GP Services — House of Commons, 2015-02-05
Topic: Health
Caroline Lucas (Green Party, Left): I very much agree with the hon. Gentleman and thank him for his intervention. Locums are costly and break up the continuity that so many GPs say is vital to being able to provide a good service to their patients The Nuffield Trust points out that in October the proportion of GP training places left vacant rose to an historic high of one in eight. NHS England has recently made efforts to make the sector more attractive, but it faces a difficult job with an underfunded, creaking primary care service beset by constant reorganisation and the kinds of fragmentation I mentioned earlier. The Royal College of General Practitioners estimates that about 543 practices in England could face closure in the coming years as GPs retire. Hundreds of thousands of patients could be forced to seek care from other overstretched surgeries, and there is a danger that this could put even more pressure on our hospitals. That exact scenario played out recently in Brighton, with what looked like the imminent closure of Eaton Place surgery in my constituency. That would have left 5,600 patients in limbo and put serious pressure on neighbouring practices. At the very last moment a solution was found, but not before many patients had been seriously worried about the future of the surgery and had started queuing to join other surgeries further afield There are serious questions to be asked about what we ask of our general practitioners and the burdens we place on them that are not directly related to patient care. Family doctors want to get to know their patients and to treat them. When I speak to GPs, the message that comes through loud and clear is that continuity is key for doctors and patients. It allows doctors to be more efficient and to get admissions to hospital right. One GP told me that doctors may be more likely to admit patients unnecessarily if they do not know them terribly well, because they do not know what their family or community support might be or how best to judge how great their needs are. On the other hand, the GP who knows their patients well is more likely to spot the early signs of psychosis in a patient who has previously never presented with mental health problems, enabling them to be admitted to hospital sooner rather than later before they have a major episode that puts them at risk. The Health and Social Care Act 2012 has mitigated against GPs having the time to get to know their patients. New research from the Nuffield Trust and the King’s Fund finds there has been a significant drop, from 19% in 2013 to 12% in 2014, in the numbers of GPs who report being highly engaged in the work of their CCGs. GPs do not have the time to invest in the new structure and there are now fears that the CCGs could become unsustainable. Ministers should be seriously considering how to lift unnecessary burdens from GPs instead of adding to them, so that doctors can spend their time on patient care. With more resources, general practice can keep more people out of hospital I pay tribute to the innovative work on well-being that can take place when doctors have sufficient time to see their patients properly. That could genuinely transform lives. For example, in my constituency a GP told me how, after getting to know her patient well, she prescribed a dog to a man who was depressed after a heart attack. That might sound funny, but it was a simple solution that worked: it was more sustainable, made him much less socially isolated and provided him with regular exercise. Another example of innovative work in my constituency is the homeless health care project. It is incredibly impressive. It works solely with homeless people and people in insecure accommodation—for example, people in hostels or who do not have a permanent address—but it needs a more flexible funding formula to extend its groundbreaking work That kind of work captures where the health service needs to be going. The current system was designed for acute infectious diseases, which were a 20th century phenomenon. The current phenomenon is of chronic, complex, multi-morbidities with poly-pharmacy. The trusted family doctor who can spend time with an elderly patient with three long-term conditions and 12 different medications and who brings his wife in to discuss his care is not only providing a good, thorough and caring service, but saving the NHS money; helping to make it more sustainable; preventing the crisis by focusing on their physical, psychological and social needs; and treating them as a family and members of the community The local GP who gave me that example is meant to have that elderly couple dealt with and written up in her notes in fewer than 15 minutes—and she is lucky because most GPs are given only 10 minutes. Her practice decided that 15-minute appointments were more efficient, because allowing more time kept more people well, but the system will not cope if there are not enough hours in the day and not enough GPs doing that work. The kindness that is shown by giving longer appointments to prevent the elderly man and his wife from having to come back another time to discuss the different chronic conditions comes out of lunch breaks and evenings. The part-time GPs with kids give a lot in this system, and they are not going to stay if things do not get better I want to reiterate the importance of celebrating what happens in our NHS today, in spite of the conditions faced by some people. It is essential that we increase GP funding.