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General Practice (Northamptonshire)

I know that my hon. Friend attaches great importance to health service issues as part of his ““Listening to Wellingborough and Rushden”” campaign, and I am delighted that he has taken this opportunity to highlight what is a real problem for many vulnerable people in Wellingborough and Kettering. Often, several members of the same family will find themselves being registered with different local GPs, which cannot be the best outcome. An increasingly important issue in Kettering and Northamptonshire is the number of people arriving from eastern Europe and seeking GP services. That is causing problems for GPs with language—many such people are unable to speak proper English, especially when it comes to medical terms—and with gaining access to previous medical records. Every GP to whom I spoke in the summer recess said that they had new arrivals from eastern Europe on their books and that it is a genuine problem for them. Many GPs feel that it is inappropriate to include translation services, which are paid for by the PCT, in the enhanced services budget, because the PCT can then claim that it spends more than the indicative sum on enhanced services. That effectively deletes the money that is available for the development of medical GP services. Will the Minister be kind enough to look into that important issue? GPs are also concerned about the recent NHS reorganisation in the county. The PCTs that existed two years ago have been merged into one PCT that covers the whole county. My hon. Friend the Member for Wellingborough (Mr. Bone) and I opposed that reorganisation, as I understand Labour Members in the county did, but the Government nevertheless went ahead with it. The problem is that part of the big overspend in the south of Northamptonshire has effectively been transferred to the north, where the overspend was not nearly as great, putting budgetary pressures that did not previously exist on GP practices in the north. As a result, GPs are prescribing cheaper drugs than they would otherwise prescribe because of the budgetary pressures from the PCT and the strategic health authority. Another big concern that local GPs have brought to my attention is the state of children's mental health services in the county. One GP wrote to tell me:"““I think the most significant aspect of healthcare in the Shire is the poor service available in Mental Health and particularly Children's Mental Health. Only this week…we have a 13-year-old girl with…an Eating Disorder who has been dismissed as ““depressed”” by the Service and she is too young to access alternative services so her (not well-heeled parents) are referring her privately.””" The letter goes on:"““If young people's mental health problems are not properly addressed, they are at best emotionally scarred for life and grow up to be emotional cripples, unable to sustain healthy relationships, and at worst end up in crime””" or on drugs. All the GPs to whom I spoke highlighted that as being an issue—patients requiring services that, all too often, simply are not available. It has been brought to my attention that computerised cognitive behaviour therapy has been proposed by the National Institute for Health and Clinical Excellence as an effective tool for many patients. It was announced some six months ago that CCBT would be available. It is due to become available in Northamptonshire this month, but the responsible PCT team has only just been appointed. To add further insult, access to the therapy is being restricted to patients with severe depression, whereas NICE recommends it for mild depression and neuroses such as obsessive-compulsive behaviour. Again, there is a real concern that GPs are not able to access the services that they would want to access from the local mental health team. GPs are also concerned that they are required to spend a growing amount of time on collecting and producing data under the quality and outcomes framework. They rightly say to me that, all too often, they spend far too much time on data processing instead of patient care, particularly as they have to deal with lists that are 30 per cent. above the national average. Unfortunately, there are also problems with the choose and book scheme. One example that I can put before the Minister is from a local GP who referred a patient through choose and book for orthopaedics. The GP phoned the number, and someone took the details and said that the patient should phone the office where orthopaedic referrals were triaged. The GP phoned the number, but an answerphone said that staff were on holiday for two weeks and to phone another number. The GP phoned the other and was told that the office was not taking bookings like that but that it would wait for a GP letter and then write back. Two weeks later, a letter was received advising that the patient needed to see an orthopaedic consultant and to phone yet another number. The GP phoned the number six times, each time being cut off when the phone was answered. The GP finally got through and was told that the phone ““is always doing that””. Those are frustrating circumstances for hard-pressed GPs. They made a particular point of wanting me to highlight the fact that choose and book is not working as it should. Now we come to the issue of GP contracts. In good faith, the Government negotiated contracts with GPs. Reference was made to out-of-hours services. NHS survey data published in July show that 85 per cent. of patients in Northamptonshire are satisfied with GP surgery opening hours. Only 7 per cent. of patients said that they would like GP surgeries to open at weekends. There may be demand for surgeries to open in the evenings and at weekends, but having asked my constituents and having spoken to GPs, I can detect no such surge of opinion in Kettering or Northamptonshire. GPs rightly say that they would expect few people to take advantage of the service if they were to open for weekend surgeries. They also point out that although the Government may be pressing the issue because they are embarrassed that, in their view, they are paying GPs more than they should get, there would be extra costs outside the GPs' remuneration for paying for staff and building occupancy at weekends. Local GPs provide an out-of-hours service through the Keydoc service. It is provided on a rota basis, and I can tell the Minister that it does a better job than NHS Direct, and at a far lower cost. In many cases, phone callers find themselves speaking with the Keydoc service because NHS Direct is unable to cope with the volume of calls that it gets. I am not saying that Keydoc is perfect. I have had complaints about it, but I have also had complaints about NHS Direct. I draw the Minister's attention to the concerns of a constituent who e-mailed me. He stated:"““I today had occasion to contact the NHS Direct service. I needed medical advice after swallowing an object…I tried to call for over 4 hours and constantly received an engaged tone. In the end I contacted my GP surgery who were able to reassure me. A quick straw poll of work associates shows this is typical and generally they call the out of hours GP service because NHS Direct is either busy or is so general in advice that it is not sufficient for purpose.””" That unsolicited e-mail was from a constituent in Rothwell. Local GPs are concerned about the amount of money that the Government put into NHS Direct, particularly when they compare its cost-effectiveness with that of Keydoc. Overall, the message from Northamptonshire is that GPs are extremely hard-working. In general, the system is working well, but GPs are beginning to feel unappreciated by the present Government, particularly in respect of the unnecessary pressure to extend opening times outside the weekday appointments system. There is growing concern about the amount of data that they have to collect, and they feel that the Government ought to reprioritise GP care rather than concentrate only on hospitals when they talk about the NHS. I close by placing on the record three surgeries in the Kettering constituency that in a recent NHS survey achieved levels of satisfaction that were higher than the national average. The Guilsborough, Dryland and Mawsley surgeries are setting an extremely good example for local GP surgeries throughout Northamptonshire.