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I’d like to begin by saying a public thank you to you, Kamila, and, by extension, to your college. In opposition, we engaged in good-natured but robust debate on the things we disagreed on and, more often than not, found ourselves in violent agreement on the state of general practice today and our responsibility to rebuild general practice for a brighter tomorrow.
That relationship, based on mutual respect and a spirit of partnership, means I come here today feeling that I am not only among friends, but among teammates – a theme I’ll build upon in my speech this morning.
In that same spirit, can I also say a special thank you to Sunaina, Paula, Rumshia and Andy for those outstanding presentations.
You are proof that, while the NHS may be in the midst of the worst crisis in its history, the biggest asset we have are the people who work in it. More than that, you provide hope to a country that is desperately looking for it, because you are showing us not only is reform possible, but it is already happening, and you are showing us what a reformed NHS could look like.
I’m delighted to be the first Secretary of State personally addressing this conference in 7 years. I can’t imagine what the others were so worried about.
I imagine some of you were quite happy to not have to hear from my 7 predecessors who held the job in that time. The good news is I’m here this year, the bad news is, whether you cheer or boo, I’ll be back for more next year. For 2 reasons:
First, I always welcome challenge, and as you might have gathered by now, I love a good argument.
More seriously, I recognise that the health service is in a deep hole, and it’s only by working together that we’ll get out of it.
It’s my job to mobilise nearly 2 million people who work across the NHS to be the team that takes the NHS from the worst crisis in its history, gets it back on its feet, and makes it fit for the future.
I can’t do it on my own. We can only do it as a team.
The team spirit we need to build together starts with honesty.
The NHS is broken. That’s what 2 in every 3 patients believe. I suspect a poll of NHS staff would find the same sort of result. I’m yet to speak to a GP who tells me – on many of the visits I’ve done in the last few years – everything going really well, my workload is entirely manageable, this is just what I signed up for.
And I want to be clear about something else too: the NHS is broken, but GPs didn’t break it.
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And that’s not just my view – that’s effectively the conclusion of the Darzi investigation.
I know he’s a surgeon. Sorry about that.
But I think that, if you’ve read his report, the analysis is so stark and so clear that you might even forgive him for polyclinics.
Lord Darzi found, “GPs are expected to manage increasingly complex care, but do not have the resources, infrastructure and authority that this requires.”
Hospital resources have shot up, while primary care has been neglected. There are 1,500 fewer fully qualified GPs in the NHS today than 7 years ago.
While hospital productivity has fallen, the reverse is true in general practice. Despite there being fewer of you, you’re delivering more appointments than ever before – squeezing the time you spend with each patient. And as RCGP’s research this week revealed, it’s the poorest areas hit the hardest.
Cuts to capital investment mean that one in every 5 of you are working in buildings older than the NHS itself.
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In Lord Darzi’s words, “GPs were to all intents and purposes set up to fail.”
We’re left with a status quo that isn’t working for anyone. Not for patients, 2 in 3 of whom aren’t satisfied with the service they receive – a record low.
Nor does the status quo work for staff – you are working harder than ever before, pushing you to burn out and in too many cases pack it in.
Patients are frustrated they can’t see you. You’re frustrated you can’t meet their demands. It’s not sustainable.
The NHS is broken, but not beaten, and I think what unites all of us – staff, patients and, crucially, the evidence – is the shared conviction that continuity of care, what most people would call the ‘family doctor relationship’ really matters. It’s what drives patient satisfaction, your job satisfaction and better outcomes for patients.
It will be at the heart of this government’s plan to reimagine the NHS as much as a neighbourhood health service as a national health service.
We’ll shortly be embarking on a wide-ranging and deep engagement exercise to build our 10-year plan.
That 10-year plan for the NHS will deliver 3 big shifts in the focus of healthcare:
- from hospital to community
- analogue to digital
- sickness to prevention
And general practice is fundamental to each one.
Just look at what the GPs who introduced me today are already doing.
Paula is using basic technology to meet demand for same-day appointments and giving patients a digital front door, leading the way on ending the 8am scramble.
Advances in big data are going to transform the NHS’s ability to end the cruel postcode lottery of health inequality. Rumshia is already showing us how – by taking screening, checks and care directly to the communities most in need – intervening early and preventing ill health from worsening, what we can already do.
And as Andy and Sunaina have shown, if we bring GPs together with colleagues from mental health services, community pharmacy and social care, all working in lockstep as one team, more patients can be treated in the comfort of their own home – where they want to be. That’s the neighbourhood health service we want to build. That’s the future of the NHS.
And I think we’ve seen in the last 3 months we’ve started as we mean to go on.
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GPs were left qualifying into unemployment this summer. While patients can’t get a GP appointment, GPs couldn’t get a job.
You asked us to act, so we did – in what might be the first example in history of someone signing a petition that actually led to action.
I received RCGP’s petition, we cut red tape, found the funding and we’re recruiting an extra 1,000 GPs this year, our first step to fixing the front door of the NHS.
In my first week as Health and Social Care Secretary, I pledged to increase the proportion of NHS resources going to primary care. And in our first month, the government made a down payment on that pledge, providing practices with their biggest funding increase in years.
I’ve never pretended that one measure on GP recruitment or indeed the funding that was announced was a panacea. But given the £22 billion blackhole we inherited, and the painful cuts we’ve had to make and are having to make elsewhere, be in no doubt how hard we had to fight to deliver that extra funding. It was a serious statement of intent. A proof point. An early decision to demonstrate that we’re serious about rebuilding general practice.
Not everything is about more money. It’s also about less waste.
When I spend time shadowing GPs, one of the things they are dying to show me is the sheer amount of paperwork you are required to fill in to refer a patient.
I was genuinely stunned to hear about one practice that has to complete more than 150 different forms to refer patients into secondary care services.
Practices spend as much as 20% of their time on admin and work created by poor communications with secondary care.
This is intolerable. That time should be spent with patients.
That’s why today I can announce that Amanda Pritchard and I will launch a red tape challenge to bulldoze bureaucracy so GPs are freed up to deliver more appointments.
The challenge will be led by Claire Fuller and Stella Vig, primary and secondary care leaders who have their bulldozers at the ready. Tell them what’s working well, but more importantly what needs to change. We will listen, act and solve this problem together.
Amanda and I will receive the conclusion of this work in the new year. And NHS England will hold ICBs and trusts to account if they fail to act.
The other frustration I hear from staff and patients alike are the pointless appointments you’re forced to hold and patients are forced to attend. You didn’t go through 5 years of medical school plus 5 years of training to tick boxes. So where there are appointments that can be cut out, with patients seen by specialists faster and GPs’ time freed up to do what only GPs can do, we will act.
Starting in November, 111 online, which is available through the NHS app, will pilot directly referring women with a worrying lump to a breast clinic.
That means faster diagnosis for cancer patients.
And more GP appointments freed up.
Better for patients and better for GPs.
I suspect there are other cases that come across your desks every week, where a patient has been passed to you by someone else in the NHS to refer them on to someone else in the NHS. It is a waste of everyone’s time, including yours, and where you give us examples of patient pathways that can be simplified through appropriate patient self-referral or direct referral by other NHS services to save your time, we will act.
It’s not just that I value your time, I respect your profession and your expertise.
General practice is a specialism.
That’s why I am committed to the creation of a single register of GPs and specialist doctors and this government will legislate to give the GMC the power to do it.
It’s symbolic, but it’s also meaningful.
It reflects the partnership I want to build with this profession.
What I need from you in return, is goodwill and the same team spirit.
When the BMA’s GPC returned their ballot result on collective action, I wasn’t remotely surprised.
I know that after years of rising pressures, declining resources and a worsening service for patients, you feel it is your duty to sound the alarm.
And trust me, you weren’t the only ones who wanted to punish the previous government.
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Capping appointments now will only punish patients and make the road to recovery steeper. Be in no doubt – it is shutting the door on patients.
Their care will suffer, receptionists will bear the brunt of their frustration, and the rest of the NHS will be left to pick up the pieces.
Worse still, our collective job will be made harder. Collective action really means collective failure.
Your message has been received. Not from this one vote, but from all the time I’ve spent in general practice in the past 3 years, literally looking over GPs’ shoulders, seeing what you deal with and the state of the crisis for myself.
There’s a reason that, back in July, I rejected the list of hospitals suggested to me for my first visit as Secretary of State, and instead went to Dr Ellie Cannon’s Abbey Medical Centre in North London.
I wanted to send a message that I understand how bad things are, and I am determined to fix them. But I can’t do that alone. We can only do this together.
So I ask GPs to stand down collective action and instead work with a new government that is serious about working with you, to rebuild our NHS together.
There are some tricky issues we’ll need to navigate together.
Take data.
It’s the future of the NHS.
Advances in genomics and data mean the NHS will be able to do things never before possible.
From the moment a child is born, we will know their risk of disease, giving you the tools you need to keep them healthy.
Cancer could be detected from its earliest signs, saving countless lives.
And the NHS will be able to treat patients with personalised medicine – far more effective, with fewer side effects.
That’s the prize waiting for us.
But beyond the day-to-day challenge of whether your machines reliably boot up and the number of passwords you have to enter across a range of applications, we don’t even share patients’ records across primary and secondary care.
I know there are issues we need to work through together around information governance, risk and liabilities. There’s also, let’s be honest, some producer interest in play.
But here’s the consequence of inaction.
Keir and I met a family at Alder Hey earlier this year. Their baby had heart surgery to save his life. When they’d taken the baby home and visited their GP, they weren’t just surprised to find their GP didn’t have sight of the hospital records, they were frightened. Imagine how those parents felt: a tiny life in their hands in front of a medical professional who had only a partial sight on their experience. Imagine how the GP felt, having to ask basic questions about fundamental aspects of that baby’s medical history.
So we need to work together to create a single patient record, owned by the patient, shared across the system so that every part of the NHS has a full picture of the patient.
This applies as much to research as to care. The two go hand in hand.
World-leading studies like the UK Biobank, Genomics England and Our Future Health are building up incredibly detailed profiles of our nation’s health.
Patients have given their consent for their data to be shared with these studies.
But we still see, far too often, that this data is not shared according to patients’ wishes.
That’s why I am directing NHS England to take away this burden from you. Just like they did during the pandemic, if a patient explicitly consents to sharing their data with a study, NHS England will take responsibly for making this happen. In return, we will demand the highest standards of data security.
My concern is that this isn’t just an information governance issue, it’s a culture issue that, unless addressed, will not only exacerbate the shortcomings of the system today, but also squander the potential of tomorrow.
A world in which genomics, AI and machine learning will combine to change our entire model of care – not simply to drive earlier diagnosis and treatment, but to predict and prevent illness in the first place – is a world that we’ve got to embrace.
The UK could lead the world in medical research.
The NHS, created in 1948, a single payer system, is ideally placed to harness the benefits of the revolution in science and technology in a way that Attlee and Bevan could never have imagined 76 years ago.
This isn’t just about the system, the model, but also the ethos. Why do we pay our taxes into an NHS that is free at the point of use? Of course it is because we all derive a personal benefit, but it is also because we are paying in for the common good. In this century, our data will be as valuable as our taxes: we contribute our data in the knowledge that it will lead to more personalised medicine, but also because it will contribute to better care for everyone.
It is that collectivist ethos that created the NHS in 1948 to see us through the 20th century, that will underpin an NHS fit for the 21st century.
Nothing I have seen or experienced in the last 3 months as our country’s Health and Social Care Secretary has weakened my conviction that, while the NHS may be broken, it is not beaten.
But the future isn’t just in my hands, it’s in yours too.
The 3 shifts that underpin this government’s reform agenda:
From hospital to community.
Analogue to digital.
Sickness to prevention.
Those shifts aren’t new ideas and they aren’t radical.
But delivering them really would be.
I can’t do it on my own.
I need every part of the NHS to pull together as one team with one purpose:
To be the generation that took the NHS from the worst crisis in its history, got it back on its feet and made it fit for the future.
That’s the mission of this government and I’m confident that together we will rise to it.
Thank you.