Asked by
To ask His Majesty’s Government what was the net change in the
number of NHS general medical practitioners (GPs) in England,
after taking account of resignations and additional recruits, in
the past three years; and how much improvement in the retention
of GPs they are planning to make as a result of the NHS Long Term
Plan published on 30 June.
(Con)
My Lords, as of September 2023 there are 2,025 more full-time
equivalent doctors in general practice than in September 2020. We
are working with NHS England to increase the general practice
workforce. This includes measures to boost recruitment, address
why doctors leave the profession and encourage them to return to
practice. Last year, a record 4,000 doctors accepted a GP
training place. The long-term workforce plan has committed to
increasing this to 6,000 by 2031-32.
(CB)
I suppose I should thank the Minister for that rather optimistic
reply, but is he aware that the number of patients has increased
by 20% since 2015 while the number of GPs has actually declined?
I can tell him that 464 GP partners were lost last year and that
a quarter of GPs work only part-time. A recent survey by the
Royal College of General Practitioners revealed that 57% of GPs
are now saying they will not be in general practice in five
years. Can the Minister explain how the new long-term workforce
plan will get us anywhere near the number of 6,000 that he
mentioned, when the plan expects a retention figure that will
expand the number of GPs by only 700 by 2036-37?
Noble Lords
Too long!
(CB)
I am coming to the conclusion. Are we not in a situation where
NHS England and the Department of Health and Social Care have
failed and we need some new thinking to sort out the problems of
GPs?
(Con)
My Lords, I take this opportunity to congratulate the noble Lord
on the work he did as a Labour Government Minister between 2003
and 2007. I am grateful for his question. We are incredibly
grateful to GPs and their staff, whose hard work ensured that
more than 32.6 million appointments were carried out until
September 2023, more than two-thirds of which were face to face.
On 30 June, NHS England published the NHS Long Term Workforce
Plan. The plan sets out the steps that the NHS and its partners
need to take to deliver the NHS workforce, including GPs, that
meets the changing needs of the population over the next 15
years. We are working with NHS England to increase the general
practice workforce in England. This includes measures to boost
recruitment, to address the reasons why doctors leave the
profession and to encourage them to return to practice. NHS
England has made a number of retention schemes available to boost
the general practice workforce.
(Con)
My Lords, does my noble friend agree that it is also important to
congratulate GPs and practices that are introducing innovations,
such as weekend working, and their attention to the patients?
They get an awful lot of attacks, but in my view they are in need
of some congratulation as well.
(Con)
I completely agree with my noble friend. The 2022 GP patient
survey showed that 72% of patients reported a good overall
experience at their GP practices. GP practices that innovate tend
to get better results in customer patient satisfaction.
My Lords, how many doctors, including GPs, have come from outside
the UK in the last year for which we have records? What long-term
plan is there to stop us relying on having to bring in doctors
from countries that need them far more than we do because they
are much poorer than here in the UK?
(Con)
The right reverend Prelate the asks an important
question but the recovery plan introduced new measures to support
international medical students, who make up more than half of all
doctors in GP training, so if we were to stop those students
coming over we would be in real trouble ourselves. On his wider
point he is absolutely right, but it is not just GPs and doctors;
it is also healthcare professionals in social services and
elsewhere.
(Lab)
My Lords, I declare an interest as a member of the GMC. On the
increase in training places in medical schools, which is of
course very welcome, does the Minister agree that this will not
come off unless we increase the number of people training the
GPs? Will he arrange for discussions between himself, the GMC,
medical schools and NHS England to ensure that we get enough
people to come in as trainers to enable even the modest workforce
projections that are in the plan for medical schools to be put
into action?
(Con)
I absolutely agree with the noble Lord. If he is inviting me to
do something with that, I will certainly take it back to the
department based on his question.
(LD)
My Lords, among the fastest-growing groups on the doctors
register are so-called specialty and associate specialist doctors
and locally employed doctors. These doctors are not currently
able to work in primary care, although they are very skilled, and
the long-term workforce plan says the Government will look into
that. What progress have the Government made in talking to the
relevant professional bodies about opening up general practice so
that more sessions are available?
(Con)
I do not have an answer in my pack to that specific question, but
the noble Lord raises a very good point. It is very important
that we bring more specialist skills into primary care, and GP
practices are exactly the right place, but I will come back to
the noble Lord on that specific point.
(CB)
My Lords, what assessment have the Government made of the number
of general practitioners required to meet the needs of the
population and for training purposes by the year 2030?
(Con)
We are working with NHS England to increase the general practice
workforce in England but, as the population grows, with the
amount of building that goes on throughout the country, it is the
responsibility of local authorities. There are two ways to do
this: they can apply for capital funding for new GP practices; or
they can apply through Section 106 agreements through local
authorities. It is for the regions and for local authorities to
plan ahead on that front.
(Con)
Has not the time come for every new medical student to contract
that they will, on qualification, work for perhaps five years in
the NHS, similar to the existing contract for men and women in
the Armed Forces who are medical practitioners, and perhaps
modelled also on the Singapore scheme?
(Con)
I am grateful to my noble friend. I am aware of the Armed Forces
scheme—that if you train as a pilot, for example, you cannot
leave the Royal Air Force to become an airline pilot. It is not
the first time that this question has been asked, and I will feed
it back to the department.
(Lab)
My Lords, the Royal College of GPs reports that 40% of its
members consider their premises not fit for purpose, something
that is not addressed by the workforce plan. As the £10.2 billion
backlog in maintenance continues to worsen as capital budgets
continue to be raided for day-to-day spending, what strategy do
the Government have to ensure that patients can receive care in
modern, safe and properly maintained buildings, particularly
where an increase in GPs and primary care staff teams is being
promised?
(Con)
The noble Baroness is absolutely right. GP practices’ premises
vary throughout the country but, as I said earlier, there is
capital funding available for new practices. From my own
experience, when GP practices merge it gives an opportunity for
them to have a purpose-built building. When I was a Member of
Parliament there was a very good example of that where four GP
practices throughout the constituency came together to form an
outstanding modern GP practice with a new GP practice
building.
(CB)
My Lords—
(Lab)
My Lords—
(Con)
My Lords, it is the turn of the Cross Benches.
(CB)
My Lords, it is clear that allowing doctors to spend more time
with their patients would permit more searching diagnoses,
leading to fewer unnecessary referrals and helping to take some
of the pressure off secondary care waiting lists. What allowance
has been made for this in the calculation of the total GP
requirement?
(Con)
The noble and gallant Lord raises a very important point. The
delivery plan for recovering access is backed by a major
investment in primary care services, up to £645 million over two
years, to expand services such as community pharmacies. Getting
more people to use community pharmacies and other such facilities
enables GPs to focus on exactly what the noble and gallant Lord
is talking about: those people who need to have diagnoses and
very quick scans in hospitals.
(Lab)
My Lords, England has 7.8 GPs per 10,000 of population, compared
with the OECD average of 10.8. That is a gap of 16,700 GPs. Can
the Minister explain how England has fallen so far behind other
OECD countries and what the human consequences of this are?
(Con)
The Government are working hard to make sure that we recruit more
GPs. Last year we saw the highest ever number of doctors
accepting a place on GP training—more than 4,000 trainees, up
from 2,600 in 2014. The number of places available will grow to
6,000 by 2031-32.
