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Independents' Day

‘I understand why GPs feel so disenchanted’

The woman tasked with holding the health secretary to account, Heidi Alexander, talks to Sofia Lind in an exclusive interview

Heidi Alexander 3x2

Heidi Alexander 3x2

When Heidi Alexander was appointed Labour health secretary in Jeremy Corbyn’s shadow cabinet five months ago, she was relatively unknown to the public and to Westminster.

But the Lewisham East MP is not new to fighting NHS battles; playing a central role in saving Lewisham Hospital in 2013, to the detriment of health secretary Jeremy Hunt.

And since taking up her new position, she has wasted no time in delivering impassioned attacks on her political opposition, accusing Mr Hunt of ‘behaving like a recruiting agent for Australian hospitals’ in his imposition of the junior doctor contact last week.

It’s apparent when Pulse sits down with Ms Alexander for her first major interview about general practice that she is still learning the ropes when it comes to primary care.

But her passion for the NHS is clear as she sweeps around her Commons office with the same air of stern urgency she applies in the Commons chambers at health questions.

She talks seven-day access, practice closures and about whether she agrees with Labour’s former policies, as she unveils how she would save general practice.

A lot of GP practices have been forced to close and patients are waiting longer for appointments. What do you think should be done to stop this?

I’m really concerned that people are finding it so much harder to see their GP. In the last few months when I’ve been out there speaking to GPs, what has become quite clear to me is that the whole of primary care is understaffed, underfunded and under prioritised.

If we want to tackle the problem about access to GP appointments, we are going to have to invest properly in primary care [and] increase the number of GPs. We are going to have to properly prioritise primary care.

Labour said we need 8,000 more GPs. Do you agree and what would you do to achieve that?

That was a commitment that we set out at the last general election. It was urgent back then and it’s even more urgent now. Clearly it takes a long time to train a GP so even if you get more GPs being trained you’re not going to automatically solve the problem.

This is a pressing problem and the Government can’t stick their head in the sand for any longer – they actually need to come up with an urgent plan to address this.

Do you support GP leaders in calling for general practice to receive at least 11% of the NHS budget?

The current situation is unsustainable because primary care is absolutely pivotal to the way the NHS operates as a whole. It is the first point of call for many patients and if you can’t get primary care right it just has a knock-on impact upon the number of people who need to use hospital services.

Whilst I can’t predict exactly what the financial framework is going to be come 2020, were there to be a Labour Government, it’s certainly an aspiration that I would have to increase the proportion of NHS spend that goes into primary care.

Your predecessor favoured a situation where more GPs would be salaried – is this something you agree with?

That’s not something I’ve looked into in the five months I’ve been in the job. I think GPs have a central role in providing care for our ageing population and what we need to work out is how we organize the system to enable them to do that. We can’t be placing additional burdens on GPs without making sure that the financial support and that the system is organized to enable them to do that.

The NHS Five Year Forward View has set general practice two options for development. Either to expand and do more secondary and community care, or be absorbed by hospital trusts also providing primary care. Do you favour either option?

I think there are some interesting recommendations about bringing the expertise that exists in the hospital around certain specialties out into the community more… Whether that’s diabetes consultants, respiratory consultants, experts in heart disease, working with GPs more closely in the community… in order to perhaps ensure that the sort of care an individual needs is accessed more quickly before a situation gets to crisis.

I think some of those ideas of models of care are very interesting [but] I think what we need to look at is what works. I think there are some interesting things happening around the country and I would like to learn more about those before jumping to any conclusions.

Do you think patients should be able to book a routine GP appointment seven days a week, as per the Government’s pledge for 2020?

Undoubtedly there is demand amongst the public to be able to see their GPs on the evenings during weekdays and probably on a Saturday as well.

I’m not totally convinced that people want to be seeing GPs at teatime on a Sunday, but more flexibility especially for people who are in work, who are struggling to make appointments is really key because if they can’t make an appointment they will often turn up at A&E trying to access the care and advice that they need.

I do think we need to improve access and that is a priority, but whether there is that demand for Sunday evening appointments I’m not so sure.

Some [seven-day access] pilots have been abandoned because the demand wasn’t there and I think that when in a period of financial constraint, which the NHS is undoubtedly in at the moment, we have to use what resources we have very wisely.

A key policy of Labour’s was the 48-hour appointment target – would you like to bring it back?

I think the aspiration of that target is completely right because the frustration that people experience when trying to get a GP appointment is considerable. We are reviewing all of our policies over the next few years.

Another Labour party policy was the QOF. Do you think that it was a mistake?

I’ll have to come back to you on this one. We’ll have a look at it. When I’ve been meeting with GPs I’ve heard some frustrations around it but that wasn’t one I’d anticipated you asking me. Is it alright if we email you on that?

Another really important thing for GPs is the rising cost of indemnity . Would you be open to the Government reimbursing GPs for the cost of clinical indemnity?

I recognize that there’s a problem here. Constituents of mine who are GPs have actually been to my advice surgery to raise this issue with me. Not only are the costs going up by very large amounts each year they also feel there’s very little explanation or warning associated with those rises. As for the particular recommendation that you are making, it would have to be something that I would need to look at in more detail.

What do you think are the big mistakes that have got GPs so angry?

I do feel that primary care has been understaffed, under resourced, under prioritised. If you don’t have enough people doing the work and you can’t fill vacancies in your surgery, then the pressure that is going to mount on the GPs who are there [and this will] invariably lead to very, very low morale.

If you are not being funded properly to do the work that you need to do – and I know there are a lot of debates about whether it was MPIG or the changes to the PMS contracts – I suspect that a lot of GPs feel that they’re just constantly fighting an uphill struggle, and so I think that those issues have led to very low staff morale.

Doctors go into their profession because they want to help people and care for people and if they feel that they cannot do that because of the pressures on the system then I can understand why they feel so demoralised and so disenchanted.

Will you make it a priority to bring up the issues of general practice?

I certainly will. If we only focus on what’s going on inside hospitals, then debates about the future of the NHS will always be futile because how we provide care in the community is so vital and it’s something we haven’t focused appropriately on in the last couple of years.

LMCs recently voted that unless Government came up with a rescue package in the next six months, they would ballot members on mass resignations. Would you support that?

That is a very sad state of affairs, when GPs feel they have no other mechanism than to possibly stage a mass-resignation walkout. I will be watching very closely to see what the feedback is. But I think this really does underline the extent of concern that exists amongst GPs about the way that primary care hasn’t been properly valued and properly prioritised by this Government.

So would you support such a campaign in case the Government doesn’t come up with a reasonable solution to the problem and rescue general practice?

The Government needs to understand the degree of disillusionment that exists among the GP community. There’s huge frustration and I can understand why they might feel that some kind of direct action is necessary.

I also know that GPs themselves will be very concerned about the impact on patients. Every single GP that I have met over the last five months, what has struck me is that they are showing incredible dedication, compassion, commitment, in really difficult circumstances. A lot of GPs will have that at the forefront of their minds when they’re responding to the canvassing of their views.

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Readers' comments (12)

  • Please can we stop placing the GP at the centre of Primary Care. The term needs to be rebranded as "Generalist Pilot" ie someone who can guide the patient's journey not be there at the the patient's demand to see them.

    Yes, use the scarce resource wisely but unless the interface between public and Primary Care changes i.e. make contact with the service (telephone, Email, self help) away from a demand to "see" your named GP etc. I fear for the NHS survival and the quicker it is dismantled the better for all of our mental and physical health.


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  • Quote .... because the frustration that people experience when trying to get a GP appointment is considerable. end quote.

    Easy, promote the National Health SERVICE and stop the outdated nonsense of a NAMED GP that is a bygone age - surely this is a luxury in a cash strapped service that is desperately trying to cope and if recruitment to the demoralised position has felt we had better sooner admit that fact.

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  • I'm surprised to see colleagues complaining about the 'named GP' situation. Those of us working in small practices (which of course patients really like) can testify to the extra level of continuity of care that having an identifiable named GP brings.

    Otherwise it seems to me that people are buying into the idea that 'any clinician will do'. That's a point of view often espoused by young(ish) politicians with no personal experience of long-term illness or the frustrations of dealing with a set of clinicians where you have (yet again) to explain (from the beginning) the complex history...

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  • I seem to recall, at the last election, the Kings Fund stated that the NHS need an extra £8 bn just to deliver its current level of service. Labour and the Conservatives were promising an extra £2 bn.

    Only UKIP promised the full amount by diverting the £8 bn currently given to the EU and diverting that same money to the NHS.

    might I also note that we have a small army of doctors who used to work for the Home Office who are not allowed onto the GP List. In my youth at medical school I was taught by two GPs. One had been a Pathologist and the other a surgeon before swapping in to general practice. If we are really that short of GPs, perhaps we ought to be sensible and start accepting doctors from other specialities.

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  • This comment has been moderated

  • Vinci Ho

    All I would say is :
    Politics is a game .
    Unite with your lesser enemy to combat the common big enemy. Whether you trust the lesser enemy is another matter ......

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  • So she basically said nothing. Another Maureen Baker.

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  • lol! just describing the iceberg about to hit the titanic.

    at least she didn't say we are going to commission a report to look into GPs morale !

    sadly no political parties have the answer as there is ?no money - so the only answer to deal with rising demand is to raid the staff's T&Cs.

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  • I'll have to get back to you with my comments.

    I need to have a think about them.

    Is it alright if I email them to you?

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  • Doctors care. That is why GPs exist. But at what price?
    Can we put up 12+ hours, 40+ patients, the hydra of GMC,Defence, CQC, never mind imposed Contracts, Penance, Neglect, falling % of NHS investment for more work, the basic unfairness and injustice, the papers and politicians and our peers like Field / Thomas.
    I cannot, so I am away. I wish all those good and kind and altruistic folks the very best in the future.
    But ultimately, the system is just unjust and for me, impossible. It may not survive, because till a few years ago, I put up with almost anything.
    But to be constantly criticized when working so hard is demoralizing. I wish the remainder good fortune.

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  • Mr Hunt is acting like a Gangster! so I have done a "Gangsta rap":

    My first rap, but as Hunt treats us all like crap....
    Any Junior doctors willing to perform??


    Wise up Brother Hunt, Imposin’ a contract, what a stunt!
    What an affront, Hunt, wiv your medical witchhunt
    You treat us like dirt, wiv you crisp white shirt
    Every day a fake story, this ain’t no Jackanory
    Who’s next in your train-crash?
    Who’s next to get a bash?
    This battlefront ain’t about cash
    So don’t make out we are trash
    You see I gotta be upfront
    I ain’t lookin to confront
    This may sound real blunt
    But you actin like a real Hunt, Hunt, hunt !

    Please add to the song.....

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