GP Appointment Availability — [Mr Laurence Robertson in the Chair]

– in Westminster Hall at 11:24 am on 26th October 2021.

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[Mr Laurence Robertson in the Chair]

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury 2:30 pm, 26th October 2021

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission. Please give each other and members of staff space when seated, and when entering and leaving the room.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

I beg to move,

That this House
has considered GP appointment availability.

It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. The chances of misdiagnosis can increase dramatically if GPs rely on emails or telephone calls exclusively. I speak from experience: for days, my mother-in-law was misdiagnosed as having a urinary tract infection, when she had actually suffered a severe stroke. Precious time was lost, and terrible damage done, because she was not seen by a GP. For every 100 ailments that can be diagnosed safely without seeing a GP, there will be one that cannot—one that could prove to be fatal, which is not a price worth paying.

I thank NHS workers and GPs for working tirelessly throughout the pandemic. I was encouraged to apply for this debate by my constituents, who came to see me again and again about this issue. I wanted to make sure that their voice was heard. I will read out some of their actual cases, because it is important to hear from them about what they have been experiencing. I would say that they are divided into two categories. The first is those who are disabled and perhaps suffer from dementia or other cognitive impairments, who find talking on the phone very difficult, and who really need to see a GP in person. The second is those who are happy to speak over the phone when they need a GP appointment, but find that the IT systems in place in certain GP surgeries cause issues with access to GPs.

The first example is from Marlow. A lady wrote to me and asked for an appointment to see me. She said:

“When I got through to the surgery, we were told that we should have a telephone appointment first. The GPs have my daughter’s number, as she cares for her grandmother. I explained that we do not live with her and cannot sit at her house and wait for a call. Also, there was a phone for her to sit around all day, and no one answers. She isn’t good with IT and has trouble explaining and expressing herself and telling someone what is wrong over the phone. I understand we are in extremely unusual circumstances, but there has to be exceptions, and there must be a way for elderly, and in some cases disabled, people to be able to get an appointment. Many do not have the capability to use the internet, and even phones in some cases.”

That was particularly true in the case of my mother-in-law, who had had a stroke. Luckily, we had power of attorney, but many people do not. I appreciate that the Government have made great strides in this regard, but we need to look at how we can protect those who are disabled, who perhaps have cognitive impairments and who need to have a carer come with them to a GP surgery in order to express what is wrong and explain what condition they have. Greater attention should be paid to this in the future.

We also have the issue of general IT and phone challenges. A resident in Farnham Common wrote to me and said:

“We have difficulty making the initial contact with GP surgeries. Most GPs operate a system which requires the patient to telephone when the surgery opens at 7 am to seek a consultation for that day. In our collective experience, it is often extremely difficult to get through. It takes a very long period of repeated calling. One friend recorded 140 unsuccessful attempts to reach the GP surgery.”

Some of the GP surgeries in my constituency are excellent. They were excellent during the vaccine roll-out and through covid, but we have certain GP surgeries that have had challenges meeting residents, challenges with the vaccine roll-out, and challenges in general throughout the covid period. Quite a number of residents have written to me and spoken to me about Burnham Health Centre, so I want to share specifically the IT challenges that it seems to face consistently.

One resident, Colin, said that if you are lucky enough to be 29th in the queue that morning at 7 am, you may get a message that says no appointments are left for the day. You can hang on in silence, or you may get to speak to a person—you may get through to a human being. You are told that there are no appointments and that you need to use Patient Access. When you try to book an appointment via Patient Access, it gives you possible ways to book, but only for things like contraceptive appointments, and nothing else. When Colin tried to access Patient Access, he was given an electronic form which he completed several times. It kept coming back saying that it could not be processed. He tried dozens of times and finally gave up and decided that Patient Access was not working.

He was not the only resident in Burnham who complained about Burnham Health Centre and Patient Access; several more wrote to me about the same issue. One said:

“I do think it’s ridiculous that you cannot get an appointment when you call, I am happy to wait a day or two, if it is urgent, there is always 111. The practice of releasing a limited amount of appointments at a certain time is not fair and just causes a bun fight. I do think the staff would benefit from customer service training”— for everyone’s benefit.

A set amount of appointments are on a first-come, first-served basis. This seems to be unique to this GP surgery, but it has become a very agitating issue for people in the area who already suffer from some health inequality. They perhaps do not have the financial ability to go privately. Many are older and vulnerable, and it is demoralising that they often cannot get hold of a GP for even a phone call and consultation. Just getting a phone call would be a positive step in certain cases in my patch.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

The hon. Lady is making really good points on this massively important issue. She just remarked that it was unique to where she is. Not at all; I have similar issues and I am sure other Members will talk about their issues. It is so important. Does she agree that the difficulty people have in accessing GPs has a knock-on effect on the National Health Service in other areas? We see people going to A&E out of frustration, because they cannot see their GP. This is really a problem that needs to be tackled head on. I congratulate the hon. Lady on introducing the debate to put pressure on exactly that.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

I thank the hon. Lady for her contribution. I agree that the problem has a trickle-down effect throughout the NHS. We will see more people presenting at A&E and perhaps with more advanced stages of disease, because they have not been seen in person. Encouraging GPs or creating a covid incentive programme for them to see people in person will decrease the amount of hospital admissions and lead to earlier diagnosis for cancer and heart disease. These things can really only be done in person. If someone is healthy and just needs a phone appointment, that is fine, but certain things cannot be seen unless a person’s vitals—their heart pressure—can be physically checked. Only a GP can do that and really only in person. If we want to reduce the overall burden on the NHS this winter, finding a safe and secure way for more residents to see their GP will reduce the overall pressure long term on the NHS. I know we have an aging population, and that GPs are under huge amounts of pressure and strain, but I believe there is a way we can work together to find a solution.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

The hon. Lady said that only a GP can check someone’s blood pressure. We know that many people can undertake many of the different clinical functions that a GP is asked to undertake. Is it not right, therefore, to look at a multidisciplinary clinical team and how to deploy it better, rather than just to focus on the GP?

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

The hon. Lady is stealing my thunder, but I agree with that comment. With the multi-disciplinary approach, even nurse practitioners and others could be recruited into a GP surgery structure, to help with many of the ailments that people are presenting at A&E with or asking for an appointment about. There is a wide range of healthcare professionals who could help and support GPs, and I think this is an important issue that needs to be further discussed and debated.

When this matter came before the House in July, several relevant questions were raised. One of them was about NHS England and NHS Improvement, or NHSEI, which leads the programme of work support practices, using digital and online tools to widen access. I would just love to hear what progress has been made since this topic was debated in July. Also, what is the progress of NHSEI’s independent evaluation of GP appointments? Again, I would like to see whether we have had any progress on that independent evaluation. Finally, what is being done by the NHSEI access improvement programme to support practices where patients are experiencing the greatest access challenges, such as drops in appointment provision, long waiting times, poor patient experiences or difficulties in embedding new ways of working related to covid-19, such as remote consultations as part of triage? I would really welcome any updates on those questions.

We could perhaps discuss today how we can provide GPs and their surgeries with some kind of in-person patient incentive during covid. Perhaps that could come from existing regional funding streams. Perhaps each time a GP sees a patient in person, they could receive an extra payment, or they could receive an additional payment for visiting someone in their home. That would mitigate the additional cost of PPE and also the additional risk posed to the GP themselves by having to see people in person during covid or high levels of winter flu.

Some GP surgeries are already receiving additional funding for cervical cancer and diabetes screening, and we have seen uptake increased in those areas very successfully, so this type of programme has been modelled in the past. It would help to mitigate the risk and burden for GPs, while still getting as many of our constituents as possible into in-person appointments if they need them.

The NHS claims that it would like more patients treated at home rather than having to stay in hospital for extended periods of time. This model could be enhanced if GPs were given the financial incentive to carry out in-home treatments for patients who traditionally would have remained in hospital. Obviously, this allocation would have to be set by the integrated care system in each region and it would be decided on within regional NHS structures, but it is worth considering.

In my own personal experience with my mother-in-law, she has been at home all the time 24/7. She is now completely disabled and needs 24-hour care, but the most difficult challenge was the out-of-hospital care provision—getting the GP, the hospital and the council to co-ordinate the care effectively. It is a full-time job for someone to co-ordinate that care. If we can make those pathways of care and co-ordination easier for everyone, then, as was said earlier in the debate, it would reduce the overall pressure on the NHS.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

Does the hon. Lady share my concerns about the provision in the Health and Care Bill for the assessment of patients to take place after they have been discharged from hospital instead of before, as happens at the moment? I have very serious concerns about that issue. I tabled a couple of parliamentary questions, which were answered by a different Minister to the one who is here in Westminster Hall today. One question was about the fact that this discharge-to-assess approach has been going on under the Coronavirus Act; I asked how many patients had been discharged that way. The reply came back that 4 million patients had been discharged from hospital without having their assessment. I asked how many of those had been readmitted within 30 days; the Minister replied that the Government did not know because the information was not held nationally.

This is a very serious concern, because we are talking about vulnerable people. I know the hon. Member for Beaconsfield is talking about a particular relative. The idea that somebody with dementia, or early-stage dementia that has not been fully diagnosed yet, should be discharged before their needs are fully understood is very alarming. An independent review of this is going on at the moment, and I would be grateful if the Minister could give us an idea when that is going to be published. It is meant to be this autumn. I would like to raise this with the Minister as a very serious issue and wondered if she would like to comment on it.

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury

Order. I remind hon. Members that interventions need to be brief.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

I recall the Member speaking on this topic previously. I commented only because of my personal experience. The change is well intended, and I understand where it is coming from, but for a disabled person, and for someone who cannot advocate for their own care needs, having a care plan in place before leaving hospital helps with accountability and the structure of the care. From my own personal experience, as someone who has taken care of a very disabled relative who cannot advocate for herself, I can only say that having this agreed before she came out of hospital made it easier for our family to co-ordinate the care. It is difficult to know which funding pathway is linked to what care once someone leaves hospital; there is a statutory responsibility, but then there is the question of who picks up the care once that period out of hospital has finished. For someone who is disabled, has had a stroke or requires long-term rehabilitation, that is a very sticky issue because whichever organisation within the health structure picks up the statutory duty picks up a huge cost. I think it is a very nuanced issue and we need another debate on it to flesh out all the different challenges. However, I take on board the comments made by the hon. Member for Wirral West and recall supporting what she said when she spoke several months ago.

I understand that these are unprecedented times, and there are great challenges for everyone across the health sector. This is not to criticise anyone; it is just about how we can positively move forward into the new covid era in which we find ourselves, and into the winter months when there are more challenges. It is about how we can work together to find solutions, particularly for the vulnerable, the disabled and those who cannot advocate for their own care needs. I am very grateful that we have been given time to debate this topic.

Photo of Kim Leadbeater Kim Leadbeater Labour, Batley and Spen

I thank the hon. Lady for securing this important debate today. Like her, I have had communication from a number of constituents who are concerned about the lack of face-to-face appointments. It definitely is an issue. We have to be careful that we do not have a knee-jerk reaction. I also think there are benefits to a hybrid approach; I have a chronic health condition, but I would actually rather have a telephone conversation. The other important point is that a survey by the British Medical Association in August found that half of GPs had faced verbal abuse in the previous month alone, and most GPs had witnessed abuse directed at, in particular, reception staff. This is certainly borne out by the conversations I have had at surgeries in my constituency in Batley and Birkenshaw. Does the hon. Lady agree that this is extremely concerning and totally unacceptable, and that we must call out abuse directed at those in public service?

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

I thank the hon. Lady for her comment. In my constituency we have GPs who have worked tirelessly throughout the pandemic and have done so much to roll out the vaccine—I commend them for everything they have done in such an incredible way. This is not to disparage the wonderful work of the majority of GPs and GP’s surgeries. I am looking for the correct terminology. There are certain GP’s surgeries that have struggled to even respond to constituents with phone calls. Many would be satisfied with just a phone call, but they cannot even reach their GP to schedule a phone call appointment.

Photo of Chris Green Chris Green Conservative, Bolton West

Does my hon. Friend share the concern of many of my constituents that there is to some degree a postcode lottery in the national health service and the GP service? Different GP surgeries and different areas provide very different levels of service, whether that is face-to-face or there is a lack of that.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield

I would agree with that. Some GP surgeries, in certain parts of my constituency, are excellent—they were excellent with the vaccine roll-out; they are excellent now; they have done everything in their power to see as many constituents as possible—and then there are certain others, in the Iver and Burnham areas, where we continually have complaints, where constituents come to me in desperation because they have nowhere else to go.

We need to find a way of giving health access to everyone in a fair and reasonable way. I promised my constituents that I would raise their concerns at the highest level, and I have done that today, both in Westminster Hall and with the Minister directly. I thank Members for their time today, and I hope that this issue will continue to be considered and debated within Parliament and by the Minister.

Several hon. Members:

rose—

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury

I ask hon. Members to now limit their speeches to six minutes, so that we can get everyone in.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 2:51 pm, 26th October 2021

It is a pleasure to serve with you in the Chair, Mr Robertson. I thank Joy Morrissey for calling today’s important debate. Let me set out the challenge, and how Government can make a difference.

York Medical Group has 44,000 patients on its books. In a single calendar month, it received 41,000 calls from people who needed to see a clinician—unprecedented demand, with higher acuity, co-morbidity and complex needs. When patients get through to the call-handling system, they are triaged and, when urgent attention is needed, that is followed up by a clinical conversation. Appointments are allocated, tests are ordered, referrals are made, and prescriptions are issued.

Of course, people are also applying to see a practitioner through the internet or are turning up at the surgery. That is managed by exceptional staff, who are really pulling out all the stops to support their local community. However, this logistical agility to meet the serious demand is outstripped by the pressures placed on it. When spending time embedded in the system—as I did, spending time with call handlers and with GPs—I saw how relentless they were in trying to meet that demand, but that demand is continuing to put pressure on them.

Photo of Alex Sobel Alex Sobel Shadow Minister (Digital, Culture, Media and Sport)

My constituency is only 25 miles from my hon. Friend’s. A constituent came to see me last week; they could not get an appointment with their GP, but were told to go to the accident and emergency department in Leeds. It took two hours at the A&E to be triaged, and they were then told it would be a further six to seven hours to see a doctor. They ended up going home because it was too cold at the hospital to wait. Does this issue not impose pressure right across our health system, to the point that it is near collapse? Winter has not even properly started yet.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

My hon. Friend hits the nail on the head. We cannot look at part of the health service without looking at the entire health service, and the pressures that are brought to bear. As we have heard, many people do go to their A&E or urgent care centre, because that is the only way that they know they can confidently access the service, which puts more pressure on those parts of the service. We must look at the whole.

However, when it comes to trying to engage with our community practitioners—that is what primary care is all about: people who would traditionally have known the patient and the family—medicine has changed so much, yet we have not caught up with where it is. I saw both the call handlers and the GPs facing burnout. They are reducing the number of sessions that they are working because, we must remember, a session then extends right through into the night, as they are catching up with paperwork, ordering tests and following things through. Individuals are just saying “If I don’t step back, it will have a serious impact on my own wellbeing.” We have got to protect the wellbeing of GPs. They are a precious resource in delivering our healthcare services.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

My hon. Friend is making an excellent speech. Does she share my concern about the shortage of GPs? The Government have committed to having an extra 6,000 GPs by 2024 or 2025, I think. The pressures GPs are under is a direct consequence of the failure to address the issue.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

My hon. Friend raises the next point in my speech. We are in this mess because for over a decade we have had failed workforce planning across the system. We have seen that most acutely in primary care. The pandemic continues to be mismanaged, which I want to stress. The Government may be looking at the numbers when it comes to intensive care and hospital admissions, but as people are less sick they instead go to see their primary care physician. That puts more pressure on them. We need to see more measurements and data on the pressure that has been put on primary care during the pandemic. In addition, we have long covid as well. In York there are around 3,000 cases. It is not coded, so can the Minister get that sorted urgently? We need to look at the support that people with long covid require.

Photo of Mohammad Yasin Mohammad Yasin Labour, Bedford

In the Bedfordshire, Luton and Milton Keynes clinical commissioning group area, there is only one GP for every 2,500 people, making it one of the worst hit by GP shortages in the country. The number of GPs employed in the area also has fallen by 12% to 390. Does my hon. Friend agree that we need an urgent independent review of access to general practice, not a “name and shame” league table that will only drive more overwhelmed GPs away from their profession?

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

Absolutely. My hon. Friend speaks for himself. We need a shift from a sickness service to a health service. The Government scrapped the health checks that were vital in picking up ill health. We need to see prevention at the front of the queue, and we need to see investment in public health, which is currently being cut by local authorities. We need to make sure proper preventive measures are put in place.

The fact that the Government are not moving to plan B right now shows that they are escalating the challenges on general practice rather than diminishing them. They are putting the vaccine responsibility on GPs when it can be done elsewhere in the service, as it was by Nimbuscare. We need to look at how not only health professionals but volunteers and the Army, even, are working together to deliver healthcare. We need to think about the broadest team available. Pharmacy also plays a crucial role in making sure that we are protecting the health service.

Looking at prevention, we do not necessarily need to move towards an individual, one-on-one health system for everybody. We can socialise and communitise health, so that people can get health support in active communities. Peer support is vital in managing disease and ensuring that people can support one another through ill health. Occupational health services can make those early interventions in workforces, often where mental health problems show up when there is stress in the workplace. There are real opportunities to expand those services and look at deploying early intervention and education to turn around this system. It will only happen if proper investment is made and proper workforce planning is put in place. The Government have got to get to grips with the figures on staffing and ensure that investment is in place.

Staff are exhausted, tired and downtrodden. The trauma of covid is hitting right now. We need to ensure that staff are properly rewarded through their pension scheme and with a decent pay rise. Get it sorted.

Photo of Chris Green Chris Green Conservative, Bolton West 2:59 pm, 26th October 2021

It is a pleasure to serve under your chairmanship, Mr Robertson. It is a pleasure to follow Rachael Maskell, who makes important points in her speech. I congratulate my hon. Friend Joy Morrissey on securing the debate and making many compelling arguments. I congratulate my hon. Friend the Minister on taking her position on the Front Bench. She is one of a small number of individuals in Parliament who has recent frontline experience and I am sure she will bring that to bear in her role.

GP appointments are an important issue about which there have been concerns for many years. The principal concern at the moment relates to coronavirus and the lockdown. We cannot avoid that or simply touch on the subject, then concentrate on a wealth of other concerns. We have to focus on that issue as the prime driver of the current problems in the sector.

The Chancellor has put forward substantial resources, but more are always needed to make sure that resources are available for the national health service and for general practitioners. More needs to be done, and I am sure that, in the coming months and year or so, more resources will come forward.

I am here to raise the concerns of my constituents who are increasingly worried. At the beginning of the coronavirus lockdown, many people chose not to take up available GP or hospital appointments, but many of those conditions that have not been investigated or checked in the last 19 months are now far worse. The pressure and demand on hospitals and GPs are more severe. People are increasingly less frightened of coronavirus but more frightened about when they will get to see their family doctor, who is now difficult to see.

People are told by their GP receptionist to call at 8 o’clock, or earlier in some areas, but they have to make call after call after call for half an hour or 45 minutes. They cannot get through until it is too late and they are told to do the same tomorrow. That is happening day in, day out. Many people are now going to accident and emergency. For a long period at the beginning of the pandemic, A&Es were quiet because people were worried about going and getting coronavirus, but the situation has changed radically. People cannot access their GP surgeries and they are going to A&E, but it is far more difficult to get the service there too.

The system is coming under significant and increasing pressure, which is piling up as we head into winter. It is not just coronavirus. There is an expectation that the pressure from other respiratory viruses will mount up along with, as I mentioned, conditions that have not been checked or investigated for all those months such as cancer and other life-threatening conditions.

We have heard about elective care for issues such as cataracts and hip replacements. In the scheme of things, when we are thinking about life and death, they may seem relatively minor but they have a dramatic impact on people’s standard of living. The situation has negatively affected all those discretionary care items, but they have to be addressed too.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

The hon. Gentleman is talking about rationing and what is happening in the wider system. With the Health and Care Bill, we are moving away from a national health service to 42 integrated care systems that will all have to balance their books every year under tight financial controls and will all have different strategies. Does he share my concern that that will embed the postcode lottery and increase the rationing of care? Have his constituents commented on that and do they share those concerns?

Photo of Chris Green Chris Green Conservative, Bolton West

The hon. Lady makes some important points about the Bill, but the postcode lottery is already there. Most people view the national health service as a one-size-fits-all service that provides the same service wherever they are in the land, but that is not true and perhaps never has been. Access to medicines is very variable and IVF is a good example of something for which different areas have different agendas, policies and accessibilities. We all know that there is already a postcode lottery.

I do think that NHS England is too large an organisation. I was not intending to talk about this, but I was hopeful about health and social care devolution in Greater Manchester. The Mayor could have taken that up and championed it, but he has not made a single speech on the subject—he has not touched it. Having seen the failure of that devolution, the Government are now looking at other mechanisms to champion the cause of better accountability—

Photo of Chris Green Chris Green Conservative, Bolton West

I am sorry, I have very little time—where local leaders may be able to champion the cause of better delivery, with organisations in a sufficiently large area in which they can make a difference, but which are close enough to people that local needs can be respected and identified. Different areas are often so very different.

About 5.5 million people are on hospital waiting lists. That is an extraordinary figure. However, there have been about 7 million fewer GP to hospital referrals during the pandemic. If we extrapolate from those figures, we have roughly 13 million people on the hospital waiting list. We need to get the GP service sorted out as soon as possible. It is appalling. I am disappointed in the British Medical Association for threatening strikes. The health system, the unions and the Government need to get together and deal with those problems as soon as possible.

I was concerned about the renewal of the Coronavirus Act 2020 because I know what that will symbolise to the civil service, the health system, the education system and wider society: that we have not and should not yet return to normal. As long as the Coronavirus Act is in place, I can see that the wider system of state, including GPs’ surgeries, will not return to normal. That has to be changed and normal service must resume as soon as possible.

Photo of Simon Fell Simon Fell Conservative, Barrow and Furness 3:06 pm, 26th October 2021

It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. I thank my hon. Friend Joy Morrissey for securing the debate; if ever there was a timely debate, this is it. It is always a pleasure to follow my hon. Friend Chris Green, who often speaks sense. [Laughter.] And did so today, I should say! That was not a back-handed compliment.

About a month ago, I got an email from one of my constituents who is a nurse working in general practice. She was very angry and frustrated with what she sees day to day, dealing with the general public and some of the challenges there. One line from that email really stuck with me:

“We used to clap for our carers, but now it feels like we get a slap for our carers.”

That really illustrates some of the challenges that those working on the frontlines in primary care are facing. It is a very difficult environment, and no one working in public service should have to be in that sort of environment day in, day out.

Many hon. Members have talked about the frustrations faced by constituents trying to access services; my constituents are in exactly the same boat. My inbox is not exactly quiet on that issue. I have experienced it personally, too: calling the surgery at 8 o’clock in the morning and not getting an appointment; being told through various messaging campaigns to send photos in and get diagnoses that way, but with no clear route of access for how to do that. That drives frustration. People are being told that they can go to the pharmacy and, for what it is worth, I think that is an excellent thing to be doing. We should be triaging people. However, we need better communication about why people should be going to the pharmacy, what symptoms they should be displaying and what questions they should have to go there instead of calling 111 or going to their GP.

The work that GPs and those in general practice are doing is just phenomenal. We should not forget that they are delivering not only a programme to work through a backlog of people trying to access services, but the vaccination programme. In my constituency in Barrow and Furness, they are doing a phenomenal job. Their day job is packed and stressful; delivering the vaccination programme before or after hours to get through those essential numbers as well is really difficult.

I held a roundtable with some GPs with my constituency neighbour, Tim Farron. I met four GPs from my constituency there, and spoke to another two beforehand. They all talked about having the same issues. After the meeting, one of my GPs sent me an email, and I want to put on record a quote about some of the challenges they are facing:

“During the pandemic we continued to provide face to face appointments despite any personal risk or even PPE in the early days...I have a memory of wearing a bin bag and a visor from B&Q for an early visit! We triaged all contacts as advised…we saw patients in a portacabin in the car park to protect staff… We are aware that not enough patients are being examined, and although we still do phone appointments first, my conversion rate to a face to face…within few days is about 40%...Our workload has increased by about 30% in the last few months. All the patients that ‘stayed at home to protect the NHS’ are now out in force and demanding to be seen, and some are really quite unwell, having suffered from self-imposed medical neglect for many months. Mental health crises dominate every day. Cancers and heart disease are presenting late. And there is a huge bottle neck in the system, as we cannot get anyone seen in secondary care as the waiting lists are so huge…This is a perfect storm”.

Another GP got in touch with me. He is now edging towards retirement. He is contracted to work three days a week, so he is only paid for three days, but he is turning up for six while also delivering the vaccine programme. His concern is not just getting through the waiting list but also the challenge of finding new GPs to backfill afterwards. If we do not get a grip of this crisis, that will be the next problem that we face.

The GP who wrote to me continued:

“If face to face is mandatory, there will be a four to five week wait for an appointment. Is that really the policy outcome anyone wants?”

Those are the challenges that we must lean into, and I would be interested to hear from the Minister what the Government plan to do about them. I know that they have announced money for general practice and the NHS, but we cannot magic up people and resources.

To my mind, we must look at improving access through technology, looking at challenges around phone calls and patient access systems, and easing information flows between GP practices and secondary care. Yesterday in the Chamber, my hon. Friend Dr Evans said that 10% of GP time is spent chasing up appointments and medical records. We should be able to use technology to get that out of the way.

However, the crucial point is about communications and signposting. Pharmacies and 111 are fantastic resources, but we must make it clear to people why, under what circumstances and how they need to use those routes. We are not there yet. That responsibility falls on both Government and general practice. Something in the comms space is really important.

If we do not tackle this now, I fear that we are building up a problem for the future and that the recruitment issue is going to come back and bite us. I am interested in the Minister’s views on how we tackle that perfect storm. What we need now is a considered and coherent route out of it; otherwise, we will face a similar debate in six or 12 months’ time.

Photo of Peter Aldous Peter Aldous Conservative, Waveney 3:12 pm, 26th October 2021

It is a pleasure to serve with you in the Chair, Mr Robertson. I congratulate my hon. Friend Joy Morrissey on securing this debate and on her graphic and very personal assessment of the current position.

Over the past two to three months, I have received a great deal of correspondence on this issue, with constituents very upset that they have not been able to secure face-to-face appointments with their GPs. Late last month, I had a virtual meeting with GPs practising across the Waveney area, who themselves are very upset at the abuse that they have been receiving—something that they and their staff should not have to put up with.

There is clearly a major problem, and, at a time when the pressures on the NHS are growing at an exponential rate, there is a need to work together to find a solution. In the Norfolk and Waveney clinical commissioning group area, notwithstanding the enormous demand for GP services, the position with regard to appointments is positive, although it is recognised that more needs to be done. In August 2019, there were 478,160 GP appointments, and this August that figure increased to 482,993. The proportion of patients being seen face to face is increasing. This August it was 69%, compared to 67% in July and 66% in June. More patients are being seen face to face in Norfolk and Waveney than in other parts of the country: the August figure of 69% compares with a national average of 58%.

That said, it is recognised that a lot of people are very distressed, and in many cases very worried, that they have not been able to see their GP. The pandemic has meant that there is now an enormous increase in demand for GP services, with people on growing waiting lists needing support, and with those who were unable to see their GP during the pandemic wanting an appointment in order to highlight something that is causing them a lot of worry and distress.

The increase in demand for GP services has been happening for some time, but there are severe capacity constraints on the number of patients who can be seen face to face. The current infection, prevention and control measures that are needed to keep patients and staff safe mean that in-person appointments take much longer. Social distancing means that, at practices with smaller waiting rooms, people have to wait in their cars and staff have to go and get them when it is time for their appointment. Additional cleaning arrangements are also required between patients. There is a need to improve and standardise the way that remote appointments are operated and to adopt a whole-team approach, as there are many cases where a patient does not always need to see their GP and can often be cared for better by a physio or pharmacist.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

The hon. Member is making some very interesting points. Does he agree that it is important that the Government review the outcomes of patients who have been consulted remotely? I have heard harrowing stories from my constituents. One woman thought she had a very minor ailment—she did not get seen by a GP, and she ended up with life-changing surgery. She will never be the same again. It is important that there is a national review of what has happened to such patients, rather than assuming that everything is all right because a patient does not come back.

Photo of Peter Aldous Peter Aldous Conservative, Waveney

I am most grateful to the hon. Member for that intervention, and I agree wholeheartedly with her. The more evidence we have, the more we can get remote forms of working to operate much better.

I previously mentioned the abuse that GPs and their staff receive. I should emphasise that it comes from only a small number of patients, but it is nevertheless making general practice a less attractive, and often quite unpleasant, place to work. That risks making GPs and practice staff harder to recruit and causing existing staff to retire early, to choose to work elsewhere in the NHS or even to leave the health service altogether.

The Government’s plan for improving access for patients and supporting general practice is largely to be welcomed, but there needs to be an emphasis on collaboration and working right across the NHS, which is something that the integrated care systems will hopefully achieve. It is also vital for the Government to see through our manifesto pledge to increase the number of GPs and other primary care professionals. There will be an increased emphasis on information technology, and the necessary investment in that infrastructure must take place right across the country in a way that is easy to operate and, most importantly, straightforward for all patients to access.

Photo of James Sunderland James Sunderland Chair, Select Committee on the Armed Forces Bill, Chair, Select Committee on the Armed Forces Bill 3:18 pm, 26th October 2021

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my hon. Friend Joy Morrissey on securing the debate. I listened to the speech by my hon. Friend Peter Aldous—I am sure he was looking over my shoulder when I wrote mine, because some of the themes are quite similar.

I find myself in the curious situation of raising the issue of NHS services in east Berkshire. Why is that curious? Because we are pretty well served, actually. The NHS is pretty good locally. We have three fantastic hospitals on the doorstep. The Frimley ICS is one of the best-performing care systems in the country and recently had a reprieve from the new Health Secretary, who had looked at breaking it up. We are in a pretty good place, and I do not tend to get letters from constituents about the healthcare that they receive, which is very good. In this case, however, I have been receiving letters, and I am quite concerned about it.

What is the perception, and what are people saying to me? Under the current policy, GP practices must now ensure that they offer face-to-face appointments. Only 57% of appointments across the UK are currently face to face, versus 79% before the pandemic, so there is an issue. There is also a perception that it is difficult to get through to practices on the phone, and that there is low availability of appointments and a lack of face-to-face care. Constituents are never wrong, my constituents are not wrong, and if they are writing to me repeatedly about these issues, clearly it is incumbent upon me as their MP to raise them.

What is the good news? Nationally, the narrative is actually very positive. If we look at the current statistics from the Care Quality Commission, the scores on GP access are the highest they have ever been, with a 67% satisfaction rate now, compared with 63% last year. Same-day appointments have gone up. People are satisfied with what they are getting from their GP, with an 88.7% satisfaction rating of “good” or “very good”. As of August 2021, 23.9 million GP appointments were offered and recorded, compared with 23.4 million two years ago, so things are getting better. Things are going up. That is in addition to the 1.5 million covid-19 vaccination appointments delivered in August 2021 by GP surgeries. The service, statistically, is improving. It is good news.

However, the data appears to contrast with what I am hearing locally. I agree with what my hon. Friend Chris Green said earlier about how there could be a postcode lottery, or it could be related to the service provider at individual constituency surgeries. Demand is clearly outstripping supply, so Houston, we’ve got a problem.

As an example, one constituent spent 45 minutes on the phone to a particular surgery, tried 159 times to get through and was then offered a telephone consultation for a lump on her neck, which is not great. Constituents have dialled 111 and been advised to contact their GP, then after being unable to get through, they phone 111. We have had multiple complaints from certain constituents in a certain part of my constituency—it would not be fair for me to say where—informing me that the practice has 20,000 patients and only two doctors. The figures do not work. Telephone triage is being used instead of an immediate face-to-face. For flu vaccinations, one particular group practice is advising constituents to travel to the central hub in Bracknell, which causes issues for those less able to get there. We have a capacity problem.

However, it is unacceptable that staff are working under challenging circumstances and facing levels of abuse not previously seen. GPs and staff are working harder than ever before. Retention and staff satisfaction are an issue. Therefore, MPs like me must do more to help to redress that balance, and to balance the narrative. By the same token, GP surgeries also need to take the inquiries that we raise with them more seriously. The GP is not the enemy, and nor is the MP.

My general advice to GP surgeries is this: I think that there are things we can do. We need more staff. Let us do more to recruit staff, particularly receptionist and telephone staff. We need to reassure patients a bit more; they want some TLC after the pandemic, and it is right that they get it. We need to sort out the phone lines. We need to improve electronic referral systems. In Bracknell, we have the new primary care network phone system, whereby calls that cannot be answered by a particular surgery will be rerouted to another, which is quite exciting. We also need communication between surgeries and their patients: tell the constituents what is going on and explain to them why their calls are going unanswered. MPs need to visit surgeries, as I am next week. Basically, let us improve customer service.

I have three points to conclude with. First, care providers in East Berkshire and across the country are working miracles, but are accountable to their customers. I would urge GP surgeries to think about what their customers are saying to them, and to do what they can to reassure them. My second point is addressed to the Minister. The new IPC guidance is forthcoming. When will it be published, and when will GP surgeries get more guidance on what it means? Lastly, I urge everyone listening to this to watch the language being used. We are all in the same space and working hard; doctors and staff are working really hard. Let us please tone it down. All of us are part of the problem, but we are also all part of the solution.

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury

We now come to Front-Bench speeches. I would like to leave a couple of minutes at the end for the mover of the motion to wind up.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Public Health and Primary Care) 3:24 pm, 26th October 2021

It is a pleasure to serve under your chairmanship, Mr Robertson, and I am grateful to Joy Morrissey for securing this debate. She gave a good summary of the issue and I am grateful for her personal testimony. I think all our communities have experienced different levels of satisfaction or otherwise with GP services.

Let me start by paying tribute to the work done by GPs and primary care staff, who, along with their colleagues throughout the NHS, have performed admirably and heroically throughout the pandemic. It would be completely wrong for anyone to claim otherwise. Incidents of harassment of GPs and medical staff—such as the Watford incident, where staff were locked into a consulting room until they agreed to carry out a face-to-face consultation, and an attack in Manchester that left a GP with a fractured skull and other staff with deep lacerations—are unacceptable and should be condemned. I trust that the Minister and every MP will join me in that condemnation.

I cannot help but fear, however, that the UK Government’s harmful rhetoric, including their threat to shame GPs for not returning to face-to-face appointments, may have played a part in such shameful behaviour. The Government must support GPs and not threaten and shame them. While the pandemic remains, it is safer for medical staff and patients to continue hybrid screening and appointments—I stress hybrid. Forcing face-to-face appointments too soon is unsafe and may harm patient care.

For many patients, the choice of using e-health and telehealth solutions to contact their GPs initially has been convenient, but clearly it is not appropriate for all. Some individuals and certain conditions would benefit from a face-to-face appointment and it is important that we get that balance right. However, forcing an immediate return to face-to-face appointments will not necessarily benefit the patients and it may harm efficiency of care.

GPs in England have overwhelmingly rejected the DHSC England plan for forced face-to-face appointments, with more than 90% saying they would increase workload and therefore decrease the amount of time caring for patients. The Royal College of GPs in Scotland said last month:

“We believe that there is a key role in modern general practice for remote consultations and would oppose any moves to deny patients this option of accessing care by reinstating pre-pandemic ways of working”.

It went on to say:

“Instead of arbitrary targets which we feel would not benefit either patients or the wider health service, we need to see concerted and urgent action in a range of areas that would improve general practice and ultimately the standards of care that patients that receive … Key to this is the need for credible workforce planning to ensure that we have an appropriately staffed service”.

That is an absolutely fundamental point. It may be worth mentioning that GP training recruitment in Scotland this year has been the most successful year of any of the last five, with 99% of GP training posts filled so far and with one recruitment round remaining. Already Scotland has a record number of GPs, with more per 100,000 of the population than the rest of the UK. We are on track to increase that number by a further 800 posts by the end of 2027. For comparative purposes, that is currently 94 for every 100,000 people, compared with 76 in England, 75 in Wales and 72 in Northern Ireland.

The BMA said on 15 September:

“Any arbitrary timetables or targets for face-to-face patient consultations would be both unrealistic, demoralising and potentially counterproductive, leaving those desperately in need of appointments waiting even longer”.

I am pleased that the Scottish Government will not be pressuring GPs into unsafe early reopening, just because some politicians and some sections of the press want to insist on it.

In conclusion, the UK Government should match the Scottish Government’s stance and insist on a safety and efficiency-first position, not bow to demands of the right-wing press, which will sacrifice patient and staff safety without providing any benefits to our patients. The key to this issue is getting the balance right in terms of the hybrid approach, which of course requires adequate recruitment levels, which are absolutely fundamental.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Mental Health) 3:29 pm, 26th October 2021

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank all hon. Members for their contributions this afternoon and Joy Morrissey for securing this debate on an extremely important issue as we recover from the pandemic. This issue is close to all our hearts and to the hearts of the people whom we service.

GPs play an essential role in our communities. They are often the first port of call for people accessing a wide variety of health services, and their hard work and dedication to serving their communities ensure that we can always obtain advice, medicine and referral to other services.

When we discuss GPs, it is important to remember that they are more than just nameless public servants doing a job. They do not just serve communities; they are an integral part of them. I myself have had the same GP for my whole life, if people can believe that. I am slightly giving my age away to say that she has been my GP for over 40 years.

GPs are the foundations of our national health service, and without access to them our whole health system would collapse. Chronic illnesses would not be caught in time, mental illnesses would go unchecked and life-saving medication would simply not be prescribed. From our birth to our death, a GP is there for us all, and everyone in this country should have access to their GP.

However, like much of the NHS, GPs are overstretched and under-resourced. Even prior to the pandemic, GP surgeries had to contend with a double hit of fewer doctors in the workforce and a rising ageing population. Demand simply outweighs supply. We need more GPs, pharmacists, physiotherapists and community health workers. But instead of supporting GPs during this challenging time, the Government prefer to blame them, making their jobs even more difficult at the time of greatest pressure for our NHS.

We have looked for virtual solutions so often during this pandemic, and for the most part their effectiveness cannot be disputed. They have allowed our economy to keep going and our public services to continue functioning, and also allowed a small degree of normality in what has been an extremely challenging and turbulent 20 months. I know from my own experience on the A&E frontline, especially early on in the pandemic, that infection protocols and social distancing made many elements of delivering compassionate care very challenging.

Digital solutions have worked well, but we know that they are not appropriate in every setting and they do not work for everyone; we have heard ample example of that today in this debate. However, we need to be careful not to conflate two separate issues. Digital solutions in practices were not just necessary for infection control. The sheer demand for appointments is through the roof. GPs have been offering telephone consultations and online appointments for some time now, even prior to covid. There were 2.2 million more appointments in August this year compared with August 2019. The percentage of appointments being delivered face to face is also rising. That shows that GPs are striving to see as many patients as they can, but to increase that number even further they need more support from the Government.

The Conservatives have promised more GPs in every one of their manifestos since 2015. However, we have approximately 2,000 fewer GPs now than we had in 2015. It seems like a simple fix for Government—deliver on manifesto commitments and expand the GP workforce. That will allow for even more appointments and it will help to reduce the burden on existing staff, leading to less burnout and less fatigue.

The British Medical Association conducted a survey of GPs in July. Half the respondents said that they are currently suffering from depression, anxiety, stress, burnout, emotional distress or other mental health conditions. I repeat—half the respondents said that. That is a huge percentage. Around the same proportion of respondents said they now plan to work fewer hours after the pandemic. When a workforce are supported, their absence rates come down and their productivity goes up; it is pretty basic. Ensuring that staff are supported not only benefits the workforce but the patients, through more effective and timely care. It is a virtuous cycle, which surely even the cynics would support, as it ultimately leads to more patients being seen and better care being provided.

We have heard about the trickle-down effect of not being able to see GPs and the knock-on impact that has on the rest of the NHS. Yet instead of delivering on their manifesto pledges, this Government would rather stoke the flames of division, by attempting to shift the blame to GPs and encouraging local residents to vent their frustrations at them rather than at the Government. The Health and Social Care Secretary has resorted to attempts to name and shame GP practices that were unable to guarantee face-to-face appointments. The Government will then deny additional essential funding to the practices they deem to be performing poorly. That provocation does nothing to improve patient care; it serves only to deflect anger away from the Government and towards the health service. I know from colleagues in GP surgeries across England that it has already resulted in abuse both online and in person. That leaves so many practitioners considering their career choices, and will lead only to further shortages in future.

Fundamentally, the Government need to make good on their manifesto pledge of an additional 6,000 GPs. Without that, there will be a detrimental impact on the workforce and, crucially, on patient care. That has a knock-on impact on how much time GPs are able to spend with patients. Patients are understandably frustrated, as the backlog of care due to covid continues to pile up, with a knock-on impact on waiting times throughout the NHS. At a time when case numbers are soaring again and the booster programme is faltering due to Government inaction, people are anxious about their health and the health of their local community.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Mental Health)

No; I want to make some progress. The imminent arrival of winter is also a great cause for concern. Winter is always an extremely challenging time for the health service. GPs will be the first point of contact for the majority suffering from winter respiratory illnesses. However, GP surgeries cannot be blamed for being unable to fill vacancies as a result of wider workforce and funding issues. It is simply not acceptable. The Government are purposefully turning communities against one another, risking the health and wellbeing of patients and staff simply because they are unwilling to put forward a sustainable plan to support GPs to manage their workloads. GPs’ needs and patients’ needs are one and the same. It is a failure of Government that has led us here.

Photo of Chris Green Chris Green Conservative, Bolton West

The Labour party voted against compulsory vaccination in the care setting, presumably because they sensed that it would have an impact on carers and their ability to carry on in the sector. Does the hon. Lady think that it would also have an impact on the NHS, with perhaps up to 100,000 people leaving, and GP surgeries?

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Mental Health)

That is beyond the scope of this debate, but I am very happy to have a discussion with the hon. Gentleman afterwards. I do not believe it is appropriate to mandate vaccinations for NHS staff, forcing them to leave their jobs if they do not accept vaccination, as I put forward in the Labour party’s position on the care sector.

Let us be clear: GPs are being scapegoated for a failure of this Government to act and put people’s health first. The war against GPs that is being propagated by the Government does nothing to serve patient needs or to serve GPs, who are exhausted and unable to fulfil the commitments that they trained hard to carry out, because of a failure of this Government. I see that the hon. Gentleman feels rather pleased with himself for his intervention on me. Forcing people to have vaccinations in the communities that have been hardest hit, for whom trust has been completed eroded by this Government, does nothing to serve our collective aim, which is to ensure that the communities that we all serve have the treatment that they need and timely and respectful surgeries and appointments. That is the very thing that will keep our communities alive and well this winter.

Will the Minister, whom I welcome to her place, please outline what steps the Government will take to tackle the workforce shortages in GP surgeries? Will she outline what resources will be provided to ease the intense workload that GPs are already contending with? Will she outline why additional funding is all directed to secondary care, while our primary services are left to crumble?

I thank all the GPs out there serving our communities. I hope that the Government have listened to our points on the support that GPs, patients and communities need.

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care 3:40 pm, 26th October 2021

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank Joy Morrissey for bringing forward the debate. As we have heard from MPs from across the political parties, their postbags show that this is a big issue from the perspective both of constituents, who are trying to access appointments, and of GPs, who are reaching out to their local MPs to highlight the pressures and difficulties that they have faced recently.

I want to start off by thanking general practice teams and GPs in particular. It is disappointing to hear what the shadow Minister, Dr Allin-Khan, had to say. There is no war on GPs. We are all in this together, including GPs, reception staff and nurses. On 14 October the Secretary of State announced a GP support package precisely to support GPs in supporting their patients. We have been listening long and hard to the difficulties faced in primary care. The range of measures I will talk about are there to help GPs as much as patients. If we do not support GPs, the patients will struggle.

I wish to put on the record my thanks to all in general practice during the pandemic. They have gone above and beyond—and often under the radar—by continuing to see patients during the crisis. They have also helped support and in many cases run vaccination programmes in their local areas, and have been a key factor in supporting community teams to help patients be discharged from hospital more quickly and to prevent readmission. That was key during the crisis. Without their hard work and dedication, much of that would not have happened.

There is, however, an issue. We all know that there are problems with accessing GP appointments, but there is also some good news. My hon. Friend Simon Fell described the situation perfectly when he called it a perfect storm. So many patients did not come forward during the pandemic, as advised in the main, and many issues, symptoms, conditions and worries are now coming to the fore. The pent-up demand is such that GPs are overwhelmed by the number of people who now need to be seen, often with symptoms and conditions that are far worse than if they had been able to come forward at an earlier stage.

The physical set-up of many GP practices—infection control measures had to be put in place to protect GPs and their staff and patients—means that they have struggled to see patients. My hon. Friend James Sunderland asked about those measures. They have been relaxed: social distancing has been reduced from 2 metres to 1 metre. Face masks are still required, but it is now safer for GPs to open their doors and get more patients into their waiting and consulting rooms. Some infection control measures have been relaxed and we should see an improvement.

Appointment numbers are returning to pre-pandemic levels. In August the average number of general practice appointments per working day was 1.14 million, which represented a 2.2% increase on August 2019. As GPs will tell us, they are seeing more patients. The proportion of face-to-face appointments is also increasing. Since August, nearly 60% of appointments have been face to face. That shows that things are starting to return to pre-pandemic levels, but the sheer scale of people who now need to be seen means that it often does not feel like that for patients.

I will give my hon. Friend the Member for Beaconsfield some specific figures for Buckinghamshire. In August, practices arranged a total of more than 200,000 appointments with patients, which is an increase of more than 3,000 from August 2019. In addition, practices in Buckinghamshire helped deliver more than 786,000 vaccines. I take her point that there are specific issues with certain practices that are struggling. My advice to her—and I am happy to meet her and discuss this more fully—is to try to broker a meeting between the GPs and the clinical commissioning group, because often additional support can be given locally to those practices that are really struggling. Sometimes GPs are so overwhelmed that they do not have the space to ask for help and support, even though that is what they need.

Many colleagues, including my hon. Friends the Members for Bolton West (Chris Green), for Beaconsfield and for Barrow and Furness, have raised the issue of telephone access. Much of the problem that patients face is that they cannot get through in the first place, whether that is to make a face-to-face appointment, have a telephone consultation or make a virtual appointment. That is an issue. GPs have historically devised their own telephone systems. They may have gone in with primary care networks or the CCG, and many have their own set-up. Given the sheer scale of the numbers, there is a real issue in having two or three receptionists tackle 300 or 400 calls on a Monday morning, most of which will be complex calls rather than quick, five-minute calls to book an appointment.

That is why part of the GP support package that the Secretary of State announced on 14 October will provide telephone support through a cloud-based system, which will do a number of things. First, it will increase capacity so that patients can get through much quicker. Secondly, it will provide an automated queuing system. I know from my own constituency that patients can be 29th in the queue and have to wait for a long time, so providing that extra capacity will take the pressure off GPs. It will also provide an insight into how much admin support GPs actually need. That valuable data will allow us to provide them with support for the long term.

There are a number of other measures in the GP support package and we are working hard on this matter. There is a £250 million winter access package, aimed at helping GPs open up their surgeries for more face-to-face appointments because this is not an either/or situation. Many Members, including the hon. Member for Batley and Spen (Kim Leadbeater), pointed out that many patients like telephone consultations and the virtual appointments, and we are not going back to pre-pandemic face-to-face-only appointments. We need to embrace the changes that technology has brought. It is far more beneficial for busy people who are working or juggling childcare to be able to speak to a GP rather than have to trundle down to the surgery, but there is a place for face-to-face appointments as well.

The access package of £250 million can be used in a number of ways by GP practices. It can be used to take on locum staff if they are available, to take on other healthcare professionals to see patients, to extend opening times, or even to change the layout of a surgery so that it can accommodate more patients. It is for local commissioners and GPs to decide how they would like to use that fund.

There are also significant moves to reduce bureaucracy for GPs. They are often the only people who can sign fit notes or Driver and Vehicle Licensing Agency requests. As has been said, there are other healthcare professionals who are equally qualified to do that. Some of it may need legislative changes, which we are working at pace to introduce, but we want to take that bureaucratic burden off GPs so that they are free to see patients when they need to.

There are also a number of other measures in terms of increasing the general practice workforce. As the hon. Member for Barrow and Furness said, communications is a crucial point because it is not always the GP that patients will see in face-to-face appointments. They might see a nurse, a pharmacist or a physio. We need to get that message out at a general practice level, but also at a national level.

Photo of Chris Green Chris Green Conservative, Bolton West

On compulsory vaccinations in the care sector, I have concerns about compulsory vaccination on the NHS sector. Would the Minister do what she can to ensure that there is an impact assessment before this is done on the NHS, if it is done in the future?

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care

My hon. Friend is certainly persistent in his questioning on that issue. It is a decision for the Secretary of State, who is looking at such factors. The vast majority of NHS staff have been vaccinated, for their own protection as much as anything else. I want to highlight that we are increasing the number of primary healthcare professionals across the board, aiming to replicate the model used in hospitals, where a consultant leads a team of multi-disciplinary professionals who will help see a patient and are, sometimes, more expert in dealing with certain clinical situation than GPs themselves.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

I have had GPs talk to me, somewhat frustratedly, about not having sufficient GPs in their surgery and having physician associates who do not have the same level of training. There is a concern that this is a backing-away from the Government’s commitment of 6,000 extra GPs. Could the Minister confirm whether the Government are still committed to 6,000 extra fully qualified, trained GPs?

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care

We are committed to increasing GP numbers, as in our manifesto commitment. However, that does not stop us increasing the numbers of other healthcare professionals. We need to get the message out to patients that seeing a nurse, physio or paramedic at the GP surgery is not second best. These are highly qualified, experienced and educated professionals who often are better placed—though I do not want to upset the shadow Minister—to see a patient than a doctor. They can make a considerable difference, but very often patients feel they are being fobbed off or seeing the second best. We need to do a lot of work to reassure patients on that.

We have already recruited 10,000 of the additional 26,000 staff we stated in our manifesto would be working in general practice by the end of 2023-24. We are strengthening our plans to increase the number of doctors in general practice. To reassure Members, so far we have filled a record number of GP speciality training places this year, with the latest data showing that there are already 1,200 more full-time equivalent doctors in general practice than two years ago. It is a challenge; I am not going to say it is not, but we are making progress.

I feel particularly passionate about the use of community pharmacists. In many other countries, the pharmacist is the first port of call for minor ailments. They are highly qualified professionals with over five years of clinical training who are able to assist patients. Over 800 practices have already signed up to participate in the community pharmacist consultation service, which enables patients to see a pharmacist, on the same day in many cases, to deal with minor conditions. That will not only help patients, but it will free GPs up to see the patients that really need to see them for clinical conditions.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport)

Will the Minister also ensure that the funding goes into community pharmacies in the right way if they are to be utilised? Likewise, with the voluntary sector involved in providing support for people through different forms of wider health support, will she ensure that it too gets proper funding?

Photo of Maria Caulfield Maria Caulfield The Parliamentary Under-Secretary for Health and Social Care

I thank the hon. Lady. The spending review tomorrow may have further updates on that, so I will not comment on the funding for now. NHS England and the Department of Health and Social Care have asked the Royal College of General Practitioners to provide GPs with more guidance on how to blend face-to-face with virtual appointments. We do need a mix of both going forward, and the comms, as has been said so much this afternoon, will make a difference, so that patients know where to go, what is available and who they can see for their particular condition.

The issue of abuse has featured heavily this afternoon. The hon. Members for Batley and Spen and for Linlithgow and East Falkirk (Martyn Day), my hon. Friend Peter Aldous and others have mentioned the impact of abuse. When patients have been waiting a long time to see a GP, cannot get through on the phone and are feeling unwell in very distressing situations, they often take it out on practice staff. It is unacceptable, and we all have a role in this place to say that we have zero tolerance for that.

We know as MPs what it is like to face a torrent of abuse. If it is not acceptable for us, it is certainly not acceptable for them. My message to general practice staff is that we are four-square behind them on this and will support them. As part of the winter support package, there is £5 million to facilitate extra security, be that CCTV, extra screens or door entry systems—whatever practices feel will make their staff more secure, that funding is available to them. That is not the only solution, and they should not face abuse in the first place, but we are taking it extremely seriously.

In the few minutes that I have left, I want to say that there are two main issues here. There is the short-term covid issue, which has seen a tsunami of patients whom we need to support as we come out of the covid period. There is the £250 million winter package, and there is support around opening up community pharmacies and enabling other healthcare professionals to see patients, which will take some of the bureaucracy away from GPs while we support them to get through the period. However, there are some longer-term solutions as well. General practice and primary care were creaking before covid, and we need to ensure that they are supported in the long term going forward.

I thank my hon. Friend the Member for Beaconsfield for securing this afternoon’s debate. She has raised some really important points. On Thursday, I am holding a cross-party call for MPs to raise some of their constituency GP issues. I urge them to feed back to me as the Minister where it is working well, because there are some brilliant examples out there. Where it is not working so well, it is not the fault of GPs. There are some fundamental solutions that we can help them with, but it is important that we hear about the problems so that we can support them. If Members have specific issues from their constituencies, they should join the call. We are hoping to hold such calls on a regular basis, if that is needed by colleagues, and I am keen to work with everyone across the House to support general practice, because that is the only way we will support patients in the end.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield 3:56 pm, 26th October 2021

I thank hon. Members from across the House for their contributions. I thank the Minister for a very nuanced and positive response, and for taking so much time to explain the measures that the Government are taking. I think many of the GPs in my constituency would welcome those things. GPs need additional support and have perhaps not been able to ask for it because they are so overwhelmed with the backlog, so it is a wonderful and really positive step. I look forward to bringing more constituency issues directly to the Minister, and I thank her for opening up that pathway. Many of my constituents have never contacted their Member of Parliament before, and they just felt desperate. I know that many GPs are doing all that they can, but having additional support from the Government is very welcome indeed.

Question put and agreed to.

Resolved,

That this House
has considered GP appointment availability.

Sitting suspended.