NHS: Shortage of GPs and Nurses

Private Notice Question

Tabled by

To ask Her Majesty’s Government what is their response to recent reports that there is a serious shortage of GPs and nurses working in the NHS.

My Lords, I beg leave to ask a Question of which I have given private notice.

My Lords, the Government recognise the pressure on the NHS workforce. The forthcoming NHS people plan will set out how we will attract more people into training and keep the workforce that we have in the NHS. In 2018, Health Education England recruited a record 3,473 junior doctors into GP specialty training—a 10% increase since 2017. Demand for nursing courses is strong: the latest data, published this February, showed a 4.5% increase in the number of applicants compared with 2018.

My Lords, I thank the Minister for her Answer and acknowledge her long-term commitment to the National Health Service. I shall not just swap statistics with her—that is easy—but I wish the Government would not keep repeating basic statistics. She talked about an increase in the number of GPs, but we have the lowest number of GPs for more than 50 years, with patients on occasion having to wait seven weeks for an appointment. We know that there is a 40,000 shortage in the number of nurses and that, according to the interim report that the Government have received and despite all their efforts, that figure could increase to 68,500. That report states that shortages in nursing are the single biggest and most urgent problem. Instead of playing around, will the Government seriously address the drastic situation that our NHS is in? We truly survive because of the efforts of the staff.

I thank the noble Lord for his Question and I echo his sentiments exactly in thanking GPs, nurses and all of our NHS workforce. Probably every noble Lord in this Chamber has a personal story of owing the NHS for personal service, as we do as a nation. That is exactly why the Government have put in a serious plan to address the challenges within the workforce. First, within the long-term plan we identified an increase in funding that is higher within general practice and community care than the wider increase in funding of £4.5 billion. Secondly, we have recruited the highest number of GP trainees ever. This is not swapping statistics, this is identifying the fact that we are being successful in recruiting into a challenging specialty. Thirdly, we are opening brand new medical schools to ensure that we have the capacity to increase training, while recognising that it takes time to grow a doctor. Fourthly, we are putting in place incentive programmes to make sure that the job is more attractive, so that we can retain those individuals.

Within the new general practice contract framework we have put funding in place for up to 20,000 more support and technical staff working in GP practices in order to relieve the pressure within that job. This will help bring down delays in getting appointments and make sure that the job is more attractive in itself. When it comes to nursing, we have put in place a pipeline, with new nursing associates and the new nursing degree apprenticeship, and we see this starting to pay off. So there is an improving picture, but there is still some way to go. We are making sure that we put in place a serious plan and we are determined to deliver on it.

My Lords, the Nuffield Trust has noted that there are fewer GPs per head in poorer areas than in wealthier areas. Health inequalities in this country are being made worse by some of the political decisions of this Government. Can the Minister say what steps the Government are taking to ensure that everyone has equal access to a GP, whatever their income and wherever they live?

The noble Baroness is right that driving out variation within the NHS is one of the key commitments of the long-term plan: it can be seen as a priority throughout every commitment within it. One of the ways in which we intend to do this is through the new undergraduate medical school places; the expansion in medical schools has been targeted specifically to address that. Those medical schools will be placed in key areas—Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury—to ensure that we recruit doctors from right across the nation. That is something that I think she will welcome.

My Lords, I declare an interest as the author of Medical Generalism, a report for the Royal College of General Practitioners some years ago. Do the Government recognise that while their moves to increase supply are admirable and welcomed by everyone, the problem is retaining staff? We have an increasing number of medical and nursing staff who, for reasons to do with taxation, their pensions and their revalidation processes, find that it is just not worth their while to carry on with the onward, uphill struggle to carry on providing services. I recently met some who have dropped off the medical register simply because the revalidation processes were just too cumbersome for them. These are good clinicians, whose skills are now being lost. Their skills are also being lost from the pool of people to teach the next generation of doctors coming through the system. These pressures are now having a knock-on effect in emergency departments, where waiting lists are going up inexorably, and we know that that is being reflected in the four-hour waiting targets. Talking to staff in emergency departments, they are routinely seeing situations that used to be unusually busy.

I thank the noble Baroness, who is very expert in this area. She is absolutely right that there is no point in our bringing new trainees into the system if we do not retain the expertise and the teaching quality within the system. We can be very proud of the quality we have within the system, which is why we have put in a number of programmes to address this. We have put in a targeted, enhanced recruitment stream to attract doctors into parts of the country where there have been consistent shortages. We have put a broad offer of support for GPs to remain within the NHS, including GP Career Plus, the GP Retention Scheme, the Local GP Retention Fund and the national GP Induction and Refresher Scheme. We have also put in place a number of schemes for nurses, including a scheme that will attract nurses into specific, targeted areas, such as mental health, learning disabilities and district nursing, where we believe we should make the career more attractive. We recognise that there is more to do, and in areas such as pensions, which the noble Baroness rightly raised, we are taking that issue up with the BMA and the Treasury.

My Lords, the increased numbers of staff coming through GP and nurse training are of course incredibly welcome but the truth is that we have a problem now, which is that we need more doctors and nurses practising today. One way to do that is to look around the world to recruit people, but another way is to make sure that we make the most of the resources we have through technology. Can my noble friend tell the House what the department is doing to enable us to use technological solutions to improve the efficiency of the GPs who are practising today?

My noble friend is absolutely right, and he has his own expertise in this area. I am pleased to be able to report that we have had an increase in recruitment of nurses and NHS workers from abroad. Compared with June 2016, we have over 5,200 more EU health and care staff working in the NHS, and we have had a 126% increase in the number of non-EU NHS workers, which shows the attractiveness of working within the NHS. But he is also right that we need to make sure that those who work in the NHS have access to the most innovative and effective tools possible, which is why, particularly within GP practice, we are launching the GP IT Futures programme. That will provide GPs with the best tools possible so that we can make their job more efficient while also allowing them to provide the best-quality care to patients.

My Lords, I think I need to declare an interest as a member of a CCG; I spend some of my time surrounded by GPs, who are utterly wonderful, and who tell me that morale is not good. The problem is that a lot of GPs are leaving because they are completely fed up with the way that they have been treated by the NHS. That has to be taken account of by the noble Baroness, Lady Harding, as part of her work in bringing forward the plan, and I know it will be.

I am afraid that it does not say much about the current lack of a workforce strategy that we are having to trawl the world to get GPs and nurses to come and work in the UK. I know that other Members of your Lordships’ House have been worried that we are taking nurses, GPs and doctors from countries where they are very much needed. Will the Minister address how to deal with the morale of GPs, as well as the ethics of the UK recruiting nurses and doctors from countries where they are needed?

I slightly question the premise of the noble Baroness’s question, given that I am the daughter of an English doctor and a South African nurse. This has always happened in the NHS, and it is an absolutely acceptable process. Recruitments go back and forth between nations, and that has always been the case.

To move on to the noble Baroness’s question about morale in the NHS, particularly within general practice, it is essential that that is addressed, and she is right that GPs are the bedrock of the NHS now and in the future. That is why we have announced in the long-term plan not only that we are investing an extra £4.5 billion in primary and community care, which is at a faster rate than the rest of investment within the NHS, but the new contract to develop partnerships to provide greater certainty for GPs to plan ahead and to give them the extra 20,000 support workers who can make the job within GP practice more effective and sustainable. That is also why we have announced the GP IT Futures programme to give them the tools that they need to deliver more effective services and to deliver better-quality care, and why we have announced targeted and enhanced recruitment schemes to support and retain GPs within practices, not only in hard-to-reach areas but within the pipeline. That demonstrates that the Government are completely committed to general practice and will retain that commitment as long as we are able to do so.