The health secretary is in expansive mood, his arms flung wide across a gigantic white sofa in his Whitehall office. Blue tie, ready smile. The very image of a future prime minister.
And he has good reason to be cheerful. In just two years, he has managed to recast his office as both captain and critic of the health service. No small feat, after the disastrous effect of his predecessor’s health reforms.
He has singlehandedly turned the Conservatives’ election albatross into a weapon to attack Labour’s record in office. And GPs have been at the centre of his political manoeuvring, with seven-day practice opening and the return of the ‘family doctor’ forming the centrepiece of his plans for the NHS. But whether these shiny new policies can paper over the widening cracks in general practice remains to be seen.
Pulse meets Jeremy Hunt at a crucial time, as he prepares for party conference season and the next election, just seven months away. Despite this, he looks relaxed, but businesslike. ‘Come in, sit down,’ he says, striding to a seating area with a coffee table covered in medical magazines and newspapers. ‘Now, shall we get started?’
GP leaders say they have never known morale to be so low in the profession, with many thinking about leaving and trainees discouraged from joining. How can this be fixed?
We have to recognise the fact that GPs are working very hard, and what I try to do is to make it clear that GPs are absolutely central to my vision of the future of the NHS. The great changes that we have seen in the NHS over the past 65 years have focused too much on the acute sector, and we now need a revolution in out-of-hospital care, which brings properly integrated care with a focus on prevention and not just cure. I think that for most members of the public – certainly for me – I would like my GP to be in the driving seat of that change. But I recognise that to do that we need more capacity, more GPs.
But it is a leaky bucket. People are leaving the profession without being replaced.
We are working very closely with the RCGP on what can be done to improve retention, looking at returners, retainers, all those things. So we are very conscious of the pressures in general practice. Some GPs, I know, feel like they are on a hamster wheel, and there is no point in just asking them to go faster and faster. We need to find a better way of doing this.
The key to this is funding, and in recent years GPs get about 8% of NHS funding and they do about 90% of the contacts. That can’t go on, can it?
What has to change, without question, is the increasing trend to spend more of the NHS budget on acute care. While I understand the importance of targets in improving, or reducing, the time people have to wait for operations or in A&E departments, they have had the unintended consequence of sucking money into the acute sector.
You have the power to say to NHS England: ‘This has to happen’. Are you going to do that?
NHS England and I are in complete agreement that this has to happen. We are serious about this. There was the extra £250m that we put into the GP contract last year for improving care for the most vulnerable older people. And there is the Better Care Fund – a £3.8bn shift of resources from the NHS hospital sector to the out-of-hospital sector. We are looking at ways to see if GP practices can be part of this. Things are happening, and we need to make sure they continue.
One thing you are directly responsible for is the pay review. If next year the DDRB recommends an above-inflation uplift for GPs, will you agree to it?
I don’t want to speculate because it’s a hypothetical situation. We haven’t decided yet what we are going to do with the DDRB. My general approach to these independent bodies is you listen very carefully to what they have to say…
…I was just getting on to that. There are times when you actually have to decide what’s right for the NHS, so in the end my final decision is based on what’s right for patients. But you would not employ people like the DDRB unless you treated what they are saying very seriously.
Pulse currently has a campaign about stopping practice closures, as there are quite a lot of practices around the country facing this. Do you think they need emergency support? Do you support our campaign?
As health secretary, you are damned if you do and damned if you don’t. There are strong voices bitterly complaining that you can have two practices next door to each other doing the same amount of work and paid different amounts, because of differences created by MPIG, PMS and so on. There is a very strong body of opinion among GPs that says we need to move to a more fair, a more equitable, funding basis.
Surely that shouldn’t involve practices closing? That’s very bad for patients.
It’s not because we are taking money out of general practice. That money is staying in general practice. It’s because we are trying, with the agreement of the BMA, to move to a fairer funding formula, and we want to make sure we handle those changes in as sensitive way as possible. We are certainly not in the business of closing practices, in fact – as I said to you earlier – we want to increase the capacity of general practice, we need more GPs.
I think most people would agree. It’s whether that should involve practices closing or whether they should be supported to merge or restructure. That’s what we are calling for.
We are looking at all these things on a case-by-case basis, because circumstances are different in different areas.
So that’s a maybe. Maybe you support our campaign?
I think I support the aims of your campaign, I’ll put it that way. But I also need to listen to the GPs who’ll say: if we are going to have modern, reformed general practice that can do all the things we all want, we have to have a fair funding formula that applies equally to all GPs.
You have talked a lot about trusting GPs as professionals and reducing bureaucracy. You said you would like to see the back of QOF. Is that going to happen?
Yes. I would like to see as much progress as possible in helping GPs to get back to what they originally chose general practice for. I think it has become too dominated by targets linked to money. But if you are not going to secure performance that way, you have to find another proxy. I think it’s much better to move to a world where we are much more open about performance and we create a learning culture, not just throughout general practice, but the whole NHS. Peer review is a much more powerful tool than the blunt instrument of money and targets.
You have talked about ‘naming and shaming’ for cancer diagnosis recently. Do you want to see that in other areas as well?
I would never want to publish just one indicator. My comments on cancer diagnosis were somewhat misinterpreted. But I do believe that across all areas that GPs operate, GPs need to know, and the public has a right to know, if they are outliers. Every GP I have met wants to know that because there may be a good reason – in which case it’s fine – or there may be something they need to improve in the delivery of a service. I think this is really important information, and one of the lessons of Mid Staffs is that we shouldn’t sit on information inside the system that we don’t share with the public.
One of the big areas of paperwork for GPs is the CQC inspection regime. Are you looking at reducing that?
We have to allow the new inspection regime to bed down. When we started the hospital inspections, people said: ‘We can’t believe 50 inspectors are coming in and seeing the hospital.’ [But] now we are hearing tremendous support for this new regime, because hospitals realise they get a huge amount of useful information. So we need to make sure we don’t overrun people with bureaucracy, but also let GPs see some of the reports they are going to get from chief inspector Professor Steve Field. I hope they will be a way of improving things.
I understand you have manned the phones at a GP practice. How was that?
It was very informative; the phone never stopped. What struck me was the point about lack of capacity, because nearly every caller wanted an appointment, and I had to say: ‘No appointments today, you can call tomorrow at 8 o’clock. Otherwise I’m afraid I can’t book you for two or three weeks.’ That’s why I’m clear that we need to improve capacity in general practice.
Jeremy Hunt’s CV
Home: Divides his time between Westminster and his constituency home in Farnham, Surrey
Family: Married Lucia in 2007; they have a son and a daughter
Education: Charterhouse School; first-class degree in politics, philosophy and economics from Magdalen College, Oxford
1990-91 Taught English in Japan
1994 Co-founded the successful educational publishing business Hotcourses
2005 Elected as Conservative MP for South West Surrey
2010-2012 Secretary of State for Culture, Olympics, Media and Sport
2012-present Secretary of State for Health
Career high: 2012 Olympics opening ceremony
Interests: Languages, Latin dancing.