Joy Morrissey MP led a debate in Wesminster Hall on access to GP surgeries both during and after the Covid pandemic. She spoke of her own experience as well as sharing those of several constituents.
Watch the full debate here: https://parliamentlive.tv/event/index/a3334a61-a7ff-4701-b830-6da0a2edf…
I beg to move,
That this House has considered GP appointment availability.
It is a pleasure to serve under your chairmanship for the first time, Mr Robertson. The chances of misdiagnosis can increase dramatically if GPs rely on emails or telephone calls exclusively. I speak from experience: for days, my mother-in-law was misdiagnosed as having a urinary tract infection, when she had actually suffered a severe stroke. Precious time was lost, and terrible damage done, because she was not seen by a GP. For every 100 ailments that can be diagnosed safely without seeing a GP, there will be one that cannot—one that could prove to be fatal, which is not a price worth paying.
I thank NHS workers and GPs for working tirelessly throughout the pandemic. I was encouraged to apply for this debate by my constituents, who came to see me again and again about this issue. I wanted to make sure that their voice was heard. I will read out some of their actual cases, because it is important to hear from them about what they have been experiencing. I would say that they are divided into two categories. The first is those who are disabled and perhaps suffer from dementia or other cognitive impairments, who find talking on the phone very difficult, and who really need to see a GP in person. The second is those who are happy to speak over the phone when they need a GP appointment, but find that the IT systems in place in certain GP surgeries cause issues with access to GPs.
The first example is from Marlow. A lady wrote to me and asked for an appointment to see me. She said:
“When I got through to the surgery, we were told that we should have a telephone appointment first. The GPs have my daughter’s number, as she cares for her grandmother. I explained that we do not live with her and cannot sit at her house and wait for a call. Also, there was a phone for her to sit around all day, and no one answers. She isn’t good with IT and has trouble explaining and expressing herself and telling someone what is wrong over the phone. I understand we are in extremely unusual circumstances, but there has to be exceptions, and there must be a way for elderly, and in some cases disabled, people to be able to get an appointment. Many do not have the capability to use the internet, and even phones in some cases.”
That was particularly true in the case of my mother-in-law, who had had a stroke. Luckily, we had power of attorney, but many people do not. I appreciate that the Government have made great strides in this regard, but we need to look at how we can protect those who are disabled, who perhaps have cognitive impairments and who need to have a carer come with them to a GP surgery in order to express what is wrong and explain what condition they have. Greater attention should be paid to this in the future.
We also have the issue of general IT and phone challenges. A resident in Farnham Common wrote to me and said:
“We have difficulty making the initial contact with GP surgeries. Most GPs operate a system which requires the patient to telephone when the surgery opens at 7 am to seek a consultation for that day. In our collective experience, it is often extremely difficult to get through. It takes a very long period of repeated calling. One friend recorded 140 unsuccessful attempts to reach the GP surgery.”
Some of the GP surgeries in my constituency are excellent. They were excellent during the vaccine roll-out and through covid, but we have certain GP surgeries that have had challenges meeting residents, challenges with the vaccine roll-out, and challenges in general throughout the covid period. Quite a number of residents have written to me and spoken to me about Burnham Health Centre, so I want to share specifically the IT challenges that it seems to face consistently.
One resident, Colin, said that if you are lucky enough to be 29th in the queue that morning at 7 am, you may get a message that says no appointments are left for the day. You can hang on in silence, or you may get to speak to a person—you may get through to a human being. You are told that there are no appointments and that you need to use Patient Access. When you try to book an appointment via Patient Access, it gives you possible ways to book, but only for things like contraceptive appointments, and nothing else. When Colin tried to access Patient Access, he was given an electronic form which he completed several times. It kept coming back saying that it could not be processed. He tried dozens of times and finally gave up and decided that Patient Access was not working.
He was not the only resident in Burnham who complained about Burnham Health Centre and Patient Access; several more wrote to me about the same issue. One said:
“I do think it’s ridiculous that you cannot get an appointment when you call, I am happy to wait a day or two, if it is urgent, there is always 111. The practice of releasing a limited amount of appointments at a certain time is not fair and just causes a bun fight. I do think the staff would benefit from customer service training”—
for everyone’s benefit.
A set amount of appointments are on a first-come, first-served basis. This seems to be unique to this GP surgery, but it has become a very agitating issue for people in the area who already suffer from some health inequality. They perhaps do not have the financial ability to go privately. Many are older and vulnerable, and it is demoralising that they often cannot get hold of a GP for even a phone call and consultation. Just getting a phone call would be a positive step in certain cases in my patch.
Margaret Greenwood intervened
I thank the hon. Lady for her contribution. I agree that the problem has a trickle-down effect throughout the NHS. We will see more people presenting at A&E and perhaps with more advanced stages of disease, because they have not been seen in person. Encouraging GPs or creating a covid incentive programme for them to see people in person will decrease the amount of hospital admissions and lead to earlier diagnosis for cancer and heart disease. These things can really only be done in person. If someone is healthy and just needs a phone appointment, that is fine, but certain things cannot be seen unless a person’s vitals—their heart pressure—can be physically checked. Only a GP can do that and really only in person. If we want to reduce the overall burden on the NHS this winter, finding a safe and secure way for more residents to see their GP will reduce the overall pressure long term on the NHS. I know we have an aging population, and that GPs are under huge amounts of pressure and strain, but I believe there is a way we can work together to find a solution.
Rachael Maskell intervened
The hon. Lady is stealing my thunder, but I agree with that comment. With the multi-disciplinary approach, even nurse practitioners and others could be recruited into a GP surgery structure, to help with many of the ailments that people are presenting at A&E with or asking for an appointment about. There is a wide range of healthcare professionals who could help and support GPs, and I think this is an important issue that needs to be further discussed and debated.
When this matter came before the House in July, several relevant questions were raised. One of them was about NHS England and NHS Improvement, or NHSEI, which leads the programme of work support practices, using digital and online tools to widen access. I would just love to hear what progress has been made since this topic was debated in July. Also, what is the progress of NHSEI’s independent evaluation of GP appointments? Again, I would like to see whether we have had any progress on that independent evaluation. Finally, what is being done by the NHSEI access improvement programme to support practices where patients are experiencing the greatest access challenges, such as drops in appointment provision, long waiting times, poor patient experiences or difficulties in embedding new ways of working related to covid-19, such as remote consultations as part of triage? I would really welcome any updates on those questions.
We could perhaps discuss today how we can provide GPs and their surgeries with some kind of in-person patient incentive during covid. Perhaps that could come from existing regional funding streams. Perhaps each time a GP sees a patient in person, they could receive an extra payment, or they could receive an additional payment for visiting someone in their home. That would mitigate the additional cost of PPE and also the additional risk posed to the GP themselves by having to see people in person during covid or high levels of winter flu.
Some GP surgeries are already receiving additional funding for cervical cancer and diabetes screening, and we have seen uptake increased in those areas very successfully, so this type of programme has been modelled in the past. It would help to mitigate the risk and burden for GPs, while still getting as many of our constituents as possible into in-person appointments if they need them.
The NHS claims that it would like more patients treated at home rather than having to stay in hospital for extended periods of time. This model could be enhanced if GPs were given the financial incentive to carry out in-home treatments for patients who traditionally would have remained in hospital. Obviously, this allocation would have to be set by the integrated care system in each region and it would be decided on within regional NHS structures, but it is worth considering.
In my own personal experience with my mother-in-law, she has been at home all the time 24/7. She is now completely disabled and needs 24-hour care, but the most difficult challenge was the out-of-hospital care provision—getting the GP, the hospital and the council to co-ordinate the care effectively. It is a full-time job for someone to co-ordinate that care. If we can make those pathways of care and co-ordination easier for everyone, then, as was said earlier in the debate, it would reduce the overall pressure on the NHS.
Margaret Greenwood intervened
I recall the Member speaking on this topic previously. I commented only because of my personal experience. The change is well intended, and I understand where it is coming from, but for a disabled person, and for someone who cannot advocate for their own care needs, having a care plan in place before leaving hospital helps with accountability and the structure of the care. From my own personal experience, as someone who has taken care of a very disabled relative who cannot advocate for herself, I can only say that having this agreed before she came out of hospital made it easier for our family to co-ordinate the care. It is difficult to know which funding pathway is linked to what care once someone leaves hospital; there is a statutory responsibility, but then there is the question of who picks up the care once that period out of hospital has finished. For someone who is disabled, has had a stroke or requires long-term rehabilitation, that is a very sticky issue because whichever organisation within the health structure picks up the statutory duty picks up a huge cost. I think it is a very nuanced issue and we need another debate on it to flesh out all the different challenges. However, I take on board the comments made by the hon. Member for Wirral West and recall supporting what she said when she spoke several months ago.
I understand that these are unprecedented times, and there are great challenges for everyone across the health sector. This is not to criticise anyone; it is just about how we can positively move forward into the new covid era in which we find ourselves, and into the winter months when there are more challenges. It is about how we can work together to find solutions, particularly for the vulnerable, the disabled and those who cannot advocate for their own care needs. I am very grateful that we have been given time to debate this topic.
Kim Leadbeater intervened
I thank the hon. Lady for her comment. In my constituency we have GPs who have worked tirelessly throughout the pandemic and have done so much to roll out the vaccine—I commend them for everything they have done in such an incredible way. This is not to disparage the wonderful work of the majority of GPs and GP’s surgeries. I am looking for the correct terminology. There are certain GP’s surgeries that have struggled to even respond to constituents with phone calls. Many would be satisfied with just a phone call, but they cannot even reach their GP to schedule a phone call appointment.
Chris Green intervened
I would agree with that. Some GP surgeries, in certain parts of my constituency, are excellent—they were excellent with the vaccine roll-out; they are excellent now; they have done everything in their power to see as many constituents as possible—and then there are certain others, in the Iver and Burnham areas, where we continually have complaints, where constituents come to me in desperation because they have nowhere else to go.
We need to find a way of giving health access to everyone in a fair and reasonable way. I promised my constituents that I would raise their concerns at the highest level, and I have done that today, both in Westminster Hall and with the Minister directly. I thank Members for their time today, and I hope that this issue will continue to be considered and debated within Parliament and by the Minister.