Norman Lamb: 'We shouldn't make back-of-a-fag-packet calculations on GP workforce figures'
The Liberal Democrats’ health spokesperson and former health minister Norman Lamb speaks to Caroline Price about his party’s plans for general practice, and why it would ditch the Government’s policy of seven-day routine GP opening
What are the Liberal Democrats’ plans around the funding of general practice specifically?
I don’t want to reveal what is in the manifesto but in our spring conference we made clear that new resources should be targeted particularly at out of hospital care, so including general practice and social care and critically mental health as well.
We recognise you can’t sustain what’s happened in general practice and we have seen the strains on the system.
I’ve recently picked up in my own county of Norfolk people waiting weeks to get an appointment and I talk regularly to GPs who tell me that they find it impossible to recruit new partners and so on. I’m conscious also that there are quite a lot of practices on the brink close to tipping point, which is deeply worrying because if one goes it just adds impossible pressure on the remaining ones in the area.
We recognise that has to change and we will ensure that we address that through the additional resources we would raise for the NHS.
We have to make an additional investment in general practice – it’s a condition precedent for a well-functioning NHS.
And we also have to make sure we have a sufficient workforce – the Government has asserted that there should be 5,000 more GPs without any means of delivering it as far as I can see.
Again I can’t go into too much detail we need to make our own assessment of what the workforce needs will be and then deliver the means to ensure that is achieved. I reject the idea of plucking figures out of the sky which then can’t be delivered.
But you are committed to significantly increasing the number of GPs?
Yes. It’s a bit of a frustrating conversation because I can’t pre-empt the announcement but what I can say at the moment is that the figure you come up with for the workforce demands has to be first of all credible, it has to be based on a proper assessment, and then you have to have a credible means of achieving that figure.
It’s work we would do in Government. We haven’t done a complete assessment of workforce needs – we’re not in a position to do so.
But we are advised by [former RCGP chair Professor] Clare Gerada, who is a member of the party now, and we completely understand the need to do this properly. We don’t want to just have a back-of-the-fag-packet calculation, it needs to be a proper workforce assessment.
What do the Lib Dems think about the Government’s policy to extend access to routine GP appointments at evenings and weekends?
I think imposing a one-size fits all model is irrational, I don’t think it would lead to rational use of resources. You can have a practice open seven days a week but if the demand isn’t there you’re actually wasting resources.
I think the attractive thing with federations or the ’Modality’ [a big GP superpractice in the West Midlands] type of model is that across a locality there can be access to general practice without every practice having to be open all hours seven days a week. There can be shared provision which reduces the burden on individual practices but makes general practice more accessible to the public.
So would you drop that plan for GP practices to be available at evenings and weekends?
I don’t support the Government’s current plan on that I think it’s much better to look at how federations and other models like Modality can increase access in localities without wasting resources in the way I think the Government’s plan is likely to do.
Would you therefore give practices more autonomy on how to manage demand?
Yes and we could incentivise different models – we can have innovation money to extend access. I’m very keen for example that we spend money on digitalising systems so that we can have better online access to consultations, Skype consultations and so forth.
We should be experimenting - particularly in rural areas where access is difficult over long distances.
And you know, for someone like me I’m working away from home, often it’s just a question I will want to ask a GP rather than needing a 10-minute appointment which then clogs up the GP. If I can ask that online then I think we can relieve some of that pressure.
I’ve seen that in Seattle in the US, in the not-for-profit Group Health integrated care organisation. They have made quite heavy use now of online consultations for routine things that don’t necessarily require you to see your GP, so I think all of these things can help to relieve pressure and make more rational use of resources.
Would this include self care?
Yeah we have to be much more effective at helping people to self care – it was part of the Derek Wanless review at the early stage of the Labour government, patients becoming better informed and equipped to self care.
But we need to make the upfront investment to make that happen.