GP Appointment Availability

[Mr Laurence Robertson in the Chair]

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.

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 refer to 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.”

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. This 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.

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, 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 number 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 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. I know we have an ageing population, and that GPs are under huge pressure and strain, but I believe there is a way we can work together to find a solution.

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?

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. A wide range of healthcare professionals 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 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 saw 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 needed them.

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 from the one who is in Westminster Hall today. One question was about the fact that this discharge-to-assess approach has been going on under the Coronavirus Act 2020; 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. Lady is talking about a particular relative. The idea that somebody with dementia, or early-stage dementia that has not been fully diagnosed, 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 gave us an idea of 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 wonder whether she would like to comment on it.

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

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 (Margaret Greenwood) 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.

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. That 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?

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.

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 when there is a lack of that.

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.

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

It is a pleasure to serve with you in the Chair, Mr Robertson. I thank the hon. Member for Beaconsfield (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.