My Lords, Amendment 297A is in my name and those of the noble Baronesses, Lady Smith and Lady Cumberlege, but I am also supportive of the other amendments in this group.
With people living ever longer, looking after older people so that they can stay healthier for longer is critical, as is ensuring that they receive the care they need and have a dignified and secure old age. Amendment 297A seeks to introduce a new clause that will not only lower, from 75 to 65, the age at which every patient is assigned a named GP but sets out to ensure that named GPs will actually have to meet and have some knowledge of each patient they are responsible for, and will communicate directly with them and the family.
We need to encourage everyone to take responsibility for their health. Having good and regular health checks is an essential part of the prevention of ill health, as well as leading to earlier identification of conditions and earlier interventions. I am sure that other noble Lords who are doctors will put me right, but I was once told that 65 is an age where things can start to go wrong. Therefore, it is important to start monitoring people’s health and being able to identify changes from this age. This will deliver better outcomes and may also enable people to stay at home and lead a fuller life for longer. The role of the GP in all this is absolutely critical.
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Last October, a study based on Norwegian health records, published in the British Journal of General Practice, talked about the benefits of having the same GP for years. In Norway, all residents are assigned a named GP. The study found that, compared with a one-year patient-GP relationship, those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital, and 8% less likely to die that year. After 15 years, the figures were 30%, 28% and 25% respectively. A senior researcher at the National Centre for Emergency Primary Health Care, part of the NORCE research centre in Bergen, added:
“It can be lifesaving to be treated by a doctor who knows you. If you lose a general practitioner you’ve had for more than 15 years, your risk of needing acute admission to hospital or dying increases considerably the following year.”
As the study showed, it is of benefit to the NHS as it is less likely that a patient will have to be admitted to hospital.
Yet in the UK, GP practices are becoming bigger, and the relationship between doctors and patients less constant. Patients over 75 in the UK are currently given a named GP, and I asked the department what exactly their duties were. The Minister, Maria Caulfield MP, wrote to me, for which I pass on my thanks. She set out that named GPs
“oversee patients’ care and support”.
She particularly highlighted: working with patients to develop a personalised care plan that recognises and responds to a patient’s physical and psychological needs; regularly reviewing patient care at an interval agreed with the patient; taking lead responsibility for ensuring that all appropriate services required under the contract, including health checks, are delivered to the patient; and working with any other health and social care services that care for the patient to make sure that there is continuity of care.
However, sadly, I know from personal experience with my mother that this does not always happen and that some doctors interpret the role of the named GP as just having to look at patient records. We have had discussions on previous clauses in the Bill where it was emphasised that there needs to be a patient-centred approach, but I am afraid that some GP practices just take it as an administrative one. Notes on a screen will never replace the intimate trust of a doctor-patient relationship—and neither is that a patient-centric approach.
I understand that patients who wish to be seen urgently cannot always be seen by their GP on that day, but how can a doctor be responsible for the care
of a patient, covering everything the Minister listed in the letter, if they have never met them? Also, surely, if a doctor has some knowledge of a patient, it is easier for them to diagnose what the matter is, and sometimes it will save them time as they will not have to inquire about a fuller history.
However, the BMA advice which sets out named GP responsibilities does not mention that the named GP should actually see the patient. Given that there should be a patient-centred approach, as we have discussed before, what is the point, as things stand, of a named GP?
This amendment will ensure relationships between named GPs and patients, enabling the positive benefits discussed in the British Journal of General Practice. It also sets out clearer responsibilities of that role, ensuring that they meet and communicate with both patient and, where needed, family members liaising on their behalf.
To conclude, this amendment is beneficial, both to patients in delivering continuity of care and therefore better healthcare, and, by keeping more people out of hospital, relieving some of the burden from the NHS.
I thank the noble Baronesses, Lady Cumberlege and Lady Smith of Newnham, for supporting this amendment, and I hope the Minister will consider it favourably. If not, I reserve the right to bring it back. I beg to move.