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Gold, incentives and meh

Jonathan Ashworth: 'It will take time to resolve pressures in general practice'

Jaimie Kaffash asks the shadow health secretary about his plans for tackling the issues facing general practice

PulseWe know about the 5,000 newly trained GPs and £2.5bn going into general practice. What measures are you going to bring in to look at the immediate workload pressures GPs are facing? Three-week waits for appointments, 13-hour days etc. Is there anything in the immediate term?

Let me put it this way. I think general practice really is the bedrock of the NHS and in some ways, if you resolve the issue of pressures facing general practice, you will be able to deal with many of the other issues in the NHS.

It would’ve been easy for me to stand up there today and say, ‘we’re going to have a new target that everyone will have an appointment within x amount of time.’ But I don’t think you would believe it that it was achievable, I don’t think your readers would believe me. I don’t think the approach to this job isn’t going to be one of ‘spin and kidology’ like Boris Johnson and Matt Hancock.

I want an honest mature relationship with NHS staff, which is why I’m saying to general practice, I understand the pressures. I’ve spent time on the frontline, shadowing GPs in surgeries and going on day visits. I know the tremendous pressures they’re under and I know that model of care is so vital. But we need more GPs, which is why we’re expanding the training places.

A big capital investment has been announced today of £2.5bn to upgrade facilities but I know things are going to take time after ten years of squeeze of budgets and cutbacks to turn things around. Public health has been decimated in recent years but if you can get public health resolved, as it were, you can prevent people getting ill in the first place. That is going to have an impact on the pressure on general practice.

General practice really is the bedrock of the NHS

Is there a case for looking at patient demand? We’ve had pledges from Matt Hancock about DNA testing at birth and being able to see your GP through an app on demand etc. Is there not a case to say to patients that we need to think what they’re using the NHS for and there’s only so much capacity in the NHS?

I don’t want to be all the old party political muckabout because I think your readers deserve better than that, but I do get fed up of these gimmicks. I think the way he jumped on the Babylon model is so irresponsible. Utterly irresponsible. Now I do think there are ways in which you can use apps and technology and algorithms can manage pressures on general practice. I’ve seen that in my local practice in Leicester.

I also want to see more investment in the primary care workforce. We’re going to face a crisis in community health nursing unless we do something about it. We’re likely to see a huge retirement rate in practice nursing in the next few years and that’s why I want to bring back the bursary, for example, to train more nurses. I want to invest more in the public health workforce: health visitors, school nurses, the team of NHS staff working in the community are absolutely vital in keeping people well, which should impact on general practice pressures.

A lot of our readers will say that the regulations have really impacted workload over the last decade - for example, the CQC. Is that something you would look at?

I want them to work in tandem with GPs but I’m going to make a false promise and say that we’re not going to have the CQC doing inspections because I think patients do want to know genuine information about how their local health services are performing. But I want them to work in tandem with GPs to find ways to relieve the burden.

I speak to GPs all the time in different parts of the country who are exploring different models. I don’t have a fundamental or ideological position on all things.

I think it should be different for each area but I want to give this commitment to your readers that I want to work together with GPs to improve things. If that is the traditional partnership model, that’s fine. In other parts of the country, like what we see in Wolverhampton, where hospitals trusts are employing lots of GPs, again I think that’s fine. It should be what the solutions are for local areas.

If you can get public health resolved, you can prevent people getting ill in the first place

Maybe the biggest issue facing GPs is the pensions tax. From our point of view, it’s not a case of GPs being greedy, it’s that they are actually having to pay to work, in some cases. You say there’s going to be an urgent review. How long is that going to take before GPs see a difference?

I totally understand that question. I hear it from GPs all the time, and consultants in the provider sector. Of course, the way in which the tapering applies where you do an extra shift and you’re hit with a tax bill, we need to review it. If I’m honest, if I came up with a solution from my back pocket now, you wouldn’t believe me. This is very complex.

Also when you’re dealing with pension changes, you do have to be fair to everybody with an NHS pension. Some of the biggest leavers are the lower-paid staff who can’t afford their pension contributions. Senior hospital management would say, ‘what about us?’ We need a solution that is fair to everyone. I know it has to be resolved and we will look at this urgently.

Going back to the 5,000 GPs pledge. Obviously, more trainees would be very much welcome, but NHS England said recently that for every three trainees trained, we would only get one FTE staff. There has been a struggle of people going into general practice. How are we going to persuade medical graduates that general practice is the right place for them?

We’ve got to convince medical graduates that general practice is really exciting. We’ve got a big agenda on health inequalities. We’ve got a big agenda to really tackle these differences in life expectancies in our poorer and more deprived areas. Given that it is going to be such a focus of mine as health secretary, really putting wellbeing at the heart of our policy agenda, I hope we’ll be able to show from a national level that general practice is the place to be. I not able to deliver my health inequalities agenda unless I’ve got general practice fully part of that.

I think the way Matt Hancock jumped on the Babylon model is so irresponsible

From my point of view, I hope we’re sending a message that general practice is hugely rewarding. We respect you and we want more of you. Obviously I also have to look at how I deal with the pressures and working conditions in general practice. We’re putting our investment in, the NHS budgets will continue to increase for primary care.

We’re bringing capital investment in, we’re investing in IT. The number of times I’ve spent with a GP and the computer had crashed. I’ve spoken to a GP who is fed up at looking at a screen and waiting for the icon to load. They are little things but they make a huge difference to peoples working life. That’s why the capital investment I’m announcing is so important.

So the £2.5 billion. Obviously, the Tories have done this through the infrastructure fund before. A lot of GPs felt they were missing out. I don’t know many GPs who benefitted from the billions of pounds put into premises. How will you ensure that all GPs will benefit from this funding?

I hear about pensions tax from GPs all the time

These decisions around capital funding have to be fair. What I’ve realised, and this has been exemplified through how Boris Johnson and Matt Hancock made announcements for supposed 40 hospitals, there is no transparency on how capital decisions are made in the NHS.

I’ve been going around the country talking to provider chief executives and chairs who missed out on capital budgets. They would say to me ‘we’re not in a Tory marginal seat.’ I’m shocked at how blatant it is, which is why I said in my remarks today we’ll have a clear transparent process for allocating capital and it should be fairly distributed across the country.

At the moment, it’s not transparent, it’s not fair, so it doesn’t surprise me that you have readers complaining they missed out. I think people will accept if they don’t necessarily get as much as they’re expecting if they see that the process is clear and transparent.

IT will be part of it. This is also on top of the NHS England allocations, the long-term plan allocations as well, so it is a substantial investment into primary care.

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Readers' comments (6)

  • How does he intend to tackle the real reasons for GPs leaving - that is lack of resources lack of pay lack of support, failure to tackle the unwarrented left shift - ie dumping or work

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  • It’s typical Labour garbage, I’m going to promise you the world but not going to tell you how, but in the meanwhile I’m going to tax you until you leave the profession or country anyways
    How disingenuous is this, when they say want to increase investment in general practice but at the same time hit GPs with hard hitting tax changes

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  • his promises are barely worth reading. There needs to be an honest acknowledgement that one of our main problems now is the disappearance of full time vocational GPs. When practices want to replace a retiring partner all the applicants want part time or salaried work. You cannot run a practice without committed full time partners. End of.

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  • I agree what’s needed is full time committed partners. However, the current pension rules mean the finances of this simply do not work. Premises and pensions are two huge issues facing general practice that a competent and motivated government could fix very rapidly if they choose to do so. Doubt anyone will though.

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  • Nothing in the answers to this interview to suggest there is any short term plan to change and reduce current workload and intensity

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  • Quite possibly even more deluded than Hancock.

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