My Lords, I welcome the opportunity to have this debate and thank the noble Lord, Lord Hunt, for having secured it. We are so very lucky to live in a country that has a health service, and we should celebrate the NHS on its 75th anniversary. I pay great tribute to the many dedicated doctors, nurses and health professionals who have worked in the NHS over the past 75 years, many of whom really are true heroes.
However, we are having this debate at a difficult time, as we have heard, with the NHS facing unprecedented challenges and the fallout of the pandemic still significantly impacting the system. There is also, perhaps, a generational change of attitude. I do not think we have ever before had doctors and nurses going on strike. On top of that, a number of very difficult situations have come to light, with maternity
scandals, as we have heard, in hospitals such as Shrewsbury and Telford, Nottingham, Mid and South Essex, Morecambe Bay and East Kent—to name some of them—revealing huge failings in safety, as well as the realisation that hundreds of avoidable deaths occur in our hospitals. No longer can we say that the UK has the best survival rates for many cancers. All this paints a picture that the NHS is somewhat in crisis. As we have heard, a recent IPSOS survey noted that public satisfaction with the running of the NHS as a whole is at its lowest level for 25 years.
Time is short in this debate and it is such a huge subject, so I thought I would concentrate my remarks on the GP system and primary care. We had the most wonderful system, but since the early 2000s this too seems to have dramatically declined, starting with the change to the GP contracts. The British Social Attitudes survey found that the proportion of patients who were satisfied with GP services, in particular, has plummeted from 68% to 38% since 2019, with people often struggling to get the care that they need. Anecdotally, we consistently hear about the crisis of patients not being able to access their doctors. Many GP practices have taken on the system of triaging patients, but if you are really feeling unwell, you do not feel like fighting with the receptionist to see a doctor—the result being that people give up and go straight to A&E, which naturally has a knock-on effect on waiting times there and on the ambulance service, which cannot discharge its patients.
It is clear that GPs too are feeling under pressure. A report published by the Health Foundation charity paints a picture of high stress and low satisfaction with workload. Just one in four UK GPs are satisfied with the time they are able to spend with their patients and appointment times are among the shortest of 11 countries surveyed. I gather that the average doctor now has to deal with 41 to 50 patients a day. When asked, GPs feel that the right number is somewhere around 30, maximum, and this situation is leading to burnout. Only one in four GPs in England is now working full time; most work three days or fewer each week. A third of GPs are considering leaving within five years, with the Royal College of GPs claiming that it is “no longer feasible” to be just a GP, despite an average salary of over £100,000 a year.
Many doctors now do not know their patients. Talking to older GPs, I learned that the job satisfaction came from knowing whole families and caring for them throughout their lives. While not knowing your doctor may not be a problem for the young and healthy, if those with small children or the elderly know their GP that makes it much easier for the GP to treat them, without having to read through all their notes each time, thus cutting their time down. I have cited in previous debates the Norwegian study published in the British Journal of General Practice, which clearly demonstrated the benefits and stated that it can be lifesaving to be treated by a doctor who knows you.
Yet in the UK, GP practices are becoming bigger and the relationship between doctors and patients less constant. While patients over 75 in the UK are given a named GP, it would appear that some doctors interpret this as just having to look at patient records. I understand that patients who wish to be seen urgently cannot
always see the same GP that day, but how can a doctor deliver appropriate and responsible care to a patient without ever meeting them?
What can we do, going forward? I believe we need to redesign the whole system so that it works for doctors and health professionals, and, most importantly, for patients. Training more GPs is one easy answer. I know that there was an increase of 25% in funded medical school places in the three years up to 2020, but clearly we need more. We must cut down the number of patients who doctors are being asked to see each day. We must make it advantageous for doctors to work in a practice, rather than being a locum. Smaller practices used to work better. Most importantly, we need to encourage doctors to know their patients again; this will lead to better outcomes, as shown by the Norwegian study, and help ease pressure on the whole system.
However, we need to do more to encourage people to take responsibility for their own health. Prevention is key: good diet and exercise are vital; health checks are important and should go on until an older age. We should also include mobility checks, as people who cannot exercise will put on weight, leading to diabetes, heart problems et cetera. That would help to prevent hip and knee problems. We need to encourage practice nurses to deal with more conditions and get qualified pharmacists to be able to give a wider selection of medication without a prescription. Community nurses are such an asset, and we need to ensure that doctors work closely with them. Those dealing with patients on the phone need to be trained to be kind and caring.
Mental health takes up more and more time. Are there better ways of dealing with this, rather than endless medication? Should we encourage people with certain conditions not to go first to their GP? For example, could those with back pain go first to an osteopath or a physio or a sports therapist, who can often sort them out? Good IT can really help with the whole system.
We must make sure that primary healthcare works better for patients, as well as being a job that is once again enjoyed and valued by doctors. This is so important, as, if we can once again restore good primary healthcare, that will ease the whole health system.
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