General practice issues in Parliament – May 2022

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On 18 May, the Health and Social Care Committee held an evidence session for their inquiry into the future of General Practice, with a specific focus on continuity of care and patient lists.

MPs heard from:

  • Dr Pauline Grant, GP in Southampton
  • Dr Jacob Lee, GP in Bristol
  • Professor Steinar Hunskår, Professor of Primary Care at University of Bergen, Norway
  • Dr Rebecca Rosen, Senior Fellow at Nuffield Trust
  • Dr Kate Sidaway-Lee, Research Fellow at the University of Exeter

Beginning the first part of the session, Dr Lee stated that he had found working at a practice without patient lists ‘really challenging’. He described a system that prioritises access over continuity as ‘inefficient’ and listed the positives of working with a set list. Seeing a manageable number of patients regularly enables him to discuss more readily preventative care and sensitive topics.

He noted that his practice, which does operate with patient lists, has never had a problem recruiting. However, he acknowledged that financial constraints and workforce problems across the service make achieving continuity harder.

Dr Grant stressed that continuity allowed GPs to learn from things that didn’t work, as they get to see the results. She stated that she would not work in a practice that doesn’t have patient lists, but that system is struggling to be continued. One reason for this was that the GPs they were attempting to hire at her practice wanted limited sessions and wouldn’t be prepared to work beyond contracted hours to deal with their lists, as she occasionally had to. Overall, however, interactions with patients are ‘easier’ and less stressful with continuity.

Dr Grant continued by affirming that there was no contradiction between access and lists, with Dr Lee commenting that lists are only the ‘gold standard of continuity’ and it is possible to have continuity without set lists. Above all, to achieve continuity it is dialogue with patients and strong determination that is required. Dr Grant suggested it would also benefit continuity if trainee doctors ‘mainly worked’ in partnerships with personal lists, so that they are convinced of the system and can implement it elsewhere in their career.

Dr Lee stated that simply having a ‘named GP’ does not alone affect who the patient sees. Practices need to be ‘supported with the right processes’ to enable a patient to see that GP. He suggested measuring existing continuity to create a target for GPs to move towards.

Starting the second half of the session, Professor Hunskår explained that there is a clear association between continuity and reduced mortality, hospitalisations – a 25-30% reduction. The professor described the UK as ‘the father of general practice,’ and so it was jarring for the country to have abandoned ‘evidenced-based health policy’.

Dr Sidaway-Lee argued that with a shortage of GPs, it is best to use them ‘as efficiently as possible, and that’s with the patients they know well. She felt that a public information campaign is needed to advertise the benefits of continuity. If patients understand the benefits of continuity, they would be more amenable to waiting longer to access their personal GP.

Professor Hunskår suggested that British general practice should adopt the Norwegian slogan that the service is ‘for everyone, but not for everything’. In the context of continuity, patients should know that ‘although you have a personal GP, you don’t need to see them every time’.

Dr Rosen believed it would be possible for every practice to have a personal list, as it was merely a matter of getting GPs to ‘pay enough attention’ to the personal list each GP already has.

On 10 May, the Queen’s Speech was delivered in Parliament. In the subsequent debate in the House of Commons, general practice was mentioned a number of times by MPs.

Responding to the speech, the Leader of the Labour Party Sir Keir Starmer claimed that the Government has ‘no plan’ to decrease NHS waiting times. He also stated that the Government ‘cannot hire the GPs they promised or get the GPs we have to see more patients’.

The Prime Minister in turn asserted that his government ‘are now investing more in our NHS than any other Government in history’. To ‘maximise the ability of our NHS to check and treat its patients’, the Government seeks to engender ‘pop-up clinics in our communities, more face-to-face GP appointments and new cancer screening machines’.

The Leader of the Liberal Democrats Sir Ed Davey remarked that ‘local health services are at breaking point’ due to the failure to recruit more GPs: ‘People are struggling to get appointments and GPs are under more pressure than ever’.

Catherine West, Labour MP for Hornsey and Wood Green, said that ‘it is essential that we tackle the lack of GP appointments’, which she attributed to there not being ‘enough health practitioners working in the health service’.

On 27 April, Bambos Charalambous, Labour MP for Enfield Southgate, led a Westminster Hall debate on International Thalassaemia Day.

Mr Charalambous noted that Thalassaemia is mostly seen in people with ‘Caribbean, South American, African, Mediterranean, south Asian, south-east Asian and middle eastern ancestry’, with the MP’s constituency having the highest rate in the UK. He highlighted that people with thalassaemia have experienced differing levels of treatment by health professionals, and that there is a ‘huge disparity in services throughout the country with regard to the accessibility of thalassaemia care’.

Responding to the debate, Minister for Patient Safety and Primary Care Maria Caulfield stated that four specific Thalassaemia centres and 10 sickle cell centres, ‘have been commissioned to provide clinical expertise’.

On 26 April, a general debate was held in the House of Commons on Childhood Cancer Outcomes.

Leading the debate, Dame Caroline Dinenage, Conservative MP for Gosport, stated that she wished to see a ‘new childhood cancer mission, a concerted effort to bring together the very best in research, genomics, training, treatment, philanthropy, medical and allied health professionals to change our approach to childhood cancer once’.

Dame Caroline stated that for many children, ‘diagnosis comes far, far too late’. In the case of one child, a GP mistreated and misidentified the problem with the cancer only found at A&E. The MP affirmed that ‘there is little or no training for general practice’ and ‘no national referral guidelines for GPs with concerns that a young person may have cancer’. She suggested that, in the long term, paediatricians should be placed in primary care.

Cat Smith, Labour MP for Lancaster and Fleetwood, argued that awareness among GPs would help ensure that young people get earlier, and consequently less aggressive, treatment.

Ian Paisley, DUP MP for North Antrim, stated that ‘waiting several months before GPs was able to get the child to A&E and then have them diagnosed is not appropriate’, but ‘it is not the GP’s fault’.

Siobhan Baillie, Conservative MP for Stroud, commented that one of her ‘greatest concerns’ was the ‘reality of pushed GPs, who are busy people and who are not equipped or trained enough to be able to spot some of the signs’ of childhood cancer.

Helen Hayes, Labour MP for Dulwich and West Norwood, spoke of a constituent who ‘had six GP visits before a GP referred her for hospital tests’ that diagnosed cancer.

Andrew Gwynne, the Shadow Minister for Health, notes his concern that ‘spiralling waiting lists could lead to missed or delayed cancer diagnoses and thus to worse health outcomes’. He called on the Government to do more to raise awareness of how to spot early signs of childhood cancers.

Maria Caulfield, the Minister for Patient Safety and Primary Care, stated that ‘GPs will only see one or two cases of childhood cancer over the course of their career’, and spoke of the current NICE guidelines which state ‘children presenting with a wide range of potential cancer symptoms’ should be urgently referred and ‘recognises the knowledge and insight that parents have’. The Minister also mentioned the education programmes available to help GPs.