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At the heart of general practice since 1960

'If we can’t fund five days, how can we fund seven?'

The (now promoted) shadow health secretary outlines Labour’s priorities for the NHS to Sofia Lind

dianne abbott paul stuart 3x2

dianne abbott paul stuart 3x2

Speaking to Pulse last month as Labour’s health spokesperson, Diane Abbott appears to have no idea of her imminent move to shadow one of the great offices of state – home secretary – a week later.

She greets Pulse somewhat late at the House of Commons because she is busy watching the TV broadcast of health secretary Jeremy Hunt’s speech from the Conservative party conference.

As her photographs are taken, she scoffs at Mr Hunt’s repetition of the statistics on weekend deaths that he used to justify his imposition of the junior doctor contract – figures that have since been called into question many times.

It is clear she is no fan of the man she has shadowed for just a few months, after being propelled into the shadow cabinet amid a mass walkout of MPs protesting against the leadership of Jeremy Corbyn, of whom she is a firm ally.

Coming hard on the heels of Mr Corbyn’s re-election as party leader, she offers an insight into what the health service might look like under his leadership.

A lot of GP practices are closing at the moment, especially smaller ones. Do you think it’s OK for GP practices to close or should they be bailed out?

I think it’s a problem that so many smaller practices are closing. Obviously we’re moving from an era where you had a lot of singlehanded GPs to group practices. For older people especially, it’s very difficult when their GP disappears, and they sometimes find it hard to adjust to a group practice. More should be done to help some of the singlehanded practices because they provide a service that particularly older people appreciate.

I know that in Hackney [part of Ms Abbott’s east London constituency] – which is a very diverse community – particular communities can build a relationship with a particular GP, so it’s important to look at it strategically and maybe help some practices.

There is definitely a role for smaller practices. As a patient, a group practice can seem enormous and the thing that people don’t like is when you see a different GP every time. People value knowing they’re going to see the same person with whom they have an established relationship.

The Socialist Health Association told me at the Labour party conference last week that it is pushing for GP practices as businesses to be phased out, and GPs to become employees of NHS bodies. Is there a shadow cabinet policy on this?

No, there isn’t. I don’t think that’s necessary, actually. I think the business model has served us well. I wouldn’t push for them all to become employees.

GPs say they’ve been underfunded for the past decade. What’s your take on that? Should there be more money going towards general practice?

In principle. I can’t promise more money, I have to say. But I think so, because for most people their GP is their main point of contact with the NHS. There’s a generation of singlehanded GPs that are retiring, and if you’re serious about health prevention, then you need to put money in because GPs are best placed to give advice, give support and identify conditions.

There seems to be an increasing use of private hospitals for NHS care. What do you think of this?

Well, people have been in contact expressing their concern about this. Obviously, the use of the private sector to manage demand started under New Labour. But I was not a supporter of that at the time. The idea was that you use the private sector not just to manage demand, but to motivate the NHS itself to do better, to do things faster. And I don’t think it’s worked like that.

I didn’t like it then and it increased under the coalition and now under this Government. I’m concerned because the problem with the 2012 Health and Social Care Act is that it led to fragmentation, and a fragmented NHS is easier to privatise.

dianne abbott paul stuart 330x330 a

dianne abbott paul stuart 330x330 a

The Government has promised 5,000 more GPs by 2020. Has Labour done any modelling on the future need for GPs?

No, we haven’t at this point. Obviously one of the things we have to look at as a party is how much more money we put into the NHS and how we would fund that. But we haven’t modelled that as yet.

Over the summer we had a little turbulence in the party (laughs), and we’ve kind of had to get past that. And now we’ve got past that, that’s the kind of thing we’ll be looking at.

Pulse’s analysis shows the Government isn’t doing too well on that 5,000 GP target. Where do you think they are going wrong?

You can bring in new GPs but they’re not doing enough about retention and they’re not giving GPs enough support, including financial support. If you want primary care to do more – more minor procedures, more public health work – you do have to make sure you have the funding structure in place for that. GPs are a really important point of intervention, but the Government is not prepared to provide funding.

One solution the Government is pushing is an increase in the number of non-doctors doing consultations. What is your view on that?

The idea of giving pharmacists a greater role isn’t new, and to a degree, it’s a good thing for advice on sexual health and so on. In my GP practice, the practice nurses do things like take your blood pressure.

The problem is people want to see their GP. You’ve already got non-doctors engaging with patients, and I think there’s a limit to how much you can do that.

As an MP, I meet people who come to my advice sessions to talk about their problems. Even over the course of our conversation they have to build a relationship with you. Only then will they really tell you what the problem is.

There’s no getting around the importance of patients being able to see their GP and building a relationship with their GP. This business about seeing non-doctors, that’s already being done and I’m not quite sure how much further we can take it.

Do you think patients are waiting too long to see a GP at the moment?

I hear it from my constituents all the time and have for some time. And it’s hard to intervene in that situation. When there were PCTs you could talk to them. City and Hackney is my health area and the PCT was trying to deal with the waiting times issue. In east London, people have always waited a long time to see a GP and it’s getting worse.

dianne abbott paul stuart 330x330 b

dianne abbott paul stuart 330x330 b

Do you support the plans to stretch an already-struggling five-day GP service across seven days?

No, no. Look, on the one hand, people do work at weekends. When I was in Liverpool for the Labour party conference, I visited the Royal Liverpool University Hospital and there were consultants and doctors there at the weekend.

But a fully seven-day service? They can’t fund a five-day service, they’re having to close down A&E departments partially, temporarily. If they can’t fund a five-day service how can they fund a seven-day service?

The thing that Jeremy Hunt never says is that you need all the other people: the pathologists, the scientists. At the weekend you don’t even have hot food. If you’re really going to have the seven-day service and you treat staff fairly, you have to look at a whole range of other things, other NHS people, as well as the facilities in the hospital that make it viable. There isn’t the money to do that.

It’s dishonest of Jeremy Hunt to imply the only problem is junior doctors not being prepared to sign a new contract. It will take money to have a genuinely enhanced seven-day service, which there’s no prospect of him providing.

So seven-day GP access is not policy that would survive under a Labour government?

If we had the money. The problem with Jeremy Hunt is he’s trying to do these things but he doesn’t want to fund them. We would not be asking the NHS to do more with less.

How would Labour fill the NHS funding gap? Do you have any plans?

This is something we’re trying to model. You can either take the money [through] general taxation, or you can do something with National Insurance, but we’re committed to filling the funding gap. We haven’t yet announced exactly how we’re going to do it. But as I say, we had a summer of distraction, but now we can get on and look at those things.

CV

Age

63

Education

Graduated in 1976 from the University of Cambridge in History

Career

  • 1982- Elected to Westminster City Council
  • 1987- First elected MP for Hackney North and Stoke Newington 
  • 2010- Stood in the Labour leadership contest, losing to Ed Miliband
  • 2010-2013- Shadow public health minister
  • 2015-June 2016- Shadow international development minister
  • June 2016-October 2016- Shadow health secretary
  • October 2016-present- Shadow home secretary

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Readers' comments (4)

  • Ivan Benett

    Of course we can fund a 7 day NHS! It just takes the Political will to do so. Sure, we're not even funding the 5 day service for planned and urgent care (we are funding 7 day urgent care already), but that's due to a deliberate right-wing Political decision to run down the NHS to encourage people to take out private insurance and to redirect NHS resources to Private Businesses (supported it seems by Pulse magazine).
    But that doesn't mean this has to be the case.
    After the 2nd World War the country was really broke, in debt up to our eyes and the people were starving. Yet there was the Political will to create the NHS and so it was done, notwithstanding fierce opposition from our profession.
    Today there is a Political rhetoric for a 7 day NHS, but not the will to resource it. Our Politicians should be putting their money where their mouth is - yes including Labour. For example, they don't think twice about loading up expensive war planes with massive bombs, or funding a never-to-be-used nuclear programme.
    It's all about the Political will to resource what the Government wants to resource.
    Having a 7 day device is the right thing to aspire to. We have an increased demand on the health service as the population ages, diseases become more complex, and interventions become more expensive. We can't afford people to be off work unnecessarily, when they could be seen at weekends. People with same day problems need to be seen the same day, or they get worse and end up as expensive emergencies. So a 7 day NHS is the way of expanding capacity and meeting the increasing needs of the population.
    And so, we need to find the resources to fund it, train the clinicians to work in it, and develop the management (rather than slagging them off) to manage it.
    The problem with a 7 day NHS isn't that it's not the right thing to do. It is. The problem is the Politicians want it on the cheap, and haven't adequately planned for it.
    This isn't a reason to abandon the idea, but to now properly plan for it and properly invest in it. And no, it doesn't mean individuals working 7 days. It means the service working 7 days.

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  • But doesn't the service already work 7 days?

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  • Quite happy to do my bit to provide around the clock emergency care for the general public every day of the year. It's not great missing out on friends and family at weekends, on public holidays and doing late shifts gets harder as you get older but I do this because I believe I signed up for this when I took up a place at medical school. BUT am I prepared to miss even more of my family and friends for the sake of convenience so general public don't have to take time off work? NO NO NO! Can you have a routine filling on a Sunday afternoon? Have your car serviced? Have a new bathroom plumbed in? Ah - No! I suspect a lot of doctors if forced to do this would simply, like me , hang up their stethoscope at that point. In addition to this there is a whopping list of things that we should spend valuable NHS funds on before we try to do something that is simply unnecessary i.e. Improve social care. Private doctors?? Well I think people need to be encouraged to start paying for more of the 'softer' health issues i.e. ' I don't want my period to interfere with my holiday to the Caribbean ' - neither would I but it's time to start self funding for these sorts of things.

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  • Kadiyali Srivatsa

    Government ignored warning, harassed, humiliated and ostrasised doctors who opposed them in 2006.

    Article published in pulse 'Systematic failure' has led to steep rise in paediatric emergency admissions, study finds and reply by Collin Powell; Do we need to change the way we deliver unscheduled care?
    Arch Dis Child 2013;98:5 319-320 "Warn other countries not to emulate UK experience".

    Evidences presented in various enquiries about wrong doings and compensation payment, speak volumes of unethical medical practice. I have not come across any one other than me pointing my fingers at non-medically trained people offering healthcare advice and treatment in UK.

    Even the GMC and BMA ignore this.

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