Meeting of the Parliament 15 December 2015
The report from Professor Sir Lewis Ritchie is a good one, which makes sensible points about the reform of out-of-hours primary practice.
I agree with much that members, including Richard Simpson, said about the extent of the primary care crisis. That said, I will also support the Government motion and the Liberal Democrat amendment.
Rather than focus on out-of-hours care, I want to talk more broadly about GP provision, in particular in the poorest places. I am assisted in that regard by an email that I received yesterday from a constituent, who is in general practice in Glasgow and has expertise in homelessness and addiction heath services.
Margaret McCulloch was right to talk about the concerns that GPs at the deep end have expressed throughout this parliamentary session. I have met the deep-end group several times, as many members have done, but I have always been somewhat at a loss to suggest what practical changes have been proposed that will resolve some of the problems that those GPs face. My constituent got in touch with me yesterday because she wanted to highlight comments that Peter Cawston made on behalf of the deep-end group. I hope that it will be helpful to members to hear some of those comments later.
At the beginning of this month, Professor Graham Watt published a paper in the British Journal of General Practice, which showed that the poorest 40 per cent of the population, with 47 per cent more complicated multimorbidity—that is, either five or more conditions or the combination of mental and physical health problems—receives 8 per cent less GP funding per patient per year.
Not only is that a matter of social justice but it has a profound effect, in that it inflates the cost of running the national health service and undermines the prosperity of the whole country. When the people with the poorest health cannot access the same level of preventative and long-term care in the community as is enjoyed by the more affluent, they become sicker sooner and end up costing far more in hospital admissions and A and E attendances than they would otherwise do. If the average age at which the workforce develops long-term illnesses in some communities is 10 years before the age of retirement, there is a devastating effect on the local and national economy.
At First Minister’s question time a few weeks ago, I was interested to hear the First Minister say:
“I welcome Professor Watt’s findings, which we will take fully into account in delivering a new GP contract for 2017 and the accompanying revised allocation formula ... The new GP contract, on which we are in the early stages of negotiation and which will take effect in 2017, gives us a good opportunity to revise the allocation formula to ensure that it reflects the varying needs of GP practices”.—[Official Report, 3 December 2015; c 21-2.]
That day, the First Minister quoted figures that show that the least deprived 10 per cent of practices receive a slightly lower level of payment per patient—£7.65 less per patient per year—than the most deprived 10 per cent receives. However, that is correct only when we compare the extremes. Professor Watt’s paper compared the poorest 40 per cent with the most affluent 60 per cent, so he covered the whole patient population in Scotland. What the First Minister did not say was that complicated multimorbidity is twice as prevalent in the most deprived 10 per cent as it is among the most affluent. None of that is reflected in how general practice care is funded.
Dr Cawston has said that it is time to move on from debating points about small differences in funding and to recognise the huge differences in premature morbidity across the social spectrum and the need to account for them, on a pro-rata basis, in the new contract formula. The issue is not necessarily about taking funding from affluent areas to give to poorer areas. All practices have common cause in highlighting that during the last decade there has been a 20 per cent reduction in NHS funding of general practice relative to the rest of the NHS budget.
Quite simply, the NHS’s focus has been on additional investment in the most expensive part of healthcare—acute care—while there has been disinvestment in preventative general practice care. The GP contract and the change to integrated health and social care must rectify those mistakes and ensure that general practice as a whole is funded in such a way that we do not need to withhold care from the poorest in order to ensure that we can continue to provide care across all areas of the country. If we do not get that right, we will continue to fund an NHS that contributes to health inequalities and becomes less and less sustainable in the long term.
Sandra White talked about the reality of what is going on the health service. She might be interested to hear about my constituent, who is a Glasgow GP who has worked in an economically deprived area for 16 years. She says:
“In many ways I believe we provide a very good service and we have a high level of satisfaction among our patients. We recently surveyed patient calls and found that we had a 25% higher demand for appointments than the number expected nationally. While we also found that we were providing 10% more appointments than the nationally recommended level, it is no solution to expect those of us working in poorer areas simply to work harder. These are not the figures that worry me however. I am especially aware of all the people who aren’t calling for appointments, or who have so many things to talk about when they see me that they neglect to mention those things that really matter, like an early symptom of cancer. Many of my patients have learned to survive adversity by having very low expectations and by accepting that they are ‘old’ when in their fifties. They are the people who are paying the true price, with their lives, for maintaining the status quo.”
Unmet need is what we should be focusing on, and I commend to members the work of the deep-end group. Unlike the Government motion, Dr Simpson’s Labour amendment mentions differential funding, so I will support it at decision time, and I commend others to do so.
15:37