Matt Hancock: ‘Things are moving in the right direction’
Pulse editor Jaimie Kaffash grills the health secretary on why his plans for general practice will produce different results this time round
Jaimie Kaffash, editor of Pulse: The first thing GPs want to know is about your pledge to increase GP numbers by 6,000 by 2024/25. We’ve seen a previous pledge by your predecessor fail. Why should this be any different?
Health secretary Matt Hancock: Because we have got a clearly costed, funded plan to increase numbers of GPs and other practice staff. Since taking over as health secretary 18 months ago when total numbers of GPs was falling, I have turned that around so that the number is rising now, albeit slowly, and I want to see that rise go much faster. I am delighted to have got the commitment to the training budget and the expansion of GP training and with the new NHS visa we’ll be able to recruit the proportion of the increase that is committed from around the world.
JK: But international recruitment doesn’t seem to have worked so far, there doesn’t seem to have been the demand we were hoping for. I think it has only recruited in the hundreds when you are talking about 3,000. What is going to be different this time round?
MH: The difference is we will be reducing a whole load of the bureaucracy that surrounded the ability to come and practice here in the UK, at international recruitment. The NHS visa will reduce the time and bureaucracy around visa rules.
Having announced in Pulse that I was talking to the Treasury about this, I’m delighted that the Treasury announced a review into the operation of the taper
We have been working with the GMC on reducing the bureaucracy around the ability to get a UK registration which in the past has seen some highly qualified, world-class doctors having to go through hundreds of pages of administration in order to gain a UK registration. The GMC are committed to simplifying that and we are committed to simplifying the visa rules with the new NHS visa. Plus a central NHS drive for international recruitment rather than leaving it to practice by practice, I am confident that we can make progress.
JK: It does seem from what we hear anecdotally that there just isn’t the demand out there, that international GPs are not particularly interested in working in UK general practice. Have you got any evidence that bureaucracy is the the thing putting them off?
MH: Yes. We have been working on removing and reducing the barriers to international recruitment, not just for GPs, but also for other doctors and for nurses and some of the feedback in terms of the time it takes and the bureaucracy has been astonishing.
JK: And there is also a pledge to improve retention of GPs. There are quite a few retention schemes in place and again they don’t seem to have worked well. What are you doing differently?
MH: There are two parts to the retention. We need to make sure that the financial rewards to staying in general practice are strong and we are committed to that.
The second is that the surveys show that the biggest reason for leaving early or reducing hours is because of pressure of work and so we have to turn what has been increasing pressure into reducing pressure. Now we can do that of course firstly through the new recruitment, because the more GPs and other practice staff that you have the more you can alleviate rather than increase that pressure.
And secondly, the access review is going to play a big part because the survey of pressure on GP staff show that there is a vast difference between different GP practices. Those who have modernised their access practice through triage and through technology in particular tend to have less pressure on staff. The variation in both access - and the consequential pressures on staff of poor access processes - shows there is a huge amount of progress that can be made.
JK: We are being told that GPs working 13-hour days and seeing an unsafe number of patients. We did a survey earlier in the year that said more than 50% said their workload was unsafe for patients. In the current climate, GPs say they don’t have headspace to have a look at their access and the way their practice is structured that you say will help them alleviate workload. What can you do in the very immediate term that can help GPs to practise at a safe level for patients?
MH: You are totally right. Look, GPs are trained experts in helping people stay healthy and diagnosing problems. The primary care networks have gone down incredibly well across general practice and they are being supported to be able to make these improvements in access and process. You know running a practice or a group of practices is a different job to clinical work. And of course some GPs are very good at both, and like doing both, but you know that is not for everybody. And one of the advantages we are already seeing amongst PCNs is not just that different practices can see what best practice looks like within a group locally, but also that there is the administrative capacity to make improvements like this.
Primary care networks have gone down incredibly well across general practice
JK: You mention they have gone down really well what evidence do you have that practices are actually in favour of PCNs? From our point of view we haven’t seen a massive amount of evidence saying one way or the other. What have you seen?
MH: Well that’s just what I pick up from my many, many visits to practices and from all the feedback that I get. Also, if you look at the speed with which they were put in place. PCNs were announced in the early part of the year. PCNs were put in place, when they were announced in July, 98% of places already had them in place. I haven’t seen an NHS England policy that has gone from announcement to full implementation in six months for a long time and that shows the level of enthusiasm behind the implementation.
JK: Moving onto pensions. You told Pulse exclusively in January you were looking at pensions. There has been quite a bit of pushback since the actual proposals were released. The original proposals called for a 50/50 scheme [where GPs can have their pensions contributions to 50%], but this met with criticism. The latest proposals involve even more flexibility, but the BMA has said they won’t do anything to alleviate the crises. They have called for an end to taper. Is that something you are going to be looking at?
JK: Have they discussed this with you or is it something you recommended to them having heard from GPs and medical groups?
MH: Having originally announced in Pulse magazine that I was talking to the Treasury about this, I’m delighted to say that the Treasury eventually, under the new chancellor, announced a review into the operation of the taper and obviously I am working very closely with them on that.
JK: Will it have changed the proposals that are on the pensions proposals, or will this be going on in conjunction with it?
MH: They’ll be done in conjunction.
That’s what I pick up from my many, many visits to practices
JK: You have talked about prevention and most recently about DNA testing from birth. GPs have said this will increase demand and they haven’t seen evidence behind it for its positive effect. What evidence is there in favour of this testing? And, at a time when we have had the worst A&E figures out ever and general practice is in crisis, is it the right time to be promoting more patient demand or should we be looking at reducing patient demand?
MH: The way to reduce patient demand is to have better information about patients and understanding somebody’s DNA is a critical piece of information to understanding as much as we can about their clinical needs.
The increase in demand on A&E, a 4.4% increase in attendances in a year is not sustainable. And hence we need to drive forward, strengthen primary care and the preventative agenda and having more information about a patient helps to diagnose better.
There is endless evidence about how this works. In the same way that the existing heel prick test gives information about a child, so do too does sequencing the genome. Of course, it’s all got to be done within a strong, ethical framework because this is sensitive information and clearly the ongoing work on that needs to come to fruition.
As for the clinical evidence, one example that is very striking is a study at Addenbrookes in which around 300 children had their DNA sequenced. The children were ill, had their care pathway improved in three quarters of cases once their DNA was known. Now, because they were all already ill, of course that figure would be lower amongst the general population obviously. But nevertheless, it demonstrates the power of the extra information that is in the genetic code.
JK: Your predecessor Jeremy Hunt and David Cameron’s big flagship policy for general practice was seven-day routine access. We have done plenty of research on this that shows there has not been the demand for this, especially for Sunday opening, that may have been hoped for. Are you going to be reviewing the seven-day access scheme?
MH: Well, seven-day access is now rolled out across the country and what matters is that doctors are available when it works for all concerned. Doctors and patients alike. There is an increase in evening availability in the same way there is an increase in telemedicine, and I think that sort of flexibility is a good thing.
In fact, one of the things we have found about evening availability is that, done by telemedicine, lots of GPs like it because you can do evening surgery from home and that suits everyone, if the patient doesn’t need to come in and wants to use the technology. Now, of course, face-to-face appointments must always be available obviously as well but this sort of flexibility where it is being used seems to be a positive step.
The way to reduce patient demand is to have better information about patients and understanding somebody’s DNA is a critical piece of information
JK: Labour has promised £2.5billion for updated GP premises and IT infrastructure. The BMA have done plenty of surveys that show that GPs don’t feel that their premises are at a safe level, and I’m sure you heard at the RCGP conference Helen Stokes-Lampard talking about 17 minutes for her computer to load up. What pledges can you give to ensure GPs that they are going to be working in safe environments?
MH: These are both critical issues. As you know, I have made technology one of my top priorities since taking over and that means upgrading the frontline technology. So we have a plan for that being led by NHS X and we also have increased our capital budgets across the board with more to come.
JK: Labour has also pledged to reinstate the student bursary for nurses at a time practices are struggling to recruit practice nurses. You have talked about increasing numbers of nurses what measure are you taking to do that?
MH: Increases in the number of nurses is important and something that we are already working on. You have to make sure you get the policy right to actually deliver the increase in the number of nurses. But I have said before we are looking at ways in which we can have a targeted approach.
JK: But you are not considering reinstating the bursaries that the Royal College of Nursing has called for?
MH: We are working to make sure we increase the number and that of course means targeted support in the areas of greatest need but we also need to the fund the increase in clinical placements because otherwise, you got to both have the applicants but you have got to have places for them to study.
The recruitment of other practice staff is going strongly
JK: What final message would you give GPs who are concerned about rising workloads, concerned about reduced recruitment numbers after 9 years of Conservative government?
MH: The recruitment of other practice staff is going strongly and going well. The number of GPs in training has hit another record high this year. We have turned around the decline in overall full- time equivalent GP numbers. And so things are moving in the right direction and we are committed to driving that further and faster.