Big Interview: The Continuity Candidate

Jeremy Hunt MP was Health Secretary for six years, now Chair of the influential Health and Social Care Committee, he speaks to GP Frontline about his plans...

“It was the wrong argument,” says Jeremy Hunt MP about the row over remote working that has plagued the GP profession over the last year. “We should have been having a discussion about continuity of care and stopping the ‘Uberisation’ of general practice than the much more mechanical issue of the nature of consultations.”

Mr Hunt, 55, a former Health Secretary, Foreign Secretary and Prime Ministerial candidate, is on a mission to reinvigorate continuity of care in general practice, indeed across the NHS.

Jeremy Hunt at the Palace of Westminster

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Now Chair of the influential Health and Social Care Committee (HSCC), he continues: “We had a fake debate about face to face versus virtual meetings [but] if people were seeing a regular doctor that they knew, they’d be happy with a phone call or a text message, or an email. It’s when they think they’re seeing someone completely new they feel uneasy about not being able to see someone face to face.”

“We know from last year’s Norway study,’ he continues, “that people are 30% less likely to go to hospital if they have a family doctor over a long period of time, and that’s the role we want GPs to be doing.”

Hunt suggests a move back towards GPs having their own patient lists would both instil continuity of care and improve morale in general practice, though he’s realistic it couldn’t ‘happen overnight’.

“GPs who remember the days when they had their own lists say that was the best bit about it,” he says, “knowing a patient as they grew older, knowing a patient’s family, having those links with generations, that’s what makes being a GP more rewarding than being a surgeon, because surgeons see someone once, GPs see someone over the course of their lives.

“It’s relationship-based care,” he says coining the description used by College Chair Martin Marshall, “and I think that’s what patients want too, so I firmly believe that in terms of patient safety and restoring joy, if it’s not too inappropriate a word, in general practice, it’s what we need to work towards.”

At this he rushes off to vote. We’re meeting on the afternoon that amendments to the Nationality and Borders Bill are being voted on in the House of Commons. Hunt has set up camp to take meetings in the bustling Pugin tea room in the Palace of Westminster where he can disappear off down the corridor to the voting lobby as necessary. It’s a cacophony of clattering tea cups, high-spirited discussion and occasional voting bells. Familiar faces come and go and people stop to thank and congratulate Hunt for speeches and interventions he’s made.

He’s clearly still at the centre of the action, despite not being in Government, and he relishes it. “On the backbenches you can say exactly what you think, you don’t have to follow the party line. I love that,” he says.

"On the backbenches you can say exactly what you think, you don’t have to follow the party line. I love that."

Hunt, who was Health Secretary between 2012–2018 – the longest-serving in British political history – has been a prominent critic of Government in its handling of the pandemic. He’s on record as saying the country should have locked down earlier and elaborates: “With hindsight it is clear that we should have worked much more quickly to adopt a mass test, trace and isolate system to prevent the need for a full lockdown. Without that in place, we should have adopted a comprehensive lockdown much earlier which would have prevented virus spread and saved many lives even though that meant going against the scientific advice which was aimed at moderating the speed of infection.”

Hunt has also spoken out against aspects of the Health and Care Bill, currently going through Parliament, defying the Tory Whip to support an amendment that would strengthen NHS workforce planning by forcing the Government to publish independently verified workforce projections every two years.

He admits he ‘didn’t get everything right’ when he was Health Secretary and that he was ‘very disappointed’ at the progress he made in building the GP workforce, particularly as the 5,000 target – upped to 6,000 by Prime Minister Boris Johnson on his first day in office in 2019 – was one he had personally chosen to make.

“We've been talking now for a decade about the principle that prevention is better than cure and GPs have a central role in the prevention agenda. The NHS will literally fall over if general practice isn't functioning and indeed it's starting to because we don't have the capacity in general practice that we need.”

He says recruitment efforts were successful with 3,250, half of medical students, choosing to specialise in general practice – a number that has continued to increase – but that officials hadn’t factored in working patterns such as ‘people choosing to go part-time or retire early’.

“It [also] means dealing with the ridiculous anomalies in the pensions system, which I tried to change when I was Health Secretary, and made some progress, but is still a massive issue,” he says.

This is why he’s very keen his successors ‘learn from the things where I wasn’t successful, because that’s the way you make progress’, and is frustrated that the Government rejected the workforce planning amendment.

He puts the Government’s reticence to support the amendment down to Treasury concerns that it will ‘give the NHS a blank cheque for getting the numbers of doctors trained that it wants’ and therefore losing control of the costs of doctors’ training. It’s a concern he understands, given how much it costs to train a doctor, but argues ‘the reality is they have already lost control’.

He explains: “We’re spending more than £6bn a year on locum doctors and agency nurses because we have lost control of the workforce and I understand the need for locum doctors, but if you believe in continuity of care, they aren’t a long-term solution to our workforce problems, and it’s very expensive.”

Despite his disappointment around failure to sufficiently build the GP workforce, he was proud that by the time he moved on from his role as Health Secretary the NHS had five new medical schools and an extra £20bn of the NHS budget. He also says that despite a public narrative to the contrary, he never saw himself as an ‘enemy’ of the medical profession. Admitting that at times he ‘had his battles’, particularly around pay negotiations, he’s adamant that he ‘worked extremely well’ with doctors and nurses due to their shared focus on patient safety, ‘something that every doctor and nurse I ever met was very passionate about.’

“I tried very hard with general practice… I sometimes felt that some GPs didn’t understand how hard I was genuinely trying to work to solve some of the issues that they faced. But I also understand it’s politics and as Health Secretary you’re always going to be on the receiving end of a lot of the frustration people understandably felt about things that were going wrong.”

Jeremy Hunt chairs the Health and Social Care Committee

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It’s one of the reasons why Hunt, as Chair of the HSCC, has launched an inquiry into the future of general practice (read about RCGP Chair Martin Marshall’s appearance in front of the Committee on p7). “The scale of the crisis in general practice is clear with an exhausted workforce and patients uncertain what to expect. GPs are the lifeblood of the NHS and making sure general practice is fit to face future demand presents a key challenge for the NHS. Our inquiry will make recommendations to Government on how to meet this challenge.”

The HSCC isn’t the only body currently thinking about the future of general practice. It’s a hot topic, with think tank Policy Exchange publishing its own ideas, and rumours circulating that current Health Secretary Sajid Javid is considering commissioning his own inquiry. An idea that keeps being mooted is reform of the independent contractor status of general practice. It’s something the RCGP is strongly opposed to, but Hunt is somewhat on the fence, recognising the partnership model for its innovation, but questioning how it can be improved to make it more sustainable long term, particularly given the workforce challenges facing the profession.

" There can be no sustainable NHS without our army of brilliant and very hard working and very exhausted GPs."

Away from the mechanics, Hunt thinks hope plays a part in making general practice sustainable for the future. “GPs need to know there is a long term plan in place to reduce the intensity of the workload so that even if it’s very hard work coming to work, people can feel, particularly younger GPs, that it’s not always going to be like this.” It’s his key message to GPs: “There can be no sustainable NHS without our army of brilliant and very hard working and very exhausted GPs, so work with me and others to try and get reforms in place to mean that you really can recommend your profession to your children and grandchildren, because we need more GPs.”

Whilst being Health Secretary was not Hunt’s ‘most enjoyable’ ministerial role – that goes to his stint as Foreign Secretary – he says the brief was his ‘most interesting and worthwhile, because it’s the NHS, it’s people’s health and you’re making an immediate difference to people’s lives.’ And he’s also shocked about how much he is enjoying being out of Government, on the backbenches, with his scrutiniser role as Chair of one of the most high-profile Select Committees.

“When you’re Secretary of State you can change the things you really want to change but 90% of your time is taken up by firefighting, so only a very small proportion of your time is spent on focussing on the really big things you want to change. When you’re on the backbenches, you can spend 100% of your time focussing on the things you want to focus on and you can spend more time to really think things through and learn from what you got right and what you got wrong, so in that sense, it’s more rewarding,” he says.

It has also given him the opportunity to spend more time with his wife Lucia Guo and their three children, aged 7, 10 and 11, and whilst he says his aspirations to be Prime Minister haven’t completely vanished – he was runner up to Boris Johnson in the 2019 Conservative Party leader contest – he describes them as being ‘dimmed'. Although, he quips that if he was Prime Minister, his main focus where the NHS is concerned would be restoring continuity of care. “That would be top of my list,” he says. •