Being a GP is like having a window on the world,” says Dr Paul Williams. “People come through the door and talk about intimate things to do with their families, their relationships, their experience of public services – of the jobcentre and of assessments for disability benefits, as well as the NHS. It gives me all kinds of insights.”
Williams has another window on the world as a Labour MP, after he won Stockton South last year from the Conservatives by just 888 votes. A year on, he is rapidly establishing himself as a fresh, distinctive voice in the Commons on the NHS – with bold new ideas for how to keep the service sustainable as it nears its 70th birthday on 5 July.
Many doctors give up medicine as soon they become MPs, such as Sarah Wollaston, the influential Tory chair of the Commons health and social care select committee, who was a GP for 25 years before her election in 2010. In contrast, Williams is one of a small number of MPs who continue to work in the NHS, albeit part-time. They include the Conservative, Dan Poulter, a health minister in the coalition, who is an NHS psychiatrist; the SNP’s Philippa Whitford, a breast cancer surgeon; and Karen Lee, the Labour MP for Lincoln, who is an NHS nurse.
Williams still works two mornings a month at his old surgery in Stockton-on-Tees, but has given up being a GP partner. “I resigned my partnership and as a director, and I also resigned from the British Medical Association. I want to be able to say what I really think without people thinking that I have any ulterior motives,” he explains. “One of the things I find most difficult about politics is keeping that connection with reality. As a GP, especially in the north-east, people come through the door and tell it like it is. But continuing to work as a GP also keeps me in touch with what NHS workers are saying.
“I came into politics very suddenly and it could equally end very suddenly. So it’s also an insurance policy. It means I don’t need to be a politician. I can always do what I think is the right thing rather than what’s politically expedient,” he adds.
Williams has worked in the NHS for 14 of the 18 years since he qualified as a doctor, as the head of a GP federation as well as being a family doctor. The other four years, between 2006 and 2010, were spent helping to run a hospital on the Uganda-Congo border while working with Voluntary Service Overseas.
Despite his profound admiration for the NHS and pride in being a doctor, Williams is firm in his belief that both it and the medical profession need to change radically in order to better care for Britain’s ageing population. “There needs to be a seismic shift in the NHS, from the treatment of illness to the prevention of illness,” he says. “It is a system under huge strain, with increasing demand and an overstretched workforce. But there is too much emphasis on what goes on in hospitals – and not enough on keeping people well and in their homes.”
While Williams welcomes the government’s announcement this week of a £20.5bn cash injection over the next four years, he argues that the fact that hospitals are overloaded and unable to cope shows that the NHS has failed in what he thinks should be its primary mission: to stop people getting ill in the first place, or at least so ill that they end up in hospital.
Williams is frustrated that, despite repeated pledges by ministers and NHS leaders to oversee a huge expansion of care services outside hospitals, that transformation has not happened. “When politicians talk about ‘the health service’ they’re often talking about hospitals,” he laments. He wants to see NHS England switch a substantial chunk of the budget that currently goes into acute care into care outside of hospitals.
“At the moment, out-of-hospital care is completely atomised. It’s delivered by lots of small general practices, district nurses, health visitors, social care, community mental health nurses and so on. It focuses on healthcare rather than improving health. The consequence of that atomisation is that patients lose out, including the old and frail, who need continuity of care.”
What’s needed, he says, are “new, single out-of-hospital care organisations, called integrated care trusts. They would draw together all the existing out-of-hospital services and aim to detect disease early, help people to live healthier lifestyles – and stop people ending up in hospital.”
Might something like his plan come to pass? The government is so keen to deliver the long talked-about integration of health and social care in England that the prime minister, Theresa May, pledged to bring forward legislation to make it happen if need be in her big NHS speech on Monday, explicitly accepting that Andrew Lansley’s disastrous NHS shakeup in 2012 had made truly joined-up services very difficult. Jeremy Hunt, the health and social care secretary, recently promised that full integration – operational and budgetary – would be completed within 10 years. So the big out-of-hospital organisations that will emerge could look very like the integrated care trusts Williams is so keen on.
Williams cites his local “hospital-at-home” service, in which patients with serious breathing problems were kept out of hospital and able to stay at home thanks to NHS staff visiting them there – as an example of proactive, disease-reducing out-of-hospital care. Early intervention, in which patients are helped to stop smoking or receive flu jabs or are put on to oxygen would reduce costly emergency hospital admissions, he says. “With integrated care trusts, patients wouldn’t have to tell their story many times over, and would know that whoever they were talking to – a doctor, a community nurse, a social care worker – all would be part of the same organisation, just as in hospital you know everyone caring for you is part of the same team. We need to re-imagine what really good preventive services look like.”
That will need what he calls “a power transfer”, from hospitals to community-based services, with the knock-on effect, he admits, that acute hospitals would need fewer staff as more and more care is delivered elsewhere.
Controversially, he wants as many GPs as possible to work for – and play the lead role in – these new integrated care trusts. The NHS has ended up atomised “[partly] because when the NHS was founded in 1948, the GPs wouldn’t join it.” While he doesn’t support forcing existing GPs to give up their practices, which are independent businesses, he would like to see all GP trainees and newly qualified mental health nurses, social workers and community nurses become employed directly by integrated care trusts and so help cut the NHS’s spiralling costs.
Williams has practised, not just preached, integration. When he played a key role in his local clinical commissioning group, he helped ensure that the GP out-of-hours service was not contracted out to the private sector, as many others have been, seeing off a bid from Virgin Care in the process. The fact that North Tees and Hartlepool hospital trust has some of the best A&E treatment times in England is in part due to its close relationship with the local urgent care centre, he stresses.
Most GPs are fiercely opposed to giving up their own surgeries, so few will back Williams’s plan, which formed part of a report released last week on the NHS’s future by the Institute for Public Policy Research thinktank and ex-health ministers Lord Darzi (Labour) and Lord Prior (Tory). Dr Clare Gerada, the then chair of the Royal College of GPs, triggered a huge row among GPs in 2013 when she proposed that family doctors being independent contractors working to but not for the NHS was “anachronistic” and should end.
But Williams is undeterred. “The NHS is an amazing institution. But it needs to undergo radical reform if it is to remain sustainable for another 70 years. It needs a massive strategic shift away from hospitals into prevention and into the community,” he concludes.
Family: partner, two daughters.
Education: University of Newcastle upon Tyne (medicine degree, Msc in health sciences).
Career: 2017-present: Labour MP and member, House of Commons health committee; 2015–present: chief executive, Hartlepool and Stockton Health Ltd; 2015–present: GP, Tennant Street Medical Practice, Stockton-on-Tees; 2012–16: governing body member, Hartlepool and Stockton-on-Tees clinical commissioning group.
Interests: Swimming, triathlon, cycling.