GPs: Continuity of Care

1. Whether he supports the continuity of care and long-term relationship between a GP and their patients.

The recent Health and Social Care Committee report rightly highlights the importance of continuity of care, recognising that there is sometimes a trade-off between speed of access and continuity of care.

I welcome my right hon. Friend back to the Front Bench in this position; it is great to see him there. Investigations in the United States and in Australia show that if there is a close relationship between a patient and one specific general practitioner, the outcomes are better in terms of both morbidity and visits to A&E. What can the Government do to encourage that practice, and what is the Government’s view of that practice?

My hon. Friend raises an important point. If one looks at the GP survey of patients, around two in five have a GP that they would like to have continuity of care with, and more than one third of those say that they see them a lot of the time or always. It is more pertinent with complex cases, where that continuity of care adds most value, as opposed to patients who want speed of access on an isolated incident.

We have seen a cut of almost 5,000 GPs and the closure of hundreds of practices in the past 10 years. My constituents are having a terrible time trying to get GP appointments and, when they do, the lack of continuity of care is impacting the effectiveness of that care; it is a strain to tell the same story again and again, particularly for older people and those with complex conditions. Can the Secretary of State outline what he is actually going to do about it?

In fact, around 80,000 more GP appointments a day are happening, so significantly more demand is being met. The Government have invested an extra £1.5 billion to create an additional 50 million general practice appointments by 2024, increasing and diversifying the staff available for those patients seeking care.

One way GPs can get better outcomes for their patients is to see them face to face if possible, particularly with prostate cancer in men. Men just do not present themselves to their GP as often as they should. Today is 1 November—Movember—so what is the Secretary of State going to do to promote men’s coming forward to see their GPs so that we can get this disease eradicated?

First, I pay tribute to the work my right hon. Friend is doing to raise awareness of this issue. It is important that those patients who want access to face-to-face appointments are able to get them, and campaigns such as Movember are a great way of raising that awareness.

In Cumbria we have lost one in six of our GPs in the past six years, most recently at the Central Lakes medical practice in Ambleside and Hawkshead. Will the Secretary of State pay special attention to the letting of that new contract to ensure that there is a GP service running out of the surgeries in Ambleside and Hawkshead? Will he also give thought to the fact that the Government’s removal of the minimum practice income guarantee has cost many rural surgeries their ability to be sustainable, and consider bringing back a sustainable small surgeries fund so that small rural surgeries can stay open?

As a rural MP and having worked in Kendal earlier in my career, I know the geography to which the hon. Gentleman refers. That is why we are investing in more GP training, increasing the number from 2,671 in 2014 to 4,000, but it is also why we introduced the payment of £20,000, to encourage GPs into those areas that are hard to recruit in.

The new Secretary of State—it is great to see him back—understands that there is a wealth of evidence that higher levels of continuity of care in general practice are good for patients and, indeed, for GPs themselves. I wonder if I could press him a little further. Is the new ministerial team open to limiting the list size of patients a GP has, as more GPs come online through the Government’s plans? Would he like to see personal lists reimplemented in the GP contract during his tenure?

Alongside the Government, no one wants to see better patient outcomes more than GPs themselves. By their training, they are evidence-led, so I look forward to discussing with the GP workforce how we can work together in a constructive spirit to deliver on whatever the evidence is showing. As I said, there is a body of evidence around continuity of care, but it is more weighted towards those with more complex needs, and not every patient prioritises that in terms of access to their GP.

The Health and Social Care Committee report showed that continuity of care was best for patient safety, which is so important, but in order to deliver that, there needs to be some headroom at practice level to bring about a reorientation of local services. How will the Secretary of State create that headroom, and will he adopt the report’s findings in full?

I know that the hon. Lady has a lot of expertise in this area, and she raises a valid and important point. That is why, through the GP contract framework for 2020-21, we announced a number of new national retention schemes and continued support for existing schemes to retain more GPs. It is also why, at the other end, we are boosting training numbers, to get more GPs into the pipeline.

The Secretary of State says they are investing in GPs, but this Conservative Government have cut 4,700 GPs in the last decade. Patients are finding it impossible to get a GP appointment in the manner in which they want one. Seeing the same doctor for each appointment means better care for patients, but under the Tories, that is becoming rarer and rarer, much like seeing the same Health Secretary at the Dispatch Box. Even his own Chancellor wishes he had done more on the issue of continuity of care, so why is this Secretary of State not matching Labour’s ambition to bring back the family doctor?

First, as I have touched on, the number of GPs in training is up. The number of GP appointments is significantly up, because there is more patient demand, so they are seeing more patients. There is often in this House a real focus on GP appointments, and that is important, but it is about the skills of the primary care workforce as a whole. If one looks, for example, at the women’s health strategy, women want to be able to go to specialist services, not always requiring the GP. It is about looking at the primary care workforce as a whole, alongside the appointment of GPs.