(1 day, 23 hours ago)
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Alex Easton (North Down) (Ind)
The ability to access GPs and maintain face-to-face appointments is a pressing issue that affects not just my constituency of North Down but constituencies across the UK. Across England, Scotland, Wales and Northern Ireland, considerable inequalities exist in access to GP services. Evidence indicates that Northern Ireland receives the lowest investment in GP services among the four regions of the UK.
I acknowledge that we live in an era of high-tech advancements and rapid changes in healthcare delivery. I am intrigued by the potential of electronic prescribing and artificial intelligence to enhance our healthcare system. However, amid these innovations, access to GP services remains as crucial as ever. Access to GP services is a cornerstone of the NHS, providing a fundamental element that allows the health service to operate effectively. However, when comparing the data, I find it concerning that during the same period, 70% of GP appointments in England were conducted face to face compared with only 45% in Northern Ireland.
Alex Easton
Although the figure in Northern Ireland has recently increased to 57%, the disparity remains worrying. I am confident that every MP aspires to see good access to GP services throughout the UK and to preserve the essential interactions within GP care that are vital to the health and wellbeing of our nation.
GPs are often the first point of contact for medical attention and their role is vital. I commend their comprehensive efforts in tackling acute illnesses, managing chronic diseases and providing preventive care, among other crucial responsibilities. However, as the MP for North Down, I share the concerns of many regarding the growing demand for GP healthcare services and the accessibility of these essential services for my constituents.
Jim Shannon (Strangford) (DUP)
I commend the hon. Member for North Down (Alex Easton). He is my neighbour and has been my friend for many years. We served in the Assembly before we ever came here. It is a pleasure to see him secure what I understand is his first Adjournment debate; it will be the first of many, no doubt.
Does the hon. Gentleman agree that trust in some GP surgeries has diminished due to the lack of face-to-face contact? While sending photographs and having discussions over the phone suits some working constituents, for others the lack of face-to-face interaction can mean that symptoms are missed that can only be seen face to face. Does he also agree that GP surgeries are struggling due to the lack of support, and that surgeries throughout the UK must be given more help and assistance so that they can thereby provide more access for their patients?
Alex Easton
I thank the hon. Member for his intervention and I totally agree with everything he said. People across Northern Ireland are not able to see their GP as much as those in other parts of the UK. That is leading to big frustrations for our constituents. The lack of support and funding for GPs is adding to the frustration that is felt across the board.
Robin Swann (South Antrim) (UUP)
This is a debate about GP access across the United Kingdom, but one issue in Northern Ireland is GPs’ ability to access indemnity insurance, whereas in England and Wales there is a Government-provided scheme. Does the hon. Member agree that if the Government worked with the Department of Health in Northern Ireland to allow our GPs to access that indemnity insurance scheme on a national level, it would ease some of the burden on our GPs?
Alex Easton
I agree, and perhaps the Minister will take that point on board in looking at how we can improve our GP services.
One of the significant challenges across the UK is the shortage of GPs, which inevitably leads to longer waiting times and, unfortunately, sometimes to a compromised quality of care.
Chris Coghlan (Dorking and Horley) (LD)
On that point, 4,000 residents in Westvale Park, a new housing development in my constituency, were promised a GP, and they had legally binding section 106 agreements in place. The construction money is there for a GP surgery, but the NHS has not provided the operational funding required for a GP. Does the hon. Gentleman agree that the NHS should be providing the operational funding for new GP services on housing developments, and that the entire Government case for new housing developments is undermined if this infrastructure is not provided?
Alex Easton
I totally agree. There is no point in building new houses if we are not going to put in the infrastructure, including health infrastructure and GPs.
While I welcome initiatives aimed at recruiting and retaining GPs, it is concerning that in Northern Ireland we have recruited only 121 GPs when we need 161 merely to restore the levels we had in 2014. The growing UK population, coupled with increasingly complex health needs, is exerting significant pressure on existing resources. In Northern Ireland alone, the population has risen by 70,000 over a decade, while 38 GP practices have closed—a reduction of 11%. It seems clear that as the population grows, funding should increase. We must also recognise that since April 2023, there have been 17 GP contract hand-backs, resulting in a decrease of 12 GP practices, leaving us with a total of 305.
Warinder Juss (Wolverhampton West) (Lab)
Does the hon. Member agree that we need to address the disparity he mentioned—the inequality in GP funding allocations—across the United Kingdom? Despite having some of the most deprived areas with a higher demand, the funding Wolverhampton receives is, on average, 10% less than more affluent areas. The ratio of GPs to patients is therefore lower, which increases the length of time people have to wait to get an appointment with the GP. Does he also agree that the experiences of patients differ? When I speak to my constituents in Wolverhampton West, they give me different accounts of the experiences they have had and the level of service they have received from their GP, depending on the surgery that they use. We need to achieve greater consistency in access to GP surgeries.
Alex Easton
I totally agree with everything the hon. Member says. There are areas across the UK where there are inequalities in people’s access to GPs, and there needs to be a level playing field across the board.
We must consider value for money. Evidence indicates that every £1 invested in GP services yields a £14 return for the local economy. Let me revisit the crucial role of face-to-face appointments. In an increasingly digital world, it is pertinent to ask just how important in-person consultations truly are. While the question is valid, what remains crucial is that face-to-face interactions allow GPs to deliver holistic care that surpasses what is achievable in the virtual environment.
Face-to-face appointments facilitate physical examinations, which are indispensable for accurate diagnosis and treatment planning. While the advances in telemedicine are certainly welcome, physical examinations remain essential for certain symptoms and conditions. In-person consultations are key to effective communication, as they enable GPs to observe non-verbal cues and facial expressions that are crucial in understanding a patient’s needs. Such interactions foster trust, empathy and understanding, greatly enhancing personalised care. This trust encourages patients to be more honest and forthcoming, directly contributing to improved health outcomes. For many vulnerable groups, such as the elderly or individuals living with poor mental health, face-to-face appointments serve as a lifeline. They offer reassurance and a sense of connection, helping to combat isolation and ensure comprehensive care.
In 2022, as we emerged from the covid pandemic, there were 9.7 million GP consultations in Northern Ireland. In 2023, that number increased to 10.1 million. However, we must face the reality that one third of GP practices need the support of the practice improvement crisis response team. I am troubled that with private GP services, we risk creating a two-tier system that exacerbates health inequalities, both in North Down and across Northern Ireland and the rest of the UK. We must have a GP service that is accessible to all, not just a service reserved for those who can afford it.
We need to invest in our GP workforce and develop effective retention strategies. I direct the House’s attention to the 17 recommendations made by the Royal College of General Practitioners Northern Ireland in its document “A Workforce Fit for the Future”, which warrants thorough consideration followed by decisive action. Other solutions, such as the Pharmacy First programme, deserve detailed consideration. That practice, enabled across the UK, has been shown to effectively serve deprived communities and has real potential to alleviate the workload on our GPs. Therefore, this challenge is not a matter of choosing one over the other, but rather of finding a balance where digital and face-to-face services complement each other in delivering optimal healthcare.
Patients are becoming increasingly frustrated at not being able to speak to or see their GP. GPs are becoming increasingly frustrated at the ever-increasing workload, which has a knock-on effect, with many people having to go to their nearest accident and emergency unit. Those have some very long waiting times, and that adds more pressure to the health system. I emphasise and underline that access to GP services and face-to-face appointments are vital to maintaining a robust health system across the UK.
As I finish, allow me to pose some questions informed by the Royal College of General Practitioners Northern Ireland. Is it not true that Northern Ireland has the lowest proportion of its healthcare budget allocated to GP services, compared with the rest of the UK? Can anyone point to anywhere that spends less? Does the Minister agree that Northern Ireland deserves better?
The Minister for Care (Stephen Kinnock)
I thank the hon. Member for North Down (Alex Easton) for raising GP access, which is a vital matter for so many of our constituents. I congratulate him on securing his first Westminster Hall debate—well done on that. [Interruption.] His first Adjournment debate—sorry. We are not in Westminster Hall right now. It has been a long day; I thank hon. Members for their forbearance.
When we ask people what their top priority for the NHS is, the chances are that they will say it is to fix general practice, because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities right across our country. Of course, health is a devolved matter in Northern Ireland, and decisions about GP services there rightly sit with the Northern Ireland Executive and at Stormont. Nevertheless, this Government are committed to being an active partner in helping to deliver better public service outcomes across the UK while respecting the devolution settlement. I am delighted that the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Putney (Fleur Anderson), is here with me on the Front Bench this evening, showing how important the teamwork between the UK Government and the Northern Ireland Executive is.
Ultimately, the underlying challenges are the same. Whether it is access, capacity or workforce pressures, we recognise those issues across the UK. Our manifesto pledged to reset our relationship with the devolved Administrations, to put country before party, and to work with them on issues from trade and tackling child poverty to a whole range of issues around the economy and growth that affect all of us. I welcome this chance to hear the perspective of the hon. Member for North Down and to exchange ideas across the Floor of the Chamber. Access to timely GP appointments is at the heart of a strong and responsive healthcare system.
Mr Tom Morrison (Cheadle) (LD)
On that point, I will raise the issue of a resident who lives in my constituency. She needs to give blood every three months for a long-term condition she has, but she can never get an appointment in Bramhall, where she lives; instead, she has to travel 3 miles to Shaw Heath. That happens every three months. Does the Minister agree that that should not be happening in our country and that access to GPs should be not only easier, but available to all our residents?
Stephen Kinnock
I agree absolutely with the points that the hon. Gentleman makes. We will very shortly publish our 10-year plan for the NHS. As I will say a little later in my speech, a big part of that is about the shift to a neighbourhood health service and shifting from hospital to community so that the front door of the NHS is fixed, and access is a vital part of that.
Chris Coghlan
The big issue in my constituency is that I have constituents who are on the point of qualifying as GPs, but they do not have jobs as GPs to go into. What do the Government plan to do as part of their 10-year plan to fix the issue that we have people qualifying as GPs who do not have GP jobs to go into?
Stephen Kinnock
I am sure the hon. Gentleman will welcome the fact that we secured a record £889 million increase in the GP contract. That is a first step in digging us out of the very deep hole that the previous Government left for us. When I look across my portfolio, whether it is GPs, mental health, dentistry or pharmacy—you name it—it is a car crash right across the piece. I was frankly shocked by what I saw when I first went into the Department back in July. We are, I hope, beginning to get things back on an even keel. The hon. Gentleman is right, though: we do not have a shortage of people coming through GP training, but supply and demand are not matching up. That has to change.
I am sure that the hon. Member for North Down will welcome the fact that we secured £82 million of additional funding through the additional roles reimbursement scheme, leading to the recruitment of an additional 1,700 GPs. The challenge is more about getting GPs in the places where they are most needed, which is something we need to work on—other colleagues have talked about the geographical imbalance. We need to look at the formula for the way that funding is allocated across the country, as it is an important part of the access issue that the hon. Gentleman raised.
Tom Gordon (Harrogate and Knaresborough) (LD)
I have been working with Lib Dem councillor Hannah Gostlow to tackle some of the issues that local health services and GP surgeries in Knaresborough are facing. I recently visited a surgery and was told that it had the staff that it wanted to get in place, but did not have the consulting rooms. The problem that surgery faces is that the money from the community infrastructure levy and other sources of funding will not come until further down the line, so it cannot take on those staff because the consulting rooms cannot be built. Does the Minister agree that we need to get funding into those GP services, so that we can provide the services that local people deserve and need?
Stephen Kinnock
The hon. Gentleman is right; one challenge we face is that, where we are developing new centres of housing, we are not getting the social infrastructure wrapping around them. We need to use things such as section 106 agreements and the CIL, as he mentioned. That process is not always working—the developers are not always coming forward with real, concrete commitments—so the integrated care boards do not commission because they are not sure that the infrastructure will be there, and we end up in a chicken-and-egg situation. We are working closely with colleagues in the Ministry of Housing, Communities and Local Government to break through some of that and attach stronger strings to the deals being done with developers. We also have the £102 million capital infrastructure scheme for primary care, which will go some way towards addressing the issue, but this is fundamentally about getting much clearer and stronger commitments from developers.
Jim Shannon
I thank the Minister for his responses, which have been incredibly helpful. When I think of GP access, I think of two things; the first is Strangford and the villages along the Ards peninsula, where I have lived for most of my life and where I represent. There, the best way of contacting a GP is by phone—that is the nature of the situation there—but one of the things that helps in Newtownards, which is the biggest nucleus of people in the area, is for people to go down to the surgery at 8 o’clock or half-past 8, join the queue and get their appointment there and then. That is another way of trying to access the GP; there is nothing as frustrating as being on the phone from 8 o’clock to half-past 8 or 9 o’clock and not being able to get an appointment. At least when people can see their doctor, they can definitely get one.
Stephen Kinnock
We have to have a mixture of access channels. The telephone is very important, as is being able to turn up in person, but we also need to shift more to online booking. I am really pleased that the new contract that we have with GPs is based on an £889 million investment that came with a lot of strings attached around reform. One of those strings is that every GP surgery—in England, at least—must have online booking facilities by 1 October. I hope that will improve access, and will make more space in the reception process for people who cannot use the internet.
We have to ensure that we get the balance right. That is why, as I mentioned, we took decisive action in October 2024. We invested £82 million in the additional roles reimbursement scheme, which was a targeted move to strengthen our frontline services and ease the pressure on practices across the country. That funding has directly supported the recruitment of over 1,700 GPs across England. Those GPs are now in place, helping to increase appointment availability and—most importantly—improving care for thousands of patients who have been struggling to get the help they need when they need it. We have also seen a rise in the number of GPs employed directly by practices over the past 12 months, which is a positive sign that general practice is stabilising and beginning to rebuild capacity on the ground. Together, these developments are making it easier for patients to access care and for practices to deliver it.
Robin Swann
As the hon. Member for North Down (Alex Easton) mentioned, there are contracts that have been handed back to the Department. We have people coming forward who want to be GPs, but it is getting harder to find those partners who want to run and manage practices. Does the Minister agree that in any training scheme and any course that comes forward, that side of general practice—how to run a business and how to run a practice—needs to be reinforced in training? There are people who want to be GPs and medics, but we need that skills mix, too.
Stephen Kinnock
The hon. Member speaks with great knowledge and expertise in this area, so I am pleased that he is here for this debate. He is right that it is about the skills mix. Many GPs really enjoy the management, administration and leadership role at partnership level. He raises an interesting and important point about the training for that. My impression is that many go into managing a practice having just learned on the job and gone through the process in an ad hoc way. Perhaps training is a matter for further discussion with the Royal College of General Practitioners. It is also about learning to run a business. Could we look at that in respect of universities and MBAs or whatever it might be, given that business administration is an important part of the equation?
I also wanted to say a word about bureaucracy. Too much red tape is holding GPs back. On 4 October, the Secretary of State launched the red tape challenge, with a clear goal to identify and eliminate unnecessary administrative burdens, freeing up GPs to see more patients and focus on delivering high-quality care. Improving access is not just about cutting bureaucracy; it is also about transforming how care is delivered. That is why we have committed to moving towards a neighbourhood health service. That model of care will bring a range of services together, breaking down barriers and silos between services and streamlining support for patients. That integrated approach will mean that patients are seen sooner by the right person in the right setting.
We will require all practices to ensure that patients can go online to request an appointment at any point during core opening hours. That is about not just adding a digital option, but transforming how general practice works for the modern world. By making online access standard, we are giving patients more control and greater flexibility over how they engage with their GP. It will mean no longer having to call at 8 am sharp or waiting in a phone queue. That is especially important for those juggling work, childcare or other responsibilities. This change also helps those who prefer to call or go to the surgery in person; by enabling more people to use online routes, we reduce pressure on phone lines and reception desks, meaning shorter waits and faster service for everyone.
We are also taking action to improve access for those who need it most by incentivising better continuity of care, particularly for patients with chronic or complex conditions. They benefit significantly from seeing the same practitioner over time. Continuity does not just improve the patient experience; it improves outcomes. When patients see a familiar clinician, issues are identified earlier, care is more personalised and time is not lost repeating history or re-explaining symptoms. Our manifesto pledge is to bring back the family doctor, and that is what we will do.
Physical infrastructure has also been mentioned by hon. Members. Our new £102 million primary care utilisation and modernisation fund will create additional clinical space in more than 1,000 GP practices across England. This investment will deliver more appointments and improve patient care.
Ben Maguire (North Cornwall) (LD)
Stratton surgery in my constituency has long been trying to get access to two rooms on the third floor of the surgery that could be used for clinical space, but the ICB seems to be dragging its feet. The rooms were previously used by Cornwall’s ICB for maternity services. They are no longer in use, so can the Minister please help in working with the ICB to help Stratton surgery to get access to those much-needed clinical spaces?
Stephen Kinnock
If the hon. Member could write to me on that issue, I would be more than happy to look into it. I am always keen to help hon. Members to get their ICBs to move in the right direction.
We have directly provided £61 million to assist the expansion of the multidisciplinary team approach across Northern Ireland, which will help to stabilise primary care, focus on the prevention and management of conditions away from hospital settings, and better utilise the skills of the community and voluntary sector. We will provide additional funding by 2028-29 to bring back the family doctor by supporting the training of thousands more GPs and delivering millions more appointments over the spending review period, and will build further on the 1,700 additional GPs who have already been recruited. Through these improvements, we are making a difference to patient satisfaction: the latest health insight survey shows a sustained improvement in satisfaction, with 72.5% of patients who contacted their general practices in the past 28 days reporting a good overall experience—up from 67.4% in July 2024.
This Government are delivering concrete results, because we believe that everyone deserves access to high-quality care closer to home. I am delighted that general practitioners committee England voted in favour of this year’s GP contract in March. This is the first time the contract has been accepted in four years. The agreement resets our relationship and marks a turning point—a shared commitment to work together on behalf of patients and practitioners alike. The changes in the contract will streamline targets for GPs, incentivise improved continuity of care, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. Those changes are backed by an extra £889 million, representing cash growth of more than 7% in overall contract investment.
The NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Everything that this Government have done since the election has been geared towards saving the NHS, giving it back to the people and getting it back on its feet. We are putting power back into the hands of patients, where it rightly belongs, because this is their health service and it must work for them. Ensuring that every patient has access to the care that they need is not just a priority, but a promise.
Tom Gordon
I thank the Minister for indulging me again. Will he join me in congratulating the many fantastic GPs in my constituency and throughout the country? It is not an easy job; we hear of the flak that they get from patients day in, day out when they are working to tight timeframes. One such GP in my area is Dr Viv Poskitt, who has been elected as a Liberal Democrat town councillor. Will the Minister share my thanks to Viv and to all the GPs across our country?
Stephen Kinnock
I will certainly congratulate Dr Viv Poskitt—I think I have got the name right—on being a GP, although I will probably not congratulate her on being a Liberal Democrat town councillor. The hon. Gentleman is right: GPs are the backbone, or the beating heart, of our NHS. They represent the front door, and we must fix that front door, which is currently creaking on its hinges. This Government are absolutely committed to fixing it, and to moving on from there to fix our NHS, get it back on its feet and make it fit for the future.
Question put and agreed to.