It’s a cold clear February evening in the heart of Westminster, and Jeremy Hunt is in expansive mood.
The health secretary welcomes Pulse into his extensive office – a serious piece of Whitehall real estate with long conference table, impressive desk and separate sitting area – and launches into a measured, cogent defence of the ‘fundamental change’ he is attempting to bring about in general practice.
There’s no denying that Mr Hunt has enjoyed a successful 18 months as secretary of state. Stepping into the role with his predecessor’s highly controversial NHS reforms hanging in the balance, Mr Hunt has played the politics to perfection, drawing the sting from the health act, cleverly positioning himself as the patients’ champion and carefully distancing himself from awkward headlines over the Mid Staffordshire scandal, NHS 111 and care.data.
Mr Hunt’s decision early on in his tenure to force through a draconian contract imposition was a rare misstep which won him few friends among GPs. But his political nous was much in evidence with the 2014 contract agreement. Somehow, against the odds, the deal was welcomed by both the BMA and the national press, even as Mr Hunt stuck the knife into his political opponents, claiming he was unpicking the worst excesses of the 2004 contract agreed under Labour.
So, will the new deal from April really ‘bring back the family doctor’, as he promised in the pages of the Daily Mail?
‘Well, I think that perhaps makes it sound a bit more traditional than what I’m envisaging,’ begins Mr Hunt. ‘But the idea of doctors taking personal responsibility for the patients on their lists, and having that strong bond between doctor and patients, is absolutely a part of what we envisage.
‘I think one of the great sadnesses in the NHS has been the way that continuity of care has become so undermined as the system has become fragmented and as the GP contract for 2004 got rid of named GPs, which I think in retrospect was a great shame.’
Quite what named GP responsibility will actually involve remains somewhat unclear, with GPC negotiators initially suggesting it will just ‘formalise’ what most GPs already do, and health minister Dr Dan Poulter recently revealing that practices will be able to devolve the care coordination element to district nurses.
But Mr Hunt insists the new contractual responsibility will mean a major adjustment to how GPs work – an adjustment fully supported by the GPC.
‘I think [GPC chair Dr] Chaand Nagpaul has been visionary in his belief that this should mark a fundamental change in the way general practice operates, so that we can move – initially for the most vulnerable older patients – from a system of reactive care to a system of proactive care,’ he says.
‘It’s a very big change, and there’s a lot of extra work, but that’s why we’ve removed 40% of the QOF targets to help free up GPs’ time, and we’ve also put in extra resources. The extra £5 [per patient funding] is a reflection of the fact that we know that to deliver better care we need more capacity in the system.’
Yet despite the promise of that pot of money, the one big unknown about the 2014 contract, at least as this issue of Pulse went to press, is what, if any, overall uplift will it be attached to?
Last year, Mr Hunt rejected the recommendation from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) for a 2.29% funding uplift, handing practices instead an increase of just 1.32%. And he refuses to be drawn on whether he will follow the DDRB’s recommendation this year, offering only that he will ‘have to see what they say’.
He does, though, offer a take on GP pay you’re distinctly unlikely to read in the Daily Mail anytime soon: ‘What I would say is that I have no problem at all with GPs being well paid, if they’re doing a good job for their local communities.’
Throughout the whole interview, in fact, Mr Hunt adopts an emollient tone, a man very much aware of his audience, lavishing GPs with praise and deftly batting away questions on the detail.
He acknowledges GPs work ‘phenomenally hard – it’s an utterly exhausting day’, but refuses to comment on the decision to cut funding for occupational health services (‘it’s not for me to second-guess NHS England’). And he is keen to address the GP recruitment crisis (‘I hope to be seen by history as one of the most pro-GP health secretaries there’s ever been’) but refuses to say how many more GPs we need (‘we’re doing the modelling at the moment’).
Like many of his predecessors, Mr Hunt has devoted considerable energy to the thorny question of GP access. His particular focus has been on seven-day opening, with a £50m ‘challenge fund’ set up to pay for pilots of much wider access across nine areas.
Yet while the nature of the pilots is limited and exploratory, many GPs fear that the inevitable banner headlines trumpeting the scheme have created unrealistic expectations among patients – particularly when some estimates suggest offering seven-day opening nationally could cost in excess of £2bn.
So, here’s his chance to clarify once and for all what the public can expect. Should every patient in England expect to be able to book a routine appointment with a GP at the weekend, if not at their own practice then at one nearby?
Mr Hunt picks his words carefully.
‘I think a lot of the public would say that. But I think we need to understand a lot better what we’re talking about, which is why we’ve got these pilots.
‘When it comes to people who are in work, of course they want to access GPs at a time which is convenient for them. And weekend opening is one possibility; another is email consultations.
‘And I understand a lot of GPs hold their hands up in horror at the thought of the floodgates opening if patients were able to email them, but in fact the evidence from the US is that it can be highly effective… So I think all these things are things we need to understand before we decide on what the right national approach is to weekend opening.’
And what about practices that close their doors within core opening hours, for training or other reasons? A slightly flustered look suggests Mr Hunt may not be entirely up to speed with the latest twists and turns in the Christmas closing row, and NHS England’s subsequent summit on in-hours closing. But his answer will reassure GPs somewhat.
‘I think it’s something which depends from practice to practice on what’s appropriate,’ he says. ‘All practices need to make sure their services are accessible to the people on their list, and all practices need to make sure we do what we can in the spirit of the new reformed GP contract to restore continuity of care for the older, most vulnerable patients. But I think it’s important we don’t just see the whole debate about general practice as a debate about opening hours.’
And with that our time is up. An engagement in Parliament beckons. With a smile and some small talk, Mr Hunt sweeps out of the room – the perfect politician, and a man very much on top of his brief.
Are there sub-standard GPs out there?
That’s not for me to say, but when I talk to people like the RCGP and even the BMA, they do say there is too much unacceptable variation in the quality of care.
Has GP commissioning improved the NHS?
Undoubtedly. A lot of changes that might have been very controversial under the PCT structure are getting much more accepted because they’re clinically led.
How can we solve the recruitment crisis?
We need to do more to make general practice more attractive to medical graduates.
How many of your constituents would you say understand care.data?
I don’t know the answer but I don’t think NHS England could have done more – they put a leaflet through every single person’s door explaining it.
Would GPs be better off as a salaried service?
There are pros and cons – frankly, I’m not looking for a system where GPs can be ordered at the drop of a hat to do this or do that.
Divides his time between Westminster and his constituency home in Farnham, Surrey.
Married his wife Lucia in 2007; they have a son and a daughter.
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.
2012 Olympics opening ceremony.
Languages, Latin dancing.