Caroline Johnson – 2022 Speech on Access to GP Services

The speech made by Caroline Johnson, the Conservative MP for Sleaford and North Hykeham, in the House of Commons on 21 June 2022.

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests. The debate is about GPs and dentists, and I will deal first with GPs. I pay tribute to the GPs who work in my constituency, and in particular those at the New Springwells practice and at Caythorpe and Ancaster medical practice, which have outstanding CQC ratings. I also pay tribute to the GPs who delivered the vaccine service. Not only did they work during covid with its challenges, but they delivered a vaccine service as well. They are a very hard-working, admirable group of people.

I agree with the Opposition that much of the overall problem with the NHS is a workforce problem. That is true. There are too many staff overall, and not enough of them are directly delivering or improving clinical care. We have expensive, very highly trained clinical decision makers being asked to do admin tasks that take them away from the clinical tasks that we are paying them for and which we need them to do. That contributes to our longer waiting times. So we need to increase the number of doctors.

The Opposition are making a big point about 12 years, but it takes 10 years to train a GP, and it takes longer than that to train a consultant. So, actually, the shortage was created during Labour’s time in government and we are trying to fix it. That is indeed why the number of medical schools has been increased by five. I am pleased that one of them is in Lincoln, just outside my constituency. It is training a new generation of doctors who will provide services locally—people predominantly stay where they train—which will help the people of Lincolnshire to have more access to doctors. However, the Government should go further. In the year when we had challenges with A-levels caused by covid and more people than expected got the grades required to get into medical school, places were exceptionally increased. There are challenges with that—only so many people can get around a bedside and a patient will be happy to have only so many people listen to their heart or feel a lump or bump or suchlike—but, nevertheless, it has been managed for one year, and I think that it could be managed for more. The best thing that the Government could do for the health service in that regard would be to massively increase the number of doctor places. At the moment, we are turning away keen, enthusiastic potential young doctors doing their A-levels because places are so oversubscribed, but then we find that we have a shortage. That surely cannot be right.

I turn to ease of access. The Secretary of State mentioned making it easier for people to be referred into secondary care, which of course is a good thing, but we need to ensure that training is in place for that. Since I became a consultant, we have seen the number of patients referred into secondary care increase rather rapidly—certainly in the department that I work in—but the quality of referrals has not always been right, and undoing an unnecessary referral can be more time-consuming than just seeing the patient. We need to be mindful of the need to have clinical decision makers doing what they need to do and, as such, if we are to broaden the scope of people making referrals, we need to ensure that either referrals are done with specific guidance or that training is provided so they are good-quality referrals, and not those that add to waiting lists.

On dentistry, we have heard much talk about children having whole-mouth teeth extractions. Clearly, that is a horrific thing to happen—it is unimaginable, really, that a child needs to come into hospital to have all their teeth removed. I look to the Minister to tell us what she doing about that, because it is not, as some have suggested, all the Government’s or the NHS’s problem. In part, it must be about diet, teeth brushing and dental care—whether the teeth are being properly looked after—as well as potentially fluoride enhancement of water and the availability of dentists. Several stages need to be looked at in a more holistic way to prevent these children from having to go through such an awful experience.

In Lincolnshire, NHS dental care is good, but the service’s availability is relatively poor. In the last two years, only 41% of adults in Lincolnshire have seen an NHS dentist, and less than a third of children saw an NHS dentist in the last year. The Minister will be aware that I had an Adjournment debate on the topic in October. I thank her for her engagement with me since and for her support in identifying potential solutions, as well as local dentists, the local dental committee, Professor Juster from the University of Lincoln and Health Education England for their time. They are just some of the people I have met to discuss Lincolnshire’s dental issues and how we can improve care.

The first thing to be solved is, of course, the dental contract. The contract was created by Labour in 2006, but I agree that we have had time and should probably have sorted it out by now. I raised that with the previous Secretary of State when I was on the Health and Social Care Committee in the previous Parliament. The contract pays for units of dental activity. There are three levels covering wide ranges of levels of care. Why Labour signed off on a contract that created such variability in both the value of a UDA and the amount of work required to be paid for one, I do not know, but it is human nature for someone to expect to be paid more if they have done more work, and that someone given the option of earning more for doing the same work will choose to do so. There, fundamentally, are the problems we have with the NHS contract. I look forward to hearing what the Minister is doing on that. I understand that she is in negotiations with dentists at the moment. I hope that she will be able to update the House on progress and that it will be good progress.

The second issue is geography. We know that our medical students predominantly stay where they train, and there is no dental school in the east midlands or in East Anglia. I am grateful to Health Education England and Ministers for discussions about solutions to this following my question at Prime Minister’s questions. There are a number of ways of resolving it. In the longer term, a dental school at Lincoln University would be a good way of ensuring that we have locally grown, locally trained dentists. The university is very supportive of that in the discussions, and indeed we have the support of all Greater Lincolnshire Members of Parliament for ensuring that this goes ahead.

I appreciate that it will take time to plan and deliver that, so in the meantime we need more dentists locally. The Minister and I have recently been talking about centres of dental development. The principle of a centre of dental development, which I would like to see in Sleaford, is that postgraduate training is delivered. It is attractive work for the sake of recruitment. People want to work at a centre because they get to deliver training and it is a more attractively remunerated job, but also, the postgraduate people being trained are immediately delivering care. Such a facility could be up and running within 18 months to two years and actively delivering care to my constituents, which is what I am looking for. I am particularly keen to see a centre located in Sleaford, because we have relatively few NHS dentists. We have great local schools, we have a fabulous community and we have great rail links, both north-south and east-west. What progress is the Minister making on these proposals?

Does the Minister have any update on what progress is being made on support for military families? I have a number of RAF bases, including RAF Cranwell, in my constituency. People who have moved around from place to place find that they have dropped off the list in one area and are struggling to get on to one in another. We have a covenant that says that we will ensure that people who are serving in our armed forces, and their families, are not disadvantaged, but clearly in this regard they are. I would be grateful for those updates from the Minister.