, the main problems being difficulties getting an appointment, exorbitant waits on the phone, about which we all know, and an end to online facilities to book slots. What assessment has been made of the detrimental impact on people struggling to access GP services, particularly those who are more vulnerable, and what is the plan to put this right?

The noble Baroness is absolutely right. We know that, for many people, their first entry into the system—their portal, if you like—is trying to get an appointment with their GP. As the noble Lord, Lord Patel, mentioned earlier, we have to look at how we can modernise this service. In the short term, we have made money available to help improve triage for people who phone up for services; this includes how to manage incoming and outgoing calls. In future, we are looking at more digitisation and extending the functionality of the NHS app so that people can book appointments for all sorts of services; if they are waiting for an appointment or secondary care, they will also be able to see how long they will have to wait and where they are in the queue.