Leading Lancaster Tory says current GP system is ‘dysfunctional’

A leading Conservative councillor at Lancaster City Council has said the current primary care system for doctors practices is ‘dysfunctional’ and the current NHS competition system ‘does not work’.

Tuesday, 5th October 2021, 4:55 am
Updated Tuesday, 5th October 2021, 9:25 am
New Lancaster City Council Conservative group leader Coun Richard Austen-Baker said problems with primary medical care system must be addressed, especially as the city grows in coming years.

The comments came during a debate in which the city council agreed to take a series of steps to encourage the creation of at least one new, independent NHS primary care practice in the district, including Morecambe, and the expansion of GP services.

The city council also heard that recruitment to new NHS developments in the district is difficult, such as blood services and mental health staff.

New Lancaster City Council Conservative group leader Coun Richard Austen-Baker said problems with primary medical care system must be addressed, especially as the city grows in coming years.

He put forward a motion calling for the city council to act, using its general influence and whatever specific powers it had, to encourage change.

He also queried the scenario under which health service concerns can be viewed as minor side issues in the planning system, such as the proposed construction of up to 9,000 new homes around Lancaster University, the M6 and south Lancaster under the Government-backed Housing Infrastructure Fund programme. An agreement for the HIF programme was recently agree despite some opposition from various councillors including the city council’s Green leader.

At the latest full council meeting, Coun Austen-Baker explained that he had amended his resolution following all-party talks and removed a n element for the creation of a primary care services for private patients. This partly reflected a new development in Garstang.

His amended resolution called on the city council, by its cabinet and its executive officers, to ‘take all such steps, working with its partners, to bring about the establishment of new primary medical care facilities for NHS patients within a new practice, independent of existing practices within the Lancaster district.’

Its amended second element called on the council’s Overview & Scrutiny Committee to establish an annual meeting to discuss healthcare matters in the district, to which should be invited representatives of relevant NHS bodies, including the local clinical commissioning group (CCG).

The NHS has been subject to many changes in recent years. The clinical commissioning group structure was established by a previous Conservative government. The CCG system is typically led by local doctors, working with other primary care professionals such as community nurses, who see patients and also commission (buy) services for their patients from local hospitals, mental health units or ambulance services. Meanwhile the national organisation NHS England funds specialist hospital services, for example cancer care or heart surgery.

However more change is forecast with the Government’s creation of integrated care systems across England. The move is designed to co-ordinate medical and social care services between local NHS organisations, including GP surgeries, and local councils.

Speaking about GP services in Lancaster at the full council meeting, Coun Austen-Baker said: “After the merger of six practices, patients began to experience a considerable diminution in the quality of service. The ability to get an appointment. was typically taking two weeks or people were asked to call back the next day. Previously it would typically have been two-days to get an appointment. Repeat prescriptions now have to be done online or, if done in person, then you can be waiting a week. It used to be two days.

“We have got quite a problem. In this country, doctors are paid for how many patients they have on a list. In other countries, they are paid on how many patients they see.

“Here, employing more GPs and receptionists is viewed as a cost coming out of the [medical practice] business. GP practices have always private businesses since the foundation of the NHS. There are just a few exceptions, such as doctors working in hospital A&E departments.

“Abroad, there is an incentive for doctors to see patients. The motivation is for keeping patients happy. The sanction is that patients can leave if they are unhappy.

“We might like to try that here in Lancaster? Thirty thousand new people in 9,000 new houses equates to 15 new GPs. Seventy per cent of GPs currently work part time, with one in seven working two days or less. In 1975, we had a UK population of 50m and had 20,000 GPs. Today we have a population of 65m and more than 61,000 GPs. It’s not a question of having enough doctors. We have got the doctors but not enough hours.”

Regarding the responsibility for considering future medical needs and facilities in planning applications, Coun Austen-Baker said: “We are giving planning permission for new homes for 30,000 people. Do we do that without caring about transport or whatever? It is not our responsibility to run the future HS2 railway but we represent residents and we have to consider relevant considerations. So do we have satisfactory primary care facilities or enough school places? These should be relevant planning considerations.

“We are responsibly, morally at least, to ensure that people who are going to live in these new homes can be properly cared for, such as with GP care. It seems to be well within the council’s remit to at least encourage others to set up a new GP practice. To do so would bring in 15 well-qualified, well-paid professionals to the area.

“I believe we can and should pass this resolution. A bit of competition improves systems. Aneurin Bevan created the NHS in 1948 but he saw the need for the discipline of business.

“I’ve heard of a number of problems with patients experiencing delays on telephone and other issues. I don’t doubt the people at practices are trying to deliver good care. But the system is dysfunctional. There has been a clamping-down and pushing-out of competition. Other types of businesses in other sectors would probably not have been allowed to have done this. The NHS system has allowed this. The facts speak for themselves. The NHS competition provisions have been tested and do not work.”

Green councillor Caroline Jackson, who is also leader of Lancaster City Council, said: “Establishing a new GP practice may take some time. Having this settled resolution means it is more likely. The NHS takes time to change. I realise it’s not our direct responsibility but having this and telling the people who are responsible we would like this to happen is worthy. I support this.”

Labour councillor Erica Lewis said: ”The city council’s Overview & Scrutiny Committee may be able to pick up on this and also with links to the county council’s strategy and access to primary care across the district. There are a few city councillors who get to sit on the county’s health committee.

“As part of the south Lancaster development, there have been talks about primary care. I’ve also had complaints about access to appointments. We can collate local views and concerns about primary care and the NHS. This issue also feeds into conversations about new hospitals and what services might go into community settings.”

A number of other councllors including from Morecambe asked for clarity that the resolution would cover future NHS needs across the whole district. This was confirmed.

Green councillor Gina Dowding also sits on the county’s council’s Health Scrutiny Committee. She said: “It’s quite difficult to get local issues on the agenda. The county health scrutiny committee will generally look at the whole county. There have been so many issues over recent years including recruitment to this district and other areas. It’s a huge problem. Its endemic in many parts of the service. We’ve seen this recently in mental health and blood services. Recruitment to new services is difficult. Regarding south Lancaster, we will need to be ahead of the game for when people actually need the new services.”

The primary care motion was passed by the full council.