THE TORIES HAVE MADE IT HARDER TO SEE A GP

THE DOCTOR CANT SEE YOU NOW.

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Contents Introduction: The Doctor cant see you now ....................................................... 3

Nearly 600 fewer GP surgeries offering extended opening hours ...................... 4

1-in-3 GP training places unfilled ........................................................................ 6

Significant pressures on GPs this Easter .......................................................... 8

Wider decline in GP access ................................................................................ 10

Five more years of the Tories would mean even longer waits to see a GP ....... 11

Labour has a better plan to improve GP access ................................................ 13

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Introduction: The Doctor cant see you now The Tories have made it harder to see a family doctor. Despite his promises on better access, David Cameron cut Labours scheme for GP evening and weekend opening. Today its harder to see your GP than it was in 2010. The NHS is now under unprecedented pressure this Easter with patients facing the prospect of queues and long waits after the Bank holiday weekend. Doctors have warned of the pressures they are under with the situation so bad that NHS England took has taken unprecedented steps to try and lessen the queues. The Tories have taken the NHS backwards over the last five years. New analysis reveals the scale of the problems in relation to GP care:

Five years after David Cameron promised GP access 8am-8pm, 7 days a week in his 2010 manifesto, new figures reveal that nearly 600 fewer GP surgeries opening at evenings and weekends under the Tory-led Government.

Over the last three years, the number of people saying their GP opening times are not convenient has risen by almost two million.

The GP workforce crisis deepens as new data shows 1-in-3 GP training places are unfilled so far this year, with doctors predicting that unless action is taken things will keep on getting worse.

The result of declining GP access has been long waits to see a GP, long morning queues to get into the GP surgery, and A&E attendances soaring because many people cannot get a GP appointment. Based on current trends, five more years of the Tories failing plan would mean that, by 2020, there would be over 20 million people waiting a week or more for a GP appointment or unable to get one at all

This record of failure is why people wont trust David Cameron when he promises seven day a week access to GPs. As Ed Miliband said at last weeks Leaders Debate, David Cameron made this same promise at the last election. He broke his promise before and he would break it again. We know what five more years of the Tories would bring because weve seen the last five years. Another Tory government would see service standards continue to deteriorate. Their plans for extreme spending cuts in the next Parliament mean they simply wont be able to protect the NHS. Only Labour has a better plan for the NHS. We will invest 2.5 billion, which the Tories will not match, to provide 8,000 more GPs and 20,000 more nurses, so the NHS has the time to care. The NHS cannot survive five more years of the Tories failing plan.

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Nearly 600 fewer GP surgeries offering extended opening hours The previous Labour governments extended hours scheme dramatically increased GP

evening and weekend opening:

o When Labour introduced its GP extended opening hours scheme in April 2008 just 12 per cent of GP practices were open in the evenings and weekends.i

o By July 2009, 77 per cent of GP surgeries some 6,384 surgeries in total were offering evening and weekend appointments, delivering over four million additional appointments a year.ii

Despite promising that people would be able to access their GP from 8am 8pm, 7 days

a week in his 2010 manifesto,iii David Cameron promptly cut the funding for Labours extended hours scheme and made it harder to see a GP:

o He cut the funding for the scheme from 3.01 per registered patient to 1.90.iv

o He relaxed the GP contract, meaning that practices only had to open for an extra

30 minutes and appointments could be offered by any healthcare professional, instead of only by a GP.v

o He removed the financial incentives for GPs to improve access to appointments in the Quality and Outcomes Framework (which awards GP surgeries points for patient care, which are linked to financial payments, including patient reports of their experience in the GP-Patient Survey)

o And he scrapped the right to a GP appointment in 48 hours.vi Incredibly, in removing this from the NHS Constitution, the Tory-led Government described this as "no longer a priority".vii

Now, new government data, revealed through a parliamentary question published in

February 2015, shows that the proportion of GP practices offering extended hours has fallen to 72 per cent in 2013/14 (the latest year for which figures are available) some 5,794 surgeries in total.

This means 590 fewer GP surgeries open at evenings and weekends compared to Labours last year in office.viii

In 2013/14 over 70% of general practitioner (GP) practices were recorded as taking part in the extended hours scheme meaning patients can access a GP outside core hours at a time that is more convenient for them (source: Health and Social Care Information Centre report NHS Payments to General Practice, England, 2013-14, published February 2015). Dr Dan Poulter, answer to a parliamentary question, HC Deb, 24 March 2015, cW http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2015-03-19/228418/

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This fall in extended opening is also reflected in the GP-Patient survey. Analysis by the House of Commons Library reveals a significant and steadily growing trend in unhappiness with GP surgery opening hours between 2012 (when the data on these questions was first collected) and 2015 (the latest wave of the survey):

o The proportion of people saying their GP surgery is not open at a convenient

time has grown steadily from 15.69 per cent in 2012 to 19.05 per cent today.

o The proportion of people saying they are dissatisfied with their surgery opening hours has grown steadily from 6.98 per cent in 2012 to 9.91 per cent today.

The GP-Patient survey has a sample size of 900,000, making trends of this magnitude

highly significant.

This House of Commons Library analysis can be used to calculate the increase in the number of people who say their surgery opening times are not convenient. This represents an increase of 1.9 million in the number of people saying their surgery is not open at convenient times since mid-2012, and an increase of 1.6 million in the number of people dissatisfied with their surgery opening hours.

Jun-12 Dec-12 Jun-13 Dec-13 Jul-14 Jan-15 Change

Jun12-Jan15 Fairly or very dissatisfied with

opening hours 6.98% 7.30% 7.81% 8.53% 9.56% 9.91%

Equivalent number of people 3,733,860 5,338,101 +1,604,241

GP surgery not open at times that are convenient 15.69% 15.96% 16.65% 17.52% 18.77% 19.05%

Equivalent number of people 8,393,162 10,261,435 +1,868,273 Source: GP-patient survey. Population calculations based on ONS population figures

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1-in-3 GP training places unfilled

New figures from Pulse, revealed on the GP National Recruitment Office website, show that 29 per cent of GP training places remain unfilled following the first round of recruitment this year, compared with 8 per cent of places being unfilled at the same point in 2013 (the last year data is available for).ix

Already, over 500 fewer GPs have been trained in this Parliament, compared to 2010 training levels.

Training posts filled Difference from 2010 levels

2010 2,800 - 2011 2,658 142 2012 2,669 131 2013 2,738 62 2014 2,630 170

TOTAL FEWER: 505 http://www.publications.parliament.uk/pa/cm201415/cmhansrd/cm140616/text/140616w0006.htm#140616w0006.htm_wqn14

Doctors told Pulse that unless action is taken the situation is going to keep on getting

worse. Dr John Ashcroft, an executive officer of Derby and Derbyshire LMC in the hard hit East Midlands, told Pulse: If they really recognise the importance of general practice, somebodys got to find some real money to put in there, otherwise its going to keep on getting worse. Dr Krishna Kasaraneni, chair of the GPCs education, training & workforce subcommittee, told Pulse: I think it wouldnt be unreasonable to say the last two years for general practice recruitment havent been that great, simple as that. Pulse, 1 April 2015 http://www.pulsetoday.co.uk/your-practice/practice-topics/education/third-of-gp-trainee-positions-remain-unfilled-across-the-uk-following-first-round-of-recruitment/20009624.article#.VSETFPw7uFw

This comes after the Governments own GP taskforce admitted there is a GP workforce

crisis.

The Taskforce has concluded that there is a GP workforce crisis which must be addressed immediately even to sustain the present role of General Practice in the NHS, let alone enable it to expand and meet the growing healthcare needs of our population, irrespective of future models of care. NHS England, Securing the Future GP Workforce: Delivering the Mandate on GP Expansion, March 2014, Page 6 http://offlinehbpl.hbpl.co.uk/NewsAttachments/PGH/GP-Taskforce-report.pdf

The Governments GP Taskforce also set out how GP numbers have failed to keep pace

with demand: the number of full-time equivalent GPs per head of population has fallen since Labours last year in office, from around 62 per 100,000 in 2009/10 to around 59.5 per 100,000 in 2013/14 (the latest figures available).

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Disturbingly, evidence is also emerging from the NHS Information Centre that the GP workforce is now shrinking rather than growing. Whilst the number of GPs per 100,000 head of population across England increased from 54 in 1995 to 62 in 2009, it has now declined to 59.5. NHS England, Securing the Future GP Workforce: Delivering the Mandate on GP Expansion, March 2014, Page 6 http://offlinehbpl.hbpl.co.uk/NewsAttachments/PGH/GP-Taskforce-report.pdf

The number of GPs applying to leave the NHS and practice abroad has almost doubled

since 2009: the number of GPs issued with a Certificate of Good Standing by the General Medical Council (a prerequisite to emigrating and practicing medicine in another country) has risen from 266 in 2009 to 529 in 2013.x

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Significant pressures on GPs this Easter

NHS England wrote to all CCGs to demand they open up GP surgeries over the bank holiday weekend to avoid an Easter crisis.

GPs have been ordered to open on Saturday over Easter and hospitals told to empty their beds in the next two weeks amid fears of a looming NHS bank holiday crisis. Health officials have drawn up emergency plans because of concerns that struggling casualty departments could become overwhelmed over the four-day bank holiday. Family doctors have been instructed to open their surgeries on Easter Saturday, and hospitals have been told to spend the next fortnight discharging as many patients as possible. The unprecedented orders from NHS England, setting out an 11-point plan for hospitals, GPs and social services, come after hospitals suffered the worst performance on record over Christmas. Officials fear problems could be even worse when GPs close for Easter, because of record levels of patients stuck in hospital, for lack of help from social services and community healthcare. The Daily Telegraph, 5 March 2015 http://www.telegraph.co.uk/news/nhs/11452874/Emergency-plans-drawn-up-amid-fears-of-Easter-NHS-crisis.html

The memo, from Barbara Hakin, NHS England deputy chief executive, orders NHS services to set out how they are going to avoid any of the issues and risks that were experienced during Christmas and New year

For this public holiday in particular, the national tripartite organisations, working with the Association of Directors of Adult Social Services, would like to reinforce the importance of all organisations producing robust demand and capacity plans for the Easter period, with emphasis specifically on the following As part of this planning process, systems should also review, and explicitly address, in plans any local issues and risks that were experienced during Christmas and New Year 2014/15. Plans should illustrate how those same risks will be mitigated at Easter. Memo from Barbara Hakin to NHS CCG Accountable Officers and Trust and Foundation Trust Chief Executive Officers, 2 March 2015

Doctors have warned this weekend will be a challenge and the weaknesses of

the NHS will be exposed.

Dr Ian Campbell said: Easter weekend has always been a challenge and usually it is GPs who get the blame. The reality is demand continues to outstrip supply. This applies right across the NHS spectrum. It is just sharply focused in A&E departments. Cost-cuttings and under-resourcing can be hidden to an extent. But when the system needs to be at its best, the weaknesses are exposed. The Nottingham GP added: The anticipated problems at Easter are, quite simply, poor management being flushed to the surface. http://www.express.co.uk/news/uk/562442/GPs-ordered-to-work-Easter-Saturday-as-NHS-faces-new-crisis-at-breaking-point

The College of Emergency Medicine has said they are expecting pressures over

Easter Dr Adrian Boyle, from the College of Emergency Medicine, welcomed the guidance, saying he hoped it would help services to sharpen up their approach to the challenges. He said: The whole system is under significant pressure at the moment so we know the four-day holiday over Easter is likely to cause some difficulties. It is a sensible resilience plan, but we are expecting pressures.

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http://www.telegraph.co.uk/news/nhs/11452874/Emergency-plans-drawn-up-amid-fears-of-Easter-NHS-crisis.html

Other doctors described the order as a pre-election gimmick. Dr Krishna Chaturvedi said: Its a bit of a gimmick. Its a short-term fix for a long-term gain. You can tell theres a General Election coming upThe Government should be looking at more long-term fixes to ease the burden on A&E. http://www.echo-news.co.uk/news/11860822.GPs_offered___1_050_to_work_Easter_Saturday/

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Wider decline in GP access The wider decline in GP access under the Tory-led Government is apparent from a wide

range of survey data:

o According to the GP-Patient Survey, 25 per cent of people now wait a week or more to see or speak to a GP, or dont get an appointment at all corresponding to 13.6 million people. The number of people waiting a week or more or unable to get an appointment at all has risen by 2.9 million since 2011 (when the data was first collected for this question)

o According to the GP-Patient Survey, 21 per cent of people are now unable to regularly see their preferred GP corresponding to 11.3 million people. The number of people unable to regularly see their preferred GP has risen by 1.1 million since 2011 (when the data was first collected for this question)

o In a 2013 survey by the Patients Association, 60 per cent of patients said they waited longer than 48 hours to see a GP.xi

o In a recent ComRes poll, 29 per cent of patients were unable to book an appointment with their GP within the same week.xii

The Royal College of GPs has said general practice is operating under the severe threat

of extinction.

General practice as we know it is now under severe threat of extinction. It is imploding faster than people realise and patients are already bearing the brunt of the problem Dr Maureen Baker, Chair of the RCGP, 23 March 2014

The BMA have warned that waits of one or two weeks are becoming the norm.

General practice is chronically under-funded and that is beginning to have an impact on the patient experience." He added waits of "one or two weeks were becoming the norm" for patients, although he said those needing urgent appointments would always be seen quickly. Dr Chaand Nagpaul, Chair of the BMA, BBC News, 25 June 2014

Patients bodies have also warned of long waits to see a GP and the pressure on A&E:

Sadly very many patients are increasingly having to wait for one to two weeks and sometimes longer to see their GP. Patricia Wilkie, Chairwoman, National Association for Patient Participation, December 24 2013 A&E wards are currently at breaking point from a continued influx of patients who cant get a quick enough appointment with their GP Katherine Murphy, Chief Executive, Patients Association, December 18 2013

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Five more years of the Tories would mean even longer waits to see a GP David Cameron didnt just promise GP access 8am-8pm, seven days a week at the 2010

election. He put such emphasis on this pledge that the Conservatives made it the focus of their manifesto launch, briefing that it was key to showing they could be trusted with the NHS.

The party also unveiled plans to guarantee access to a local GP 12 hours a day, seven days a week amid concerns over out-of-hours services. It is one of the promises to be included in the Tory manifesto, which will be unveiled on Tuesday the day after Labour publishes its own. Mr Cameron will hope the commitment helps to convince voters that he can be trusted with the NHS traditionally core Labour territory. Daily Mail, 11 April 2010

But having made it harder to see a GP, no-one will believe David Cameron when he

repeats his broken 2010 promise at this election: 2010 Conservative Party manifesto 2014 Conservative Party Conference

We willensure that every patient can access a GP in

their area between 8am and 8pm, seven days a week.

Conservative Party Manifesto, 2010

Everyone will be able to access a GP practice seven

days a week - from 8 til 8 - by 2020 if the Conservatives are returned to power at the next

election, the PM promised todayThe Prime Minister said: People want to be able to see their GP at a time that suits them and their family. That is why we will make sure that everyone can see a GP seven days a

week by 2020. http://www.pulsetoday.co.uk/your-practice/practice-

topics/access/seven-day-access-to-gps-for-all-patients-promises-

pm/20008055.article#.VQ3kxtE8aM8

Ed Miliband called out David Cameron in last weeks Leaders Debate for his broken

promise on seven-day GP access:

David Cameron: I want to see the NHS move to a much more seven-day operation, like your GP being open eight in the morning, eight in the evening, all the way through the week Ed Miliband: David, you promised seven day opening in your last manifesto and you failed to deliver it. It sounds very familiar. Thats because it is. Leaders Debate, ITV, 2 April 2015

In fact, five more years of the Tories would see continued deterioration of the NHS

standards and services, making the NHS unrecognisable from the service people cherish and rely on. Based on current trends, it would put the NHS on course for:

By 2020, over 20 million people waiting a week or more for a GP appointment or

unable to get one at all

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In the latest GP-Patient Survey, 10.9 per cent of people say they were unable to get an appointment with a GP the last time they tried 5.9 million people. This is up from 9.6 per cent in 2012. On this trend, by 2020, 14.8 per cent of people, some 8.4 million people, will be unable to get a GP appointment. Also in the latest GP-Patient Survey, 14.4 per cent of people say they waited a week or more for a GP appointment the last time they tried 7.8 million people. This is up from 12.0 per cent in 2012. On this trend, by 2020, 21.7 per cent of people, some 12.3 million people, will wait a week or more. This means that, on current trends, by 2020, 20.7 million people could be waiting a week or more for a GP appointment or wont get one at all.

By 2020, over 14 million people unable to regularly see their preferred GP

In the latest GP-Patient Survey, 21.0 per cent of people are unable to regularly see their preferred GP 11.3 million. This is up from 19.8 per cent in 2012. On this trend, by 2020, some 24.7 per cent of people, some 14.0 million people, will only see their preferred GP some of the time or never.

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Labour has a better plan to improve GP access We will recruit 8,000 more GPs by 2020 to ensure better access and help surgeries offer

more convenient opening times. Based on the current distribution of GPs in England, Labours plans would mean significant increases in GP numbers in every region, as shown in the table below.

Region Number of extra GPs East Midlands 600 East of England 900 London 1200 North East 500 North West 1100 South East 1400 South West 700 West Midlands 800 Yorkshire and the Humber 800

Numbers are rounded to the nearest hundred. London region covers the Health Education England regions of North West, North, Central and East, and South London, while South East region covers the Health Education England regions of Thames Valley, Wessex, and Kent, Surrey and Sussex Labour will also guarantee people GP appointments within 48 hours, or on the same day

for those who need it. And on top of this, we will ensure people have the right to book further ahead with the GP of their choice.

Helping people get quicker access to the help they need will be better for them and will

also help relieve the pressure on A&E. Giving people the right to book ahead with the GP of their choice will help those patients whose priority is not speed but the ability to plan ahead and to see the same doctor.

Labours plan to deliver 8,000 more GPs will play a key part in helping the NHS deliver

this guarantee. But we know that General Practice is under enormous pressure, so we will also invest an extra 100 million in GP surgeries to support the delivery of these new standards, paid for through savings from scrapping David Camerons competition bureaucracy in the NHS.

Over the longer term, ensuring better access to primary care can generate dramatic

savings by alleviating pressure in A&E and reducing the need for more expensive hospital care. So this GP access guarantee is not only about improving healthcare, but is also a key part of our plan to ensure the NHS remains sustainable for the future.

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Notes ihttp://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performanced

ataandstatistics/PrimaryCare/DH_089459 iihttp://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performance

dataandstatistics/PrimaryCare/DH_089459 iii Conservative Party Manifesto, 2010, page 47 iv http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Primarycare/PMC/AccessResponse/DH_120575 v http://www.hsj.co.uk/primary-care/exclusive-poor-patients-face-shorter-gp-opening-hours/5043677.article#.UoYJOElFBdg vi http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Primarycare/PMC/AccessResponse/DH_120575 vii https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167913/Consultation-on-strengthening-the-NHS-

Constitution.pdf : Proposed waiting time pledges removed from the NHS Constitution Handbook as these are no longer a priority and their

delivery is not monitored or measured separately: access to a primary care professional within 24 hours or a primary care doctor within 48

hours: now measured through GP Surveys and the focus is on overall access rather than specific access within these time periods;

Department of Health, 5 November 2012, A consultation on strengthening the NHS Constitution, p37 viii http://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2015-03-

19/228418/ ix http://www.pulsetoday.co.uk/your-practice/practice-topics/education/third-of-gp-trainee-positions-remain-unfilled-across-the-uk-

following-first-round-of-recruitment/20009624.article#.VSETFPw7uFw x Figures from the General Medical Council xi Patients Association, March 2013, http://www.patients-association.com/Portals/0/PCR_Vol-II%20(Access%20Denied)_Final.pdf xii http://comres.co.uk/wp-content/themes/comres/poll/RCGP_ComRes_September_2014_Data_tables.pdf

Reproduced from electronic media, promoted by Iain McNicol, General Secretary, the Labour Party, on behalf of the Labour Party, both at One Brewers Green, London SW1H 0RH.