I beg to move,
That this House has considered access to GPs and primary care in North East Bedfordshire.
It is a pleasure to serve under your chairmanship, Mr Betts, and to welcome the Minister to her place. The reasons for this debate are, in essence, two of the main commitments that I made when standing for election in 2019: to promote access to local services; and to maintain the rural character of North East Bedfordshire, in the light of high levels of persistent housing development stretching back over a number of years. Those issues are related, but each of them also has certain distinct resolutions.
What has informed me, in calling for the debate, is that over the past six months I have spent a considerable amount of time speaking to GPs and primary care staff across my constituency. I have listened to their points of view and analysed information from their practices. I commend the work of our GPs and their staff, most particularly in the period through covid. I will touch on some of my concerns about how GPs were feeling and about morale over that period when I talk a bit about the responses I have had from constituents in my email inbox.
The debate is also informed by previous debates about the impact of development and of population on access to health services, such as GPs and dentists, although the latter are not my primary focus today—I have participated in debates led by my hon. Friends the Members for Waveney (Peter Aldous) and for South West Bedfordshire (Andrew Selous). My inbox, however, has been full of emails from constituents on the issue of access to GPs.
This will be known to the Minister, but I always think it is useful for Ministers to hear directly from constituents, so I will briefly quote three of mine. One wrote:
“My wife is 75 and in acute pain. She can barely walk. Several days last week and yesterday she has been attempting to see a GP…she phones at 8 am and eventually gets through some 2 hours later. She is then told there are no appointments remaining that day!, and that she should phone the next day at 8 am to try again. This same pattern is repeated day after day. Hours and hours spent listening to a recorded message with zero result.”
Another constituent wrote:
“I am writing to you about the absolute terrible Healthcare Centre… I’ve phoned the surgery 3 times last week to be told they have no appointments…this is disgraceful. I rang again today to be told no appointments available again today and to phone 111. Apparently they have to hold appointments for 111 to allocate. The lady from 111…told me to go to A&E to sit there for hours on end to see a doctor”.
The third constituent wrote:
“I have tried phoning the practice at 8 am as told to in order to arrange a telephone conversation. For about 50 minutes the dialling tone cut off with a message saying the line was overloaded. Thus, redialling over and over again was necessary (not something it is pleasant to do when feeling unwell). Eventually you may get through to be told you are in a queue. When you finally get through to a receptionist you are told that GPs are only taking emergency calls. When querying what I should do now, I was told to try again tomorrow at 8 am.”
Such issues are, to a certain extent, part of the recovery from covid and of the post-covid period, but they also highlight issues of concern more generally. The Minister must recognise the irritation of my constituents at the requirement to repeat and repeat a process in order to do something as simple as seeing someone in primary care for their health needs. Further irritation comes from the pressure on the ability to find an appointment within a reasonable amount of time.
That also has a significant impact on the morale of staff in GP practices. Given people’s problems getting through, they are naturally at a rather heightened level of irritation, and that has often spilled over into abuse of staff. The Minister will agree that there is never a rationale or reason for any of us to be abusive towards staff who are trying to do their best.
I will share with the Minister some data on my area. As of April 2021, the patient-to-GP ratio of my clinical commissioning group area, which covers Bedfordshire, Luton and Milton Keynes, was ranked eighth highest of 106 clinical commissioning groups, with 2,169 patients per GP, against last year’s average of 1,772 patients per GP. I have looked at the data running back to 2014—I am grateful to the local medical council for helping me with it. From 2014 to 2022, the list size for GPs in my constituency—a subset of the clinical commissioning group area—grew by 13%, compared with national growth of 8%, so it is growing considerably faster than in other areas of the country.
Let us look now at personnel. For the same period of 2014 to 2022, the total headcount of qualified GPs grew by 2.1% nationally but fell by 2.2% in North East Bedfordshire. Over that eight-year period, the number of GP partners fell by more than a quarter. Those staffing numbers are troubling. The CCG area has 2,169 patients per GP, but for practices that serve my constituents the number is 2,482 patients per GP— up 28% in eight years. I point out to the Minister that housing growth in my constituency is already three times the national average. That problem will not go away, and nor will it stay the same; it is going to get worse.
I will go through some specific findings from my discussions with GPs. The first is fairly obvious: GPs—and I and my constituents—think that primary care in North East Bedfordshire is under severe strain. One GP told me:
“The vulnerability of the service provided by GPs in my area was off the scale large”.
I believe that my constituency is actually a test case for our Conservative manifesto commitment to infrastructure first. I will raise some points about that in a minute.
In my view, and in the view of the GPs with whom I have spoken, remuneration systems provide insufficient incentives for GP partners to take on additional responsibilities. If we wish to stem the decline in GP partners, the Government have to show by words, actions and remuneration that they value the additional work that partners take on to enable broader provision of primary care in their local practices. More generally, pay systems provide more reward, rather than less, for GPs who pick and choose their hours rather than work full time. On the issue of locums versus salaried GPs versus partners, what is the Government’s strategy and what is their preference? My view is that the partner model has worked well historically and is the best model for the future, and even if the Minister agrees, there should be some substantial changes to how the remuneration systems work.
The NHS provides practices with payments based on hitting specific targets set at a national level, or sometimes a local level, such as the qualities and outcomes framework and the investment and impact fund. I hear that some of those targets can be onerous and the benefit is outweighed by the bureaucratic cost of achieving them. I worry that there is a tendency to prioritise bureaucratic target setting and undermine the professionalism, integrity and insight of GPs. We have to recognise that GP partners are some of the best qualified people in the country. To drive them to little target boxes that they have to check is in some ways a little bit demeaning to what a GP thinks is best for their patient. I can see that there is a need, but I think that perhaps the Government are overdoing the balance, towards bureaucracy.
This is perhaps a very minor point, but to me it sounds quite significant if it is true. I was intrigued when I learnt that GPs cannot create a corporate shield against personal liability when they wish to become a leaseholder of property. Normally, if someone is in business, for example, and they are a director or chief executive, their personal liability is not put on the line for a lease that they sign. I was given this impression, and perhaps the Minister can write to me with an answer to this question: is it right that there is no personal liability shield on this issue? That seems to me an unnecessary disincentive to becoming a GP partner.
Increasing the pathways to contact GPs is significantly under way. These range from face-to-face consultations, to e-consultations, to phone consultations. This is currently adding to the frustrations both of my constituents and of some of my local GPs, but there are signs and reasons for hope that the change can be for the better. Some constituents greatly prefer the opportunity to have a phone consultation. Although 50% of phone consultations require a face-to-face follow-up, 50% do not. That creates opportunities for scale economies in telemedicine. One practice that tracks those changes very carefully has been positively encouraged by the reduction in missed appointments for face-to-face consultation, which is a real saving of GP time. I would encourage the Minister to pursue further those efforts for new pathways but to recognise that there will be teething problems as we broaden things out.
Similarly, the broadening out of clinical roles—particularly those of paramedics, nursing roles and other direct patient care positions—in primary care is generally welcomed by GPs, but they would make the point, and I make it to the Minister, that there remains patient resistance to seeing someone other than “my GP”, even if seeing them is not required, and that it can remain a bottleneck. Also, that will not be a full answer to the issue of GP access, even in the long term.
I also heard that the relationship between primary care and secondary care has become a little fraught post covid. I am not sure that it has always been the most harmonious, if I am being honest. But will the Minister look or has she looked at the additional roles that GPs took on during covid to relieve pressure on hospitals, to see whether the balance is right and whether the remuneration is still right or whether there needs to be some clarification on those roles?
Similarly, there is the issue of the relationship between GPs and pharmacies, specifically as regards regulatory intrusion on efficient communication and simple processes such as the issuing of prescriptions. I know that the Minister and Government are looking at that, but it seems to me, from what I have heard, that more progress can be made. That could have significant benefit in broadening the ways in which people can access primary care.
Customer service attitudes and procedures, particularly post covid, created widely different outcomes between practices. This was one of my two most significant findings. It really matters how the practice manager and the receptionist interact with the patients when they arrive or when they get through on the phone. It is interesting how some practices have done a fantastic job and some have fallen short—there is such a wide variety. I wondered whether there was training and protocols about that human interaction, to ensure that standards were kept up. A similar thing—this is the other thing that is most important—is phone systems. Who would have thought that a GP’s choice of phone system would be a critical factor in patient satisfaction with the service that they get? In my own constituency, there is one particular practice whose choice of system A rather than system B has created for it an enormously larger problem with its patients than other practices have.
The rate of population growth in North East Bedfordshire has been so high for so long, and I am afraid to report that I believe that the NHS has failed to keep pace with regard to the modernisation of premises, particularly ones that bring individual practices together. This will be my final and key point as part of my asks of the Minister. The slow pace of NHS performance has been further frustrated by inefficiencies of section 106 and community infrastructure levy payments. That is most vividly highlighted in my constituency by the plans for a new surgery to serve the villages of Biddenham and Bromham. The land was promised years ago, all the houses have been built and yet the building of the new practice has not begun. That is a crucial “infrastructure first” test case for the future.
North East Bedfordshire is already near to the top of ratios, and population growth at three times the national average means that, without action, the situation will get worse. I ask the Department to look at North East Bedfordshire as a test case for our manifesto commitment on “infrastructure first”; to go back over the past eight years, to identify lessons learned from the inability to keep pace in personnel, processes and facilities; and to map out what could have been done and what could now be done to improve the situation. I am asking for a specific test for my constituency for that historical analysis, and I hope the Minister will agree to that today.
Practically speaking, I also ask the Minister to get her Department to look at unblocking the jam on the hospital site in Biggleswade. It appears that Treasury restrictions, which are legitimate but causing a problem here, are blocking the transfer of facilities so that it can provide GP services in one of the fastest growing towns in my constituency. I have spoken with Central Bedfordshire Council, which is willing to fund the rebuild, but it needs more reassurance and flexibility on long-term use. Will the Minister please talk with her Treasury colleagues to enable progress, as that would be a vital element in relieving the strain?
There are similar issues at Great Barford surgery, which is still located in cramped facilities. Right across the road there is an available facility, which everyone knows is the right one and has been talked about for years. I ask the Minister to look at that issue and see whether it has to be resolved locally, between the council and the local clinical commissioning group, or whether the Department can assist. In closing, I am grateful to our GPs, who have worked, sometimes with hostility from their patients, exceptionally hard in my constituency in difficult circumstances. I am very grateful to them and their staff.