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Martin Wrigley (Newton Abbot) (LD)
I beg to move,
That this House has considered GP funding in the South West.
It is a pleasure to serve under your chairship, Dame Siobhain. GPs are the front door of the NHS. They diagnose and treat illness, prevent disease and provide vital mental health support. As Lord Darzi once observed, general practice displays “the best financial discipline” in the NHS family while constantly innovating to keep patients out of hospital. However, GP funding is complex, obscure and insufficient. The bottom line is that the amount of money GPs receive is insufficient to deliver the obligations they carry. That is a view held by every single one of the 28 practice managers I met in and around my district, who tell me the situation is unfunded, unsustainable and unsafe.
GP funding is broadly based on two elements: a so-called global sum for core service costs, and additional quality and outcomes framework payments. The global sum starts with a payment per patient per year of £121.79—that is less than we might pay for our dog to go to the vet for an annual check-up, or about a third of the cost of servicing a Renault Megane. It is no wonder that practice managers spend their evenings juggling spreadsheets simply to keep the lights on.
It gets worse. That paltry sum is then modified by something known as the Carr-Hill formula. Carr-Hill was designed for a different era. It weighs patient numbers and postcodes but underrates deprivation, multimorbidity and today’s population health priorities. The consequences are stark and deliver what is known as the inverse care law. In my constituency, the Buckland surgery looks after some 4,000 patients on its list but is effectively funded for 3,200.
Will Stone (Swindon North) (Lab)
The hon. Member talks about the number of patients that GP practices have on their books. We have an ambitious plan for building more houses. Does he agree that we need to consider not just existing GP practices but funding the infrastructure for future practices, so that we have adequate services for people? There are places in Swindon that will be expected to take on thousands more patients, and the infrastructure is simply not there right now.
Martin Wrigley
The hon. Member is absolutely right: we have to consider these things. I have spent many hours persuading my local hospital trusts and the integrated care board to talk to the local authorities and work in the cycles of the local plan, so that they get their requirements into that plan. All too often they say, “A new housing development has just been built. We need a new GP practice with it,” and that is too late. The cycles do not add up. The system is broken, and we need to change that.
The Buckland surgery is underfunded by some 800 patients every year. It is part of the Templer primary care network, in which 2,500 patients are effectively treated for nothing. This means that the Buckland practice faces an annual shortfall of approximately £84,000—money that would cover another GP. If we then look at the changing number of patients per GP, in 2019 each GP was supporting 1,800 patients, compared with around 2,400 today.
Sir Ashley Fox (Bridgwater) (Con)
My constituents tell me of their difficulty in getting an appointment with their GP. Does the hon. Member share my view that GP practices should get a bigger share of NHS funding, which would enable them to improve the health of our constituents? And does he share my concern that much of the extra money allocated by the Government risks being swallowed by increased national insurance contributions, inflation and pay awards?
Martin Wrigley
Practice managers tell me that that has already happened and they are less funded now than they were last year.
On the changing numbers, each GP was supporting 1,800 patients in 2019 and is supporting 2,400 today, but safe care is often estimated to be closer to 1,400 per GP. So we are overloading GPs with patients. Practices make heroic use of pharmacists, physios and nurse practitioners, but the arithmetic does not add up. Meanwhile, the other part of their funding, the quality and outcomes framework scheme, has faced changes that have negatively impacted primary care. This meant that, nationally, £298 million was redistributed from the QOF into the global sum—we can see how bizarre this funding set-up gets; the names are just weird—and into cardiovascular disease prevention funding. Another £100 million of funding was repurposed but does not put extra capacity into the system. Rather than providing new money to support GPs, this felt to practice managers that the Government had been rearranging the deckchairs.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Gentleman on securing this debate. He is right to address this issue—I spoke to him just before his introduction. We have great difficulty across all this United Kingdom of Great Britain and Northern Ireland when it comes to securing GPs for practices. In recent years, I have been trying to ensure, with the health service, that action can be taken regarding the student loans of young medical students, if they give a commitment to remain in a GP practice for a set period of, say, five years. That would enable more GPs to stay in the system. Does he feel that that is something the Minister and the Government should take on board?
Martin Wrigley
All those things help, along with things like bringing back nurses’ bursaries. On rearranging the deckchairs, it is no wonder that practice managers described this year’s settlement as unfunded, unsustainable and unsafe.
Steve Yemm (Mansfield) (Lab)
Does the hon. Member agree that the increase of over 7% in GP contract funding for 2025-26, which the Government put in place, represents the biggest investment in GPs for more than 10 years? We always want to get more money for GPs and the Government are committed to that, but does he think that the largest increase in 10 years should make at least some difference for his constituents in Newton Abbot as well as mine in Mansfield?
Martin Wrigley
I thank the hon. Gentleman for that intervention, but sadly, I must disagree. That is not what practice managers are telling me. Their costs have gone up so much that all of the increase has been swallowed up, and they are not sure they can keep the lights on. They are really struggling. I have partners in GP practices who are paying themselves less than the minimum wage, which is not sustainable.
Patient demand has also increased post pandemic, and continued cuts have seen the removal of many services and social care that have supported what GPs do. On top of the cuts to Sure Start and a 40% drop in health visitors since 2015, carers already stretched thin face the prospect of losing personal independence payment support, which will inevitably rebound on general practice—the first line of defence. That is not to mention long covid and pandemic backlogs. All of those drive more people to want to see their GP. The cost of living crisis is compounding multimorbidity, where the most vulnerable in society with chronic illnesses are further pressured.
And then, we get the new requirement to run the appointment schedule from 8 am to 6 pm, filling every single slot. From October, practices must hold digital front doors, open all day, for non-urgent requests. With 100% booked appointments, there is no spare capacity for the person who falls in the care home or for the child who needs attention after school. Partners in the Albany surgery in Newton Abbot warn me that an unlimited invitation will flood a service that simply cannot be limitless. This is unsafe—unfunded, unsustainable and unsafe.
Talented doctors are leaving. The partnership model, still the cheapest and most community-rooted option, is no longer attractive when partners shoulder unlimited liability for premises, pensions and payroll, yet cannot guarantee safe staffing levels. The Royal College of GPs reports a 25% fall in GP partners over the past decade. The chair, Professor Kamila Hawthorne, put it bluntly:
“It makes no sense that trained GPs cannot find sustainable posts while patients wait weeks for appointments.”
Ian Roome (North Devon) (LD)
I thank my hon. Friend for securing the debate. Patients in Lynton, one of the remotest communities in North Devon, will soon have access to a GP, but that only happened because of a spirited campaign by local patients. Does he agree that if we are relying on an active community to highlight gaps in provision, it will always be the marginalised communities who find it hard to see a GP?
Martin Wrigley
My hon. Friend is absolutely right. I commend him on obtaining a ministerial visit to his hospital in North Devon. North Devon district hospital is fantastic and we need to ensure that it gets the investment it needs—just so long as we can get some south Devon patients there as well.
In Teignmouth, the previous four practices have merged into one, mostly due to not being able to find new partners. In Newton Abbot, one practice was on the verge of handing back its patient list due to not being able to replace retiring partners. We have not even talked about specific issues facing some of these surgeries, such as the unbreakable lease on a building that is not fit for use as a GP surgery, where the only possible course of action they could see was to declare themselves bankrupt. As doctors, that ends their careers.
And yet, these practices are doing amazing things. The Kingsteignton medical practice, partnering with the charity Kingscare, has created a model that is delivering for patients. Just think what could be done with a better funding model. Buckland surgery would like to link with the local school to tackle adverse childhood experiences before they turn into permanent ill health, providing better family support—much as it has already done with its links to a number of local support services through the Buckland hub.
Prior to the election, the now Health Secretary often quoted that a GP visit cost £40, whereas an A&E visit cost £400. I am not sure I agree with the absolute numbers, but the principle is fine: it is 10 times more expensive to put somebody through A&E than it is to put them through a GP. If we talk to Devon integrated care board on GP resilience and prevention, the evidence is crystal clear: prevention saves money. And yet, as Torbay and South Devon NHS foundation trust remains in NHS operational framework 4—we might perhaps equate it to “unsatisfactory” if it was a school—because of historical deficits, it is tasked with huge efficiency savings and is understandably risk-averse. Community services that once propped up primary and secondary care—the stroke recovery group, Devon Carers hospital service, the Torbay and Devon dementia adviser service—have vanished as funding evaporates. Closing gaps in prevention only widens cracks elsewhere. It is not getting better.
To sum up, the funding formula is broken. It delivers the inverse care law that the availability of good healthcare tends to be inversely proportional to the need for it within a population. We need to fix it. I am asking the Government today to: end the Carr-Hill formula, and make deprivation, rurality and workload properly weighted; invest in core general practice, not just peripheral schemes, so that partnerships remain viable; protect prevention budgets in the next spending round, as it is cheaper to keep people well than to rescue them later; support premises and digital infrastructure so that online access enhances rather than overwhelms safe care; and publish a workforce plan that retains experienced GPs, accelerates training and makes partnership an attractive career again.
Several hon. Members rose—
Dame Siobhain McDonagh (in the Chair)
Order. I remind Members to bob if they wish to be called. I ask for some self-restraint, with speeches restricted to six or seven minutes, so that we can get everybody in.
Noah Law (St Austell and Newquay) (Lab)
It is a pleasure to serve under your chairmanship, Dame Siobhain. I thank the hon. Member for Newton Abbot (Martin Wrigley) for securing this important debate and for his contribution on this matter of long-overdue concern.
Cornwall faces some of the most severe health inequalities in the country. In January, more patients waited more than 30 minutes in ambulances outside hospital in Cornwall than anywhere else. That is not just a statistic; it is a clear sign that our health system is under serious pressure locally.
We know the reasons: our higher levels of deprivation, an older population, poor transport links that make it harder to recruit and retain the NHS and social care staff we urgently need, and the enormous impact of our visitor economy, which is finally going to be taken into account in local government funding, thanks to the fair funding review. Those deep-rooted structural challenges mean that many people across Cornwall struggle to access timely care.
For that reason, I welcome the forthcoming announcement by the Secretary of State for Health and Social Care that the Labour Government will top up the system with £2.2 billion to improve general practice in the poorest areas with the highest health need. That is the right decision and the right priority for communities like mine in St Austell, Newquay and the clay country. The impact is already being felt. In mid-Cornwall, Newquay health centre and Brannel surgery are already set to receive vital upgrades. That is part of the biggest investment in GP facilities for five years, even before today’s announcement.
Steve Yemm
Last month, the Government announced the primary care utilisation and modernisation fund, which will deliver more than £100 million for upgrades to more than 1,000 GP surgeries. A number of GP surgeries in my constituency will benefit, including the Sherwood Medical Partnership surgery in Forest Town, Mansfield. Does my hon. Friend agree that that funding will make a huge difference? It will enable practices to boost productivity by seeing more patients and will improve patient care overall.
Noah Law
Yes, I agree. I am greatly relieved for my hon. Friend and his constituents that vital funding is already coming through and that the urgency has been recognised. In Newquay, for example, people have not even been able to sign up with a new GP. That is shocking, given that it is now Cornwall’s biggest town and one of the fastest growing. The assertion should not be levelled that we are not doing enough to invest in infrastructure and services alongside house building, because we are coming forward with the needed investment.
Nationally, we are looking at 8.3 million more GP appointments a year, but it is not just about the numbers. It is about restoring trust in the NHS—trust that the infrastructure and services that we need will come together with growth, which will make care local, accessible and timely. We are fixing the front door of the NHS in our GP surgeries and, thanks to our Health Secretary’s leadership, we are fixing the corridors, the consultation rooms and the care that happens before patients reach A&E, as the hon. Member for Newton Abbot mentioned. That should be the goal.
Cornwall must not be overlooked. We must be prioritised in the 10-year plan for health. How will the Government ensure that rural and coastal communities such as those in Cornwall are prioritised for once and receive their fair share of new investment, particularly considering our peninsula penalty—just as we are now starting to see happening through local government? Will the Minister commit to delivering not just more appointments, but a long-term workforce plan that reflects the needs of our ageing population and the barriers to staff recruitment in rural areas? Cornwall’s health inequalities have been ignored for too long, but with this new Labour Government we finally have a partner in Westminster that is listening and acting.
Dr Roz Savage (South Cotswolds) (LD)
I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing this important debate on GP funding in the south-west, and for his passionate speech.
I want to shine a spotlight on a village in my constituency called Sherston, where the future of the local GP surgery hangs in the balance. I realise that Sherston may not be the centre of everybody’s universe, as it is of mine, but in many ways it is a microcosm of the wider issues facing NHS-funded GPs in the rural parts of the south-west. For years, residents of Sherston and the surrounding villages have lived with growing uncertainty as to whether they will continue to have access to primary care close to home.
Here is the situation: the lease on the current building for Tolsey surgery expires in 2027 and, for a range of reasons, it cannot be renewed. A local housing developer stepped in and offered to build a brand new surgery at no cost to the NHS, in exchange for a modest increase in the number of homes in a proposed development. Understandably, the community overwhelmingly backed the plan. The only missing piece is a commitment from the integrated care board to fund the running of the surgery.
The issue has been running and running. It is not just the local residents who have been calling for action; the parish council, our county councillor and I have all repeatedly urged the ICB to commit to supporting this facility—not just the bricks and mortar, but the long-term operation of a much-needed service. After months of dialogue, however, no clear answer has been given.
The ICB relies on a toolkit to decide how to allocate resources. Early in our discussions, it acknowledged that the toolkit was designed with urban settings in mind and is not well suited to rural areas, yet the ICB has continued to defer to the toolkit, as if it is unable or unwilling to apply common sense to a rural context. It argues that there is spare capacity at the Malmesbury primary care centre, but anybody familiar with these places knows that that is simply not the case. Staff are stretched, appointment slots are limited, car parking slots are even more limited and patients are already struggling to get seen. Understandably, the people of Sherston are at their wits’ end. This is not just about one surgery; it is about a broader failure to meet the healthcare needs of rural communities.
Access to healthcare in rural areas is closely tied to transport. Sherston has no regular reliable public transport to Malmesbury, which is five miles away. Many elderly residents no longer drive. For a sick or disabled person in significant need of a GP, or for a parent with young children, getting to a GP appointment in another town can be close to impossible. Once again, as in so many other contexts, we see rural issues—transport, healthcare, infrastructure and resilience—being treated in silos, when in reality they are deeply interwoven. We must start recognising that in the system.
Following the Health Secretary’s announcement in May of new funding for GP surgeries, I wrote to his Department to ask whether Sherston might benefit. Unfortunately, the reply was disappointing. I was told that the surgery did not meet the criteria and has
“not been selected for this year’s funding.”
Well, Sherston surgery does not have very many years left. This response reflects a deeper issue: a fundamental lack of understanding of rural life in our national decision making. A site visit and a short attempt to navigate the journey from Sherston to Malmesbury by bus—or, more likely, the lack of a bus—would speak volumes. I understand that not every village can have its own GP surgery, but when a brand-new, purpose-built facility is being offered, free, to replace a much-used existing practice, why would we say no?
It is not just Sherston. Across the south-west, rural GP surgeries are being overlooked in NHS investment planning. If we are serious about levelling up healthcare access, that has to change, so I have launched a petition to save Sherston surgery. I invite residents to sign and share it. Once we have gathered sufficient support, I will present it in Parliament to show the Government just how strong the feeling is.
I was impressed by the figures from the Health Secretary that my hon. Friend the Member for Newton Abbot cited—that the cost for a GP visit is about £40, versus about £400 for an A&E visit. Failing to fund rural GPs adequately is a false economy. For economic reasons as well as for health reasons, rural communities should not be treated as an afterthought. Everybody, wherever they live, deserves compassionate, reliable and, above all, accessible healthcare.
Vikki Slade (Mid Dorset and North Poole) (LD)
It is a pleasure to serve under your chairship, Dame Siobhain.
GPs epitomise the NHS for us all. They support us from cradle to grave like no other part of the NHS. Although they represent 90% of the patient’s experience of the NHS, they get less than 10% of the budget. To better understand these issues, I have spent recent months meeting doctors and practice managers, but I have also spent a morning shadowing a GP at Walford Mill medical centre in Wimborne to see the reality of their life at first hand.
I thank Dr Wright and every patient who kindly allowed me to observe often deeply personal and distressing consultations. I witnessed high-quality, compassionate care. Despite a busy schedule, the GP took time to liaise with hospitals, arrange tests, write referrals and fully support his patients. Almost every patient was supported with more than they arrived to discuss. He sensitively raised worrying comorbidities with them and encouraged them to come back and think about their wider life. I could not fault the care that he gave.
That brings me to appointment times. The British Medical Association recommends 15-minute appointments for GPs. Most surgeries allow only 10 minutes, but they typically try to get away with five minutes. There is no way a GP can look after a person in that time, particularly given the emotional connection that they have with their patients. One minute they are telling a patient that they have cancer; the next, they are comforting a new mum who is worried about the health of her baby. How does a doctor download their own emotions in between, particularly when they are dealing with financial pressures and their own home lives too?
GP surgeries are also struggling with having to do things that they were not designed to do and not being reimbursed properly. One of the issues I witnessed was the reimbursement of blood tests. That practice recently negotiated a contract with NHS Dorset, which not only did not agree with the amount that the GP said they needed, but cut it dramatically. The GPs are being reimbursed at 25% of the actual cost to them, so they personally subsidise every blood test that they undertake, in a drive to push blood tests to hospitals where patients do not want to be and that they cannot get to. It is quite distressing for them. It is in the patients’ best interests for blood tests to be taken locally.
On the flipside, NHS Dorset’s pathway for cancer means that the follow-up investigations, including some very personal examinations, have to take place at a surgery with a GP who does not know the patient. The patient does not start their cancer journey by going to the hospital and seeing people who actually know about cancer. I found that quite worrying and distressing.
The other issue I experienced was the discrepancy between the electronic systems used by GPs and the paper systems used by doctors in hospitals, where letters were still being sent by post, causing delays and additional administration in surgeries. Bizarrely, paper prescriptions were still being issued by hospitals, meaning that patients were not able to leave to get their prescription elsewhere, and people rushing to get their family member home were having to get a new prescription, creating more delay and unnecessary work for GPs.
I have some examples with which the Government can perhaps help. I am grateful to the Minister for replying to one of these cases, so it may be familiar to him. The GPs at Wareham surgery are all partners, and they are working out of a building that was part of a hospital and ambulance station, but the building is falling down. The hospital was going to be rebuilt, but that was shelved long ago, and the surgery has finally found a new building. Unfortunately, the building comes with a 25-year lease, which extends beyond even the most youthful of partners, and there is no break clause. It also has a requirement that there be at least three GP partners, and if there are not, retiring GPs will remain personally liable until there are.
However, what we are finding in both Wimborne and Wareham is that people can no longer afford to be a partner in these surgeries. Bethan, my niece, is a GP in her early 30s, and she has probably accrued more than £100,000-worth of debt to get there. She probably has a £250,000 mortgage, because she lives on the south coast. How on earth can she, as a young woman, be expected to take unlimited personal liability on top of that? More people are therefore becoming salaried GPs. They are working their socks off in clinical terms, but they do not have any of the burden of running their surgery, taking that responsibility and subsidising patients.
The GP surgeries I mentioned are struggling to find people willing to be a partner, so that they can take up that lease. I did not hear from the Minister any real reassurance or understanding of the fact that the nature of being a GP is changing. What are the Government doing? Are we expecting the GP partner model to be phased out, and if so, what will replace it? How do we make sure that these organisations can remain?
I was most bothered when the chief executive of NHS Dorset said that GPs are independent contractors and are responsible for sorting out their own businesses. I find it absolutely appalling that we treat our GPs as if they are the local carpenter. GPs are the heart of our communities, and we need to start talking about them as an integral part of the NHS, not as an independent business that needs to make money. These people are not making money; they are saving our lives and keeping us well, and we need to treat them much better.
The population of Wimborne has doubled, and people are worried because the town has lost a GP surgery. They are constantly writing, “We need another surgery.” The surgery in Wimborne, like most surgeries, wants to expand, but one of the problems with the funding model that GPs can access—I would be grateful if this could be looked at—is the requirement to bid, design, obtain planning permission and build within a financial year. With the best will in the world and the most efficient planning system, there may be a tiny district that can do that, but I do not know anywhere that can complete the whole process in a year. We need to find a way for GP surgeries to access funding over multiple years, so that communities know they have an NHS fit for the future.
I look forward to the Minister’s comments.
Adam Dance (Yeovil) (LD)
It is a pleasure to serve under your chairmanship, Dame Siobhain. I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing this important debate.
GPs are the front door of our health service, particularly in rural constituencies such as Yeovil and many others in the south-west. Despite their hard work, GPs in Yeovil are stretched thin because the necessary funding and support simply are not there. Everyone deserves access to safe and accessible local healthcare, and all of our constituents should be able to see a GP within a week. Unfortunately, 23% of patients in Somerset are waiting more than 14 days for an appointment, and over 7% are waiting more than 28 days. I have heard from too many constituents who have waited that long or even longer, which is also not good enough.
We need to ensure that everyone has the right to see a GP within seven days, or within 24 hours in urgent cases, and we need more GPs to deliver that. We should also ensure that everyone aged over 70 or with a long-term health condition has access to a named GP. Many of my residents and constituents are concerned that they do not know who their GP is, or that they do not have access to a named GP. They find it concerning that they regularly have to see different GPs or locums.
Many of our GP surgeries are struggling with their buildings. As I have previously said, I am grateful to have received confirmation from the Minister that Crewkerne health centre and Church View medical centre in Neroche are set to receive a share of the £102 million to deliver upgrades to their practices, but other surgeries are seriously struggling and feel overwhelmed and overlooked. Ariel Healthcare in Chard urgently needs funding and support to upgrade its services to help local residents with urgent needs.
We cannot support our GPs in isolation. We desperately need to improve public transport in the south west so that people can get to their appointments. The cancellation of the No. 11 bus service in Yeovil highlights that issue, and residents, particularly those who are vulnerable, now struggle to access Preston Grove medical centre and Hendford Lodge surgery.
We also urgently need to fix NHS dentistry, because people are forced to go to their GP or hospital for help. Can the Minister provide a clear timeline and costed proposals for fixing the NHS dental contract? The British Dental Association has only had scoping meetings so far, so I hope the Minister and the Government will push that.
We also need to increase investment in public health. Somerset is 11th from the bottom in public health grant allocation despite having a growing public health crisis, particularly around addiction. I was a public health cabinet member for two years and we had only £100,000 to push dental health. It is just not good enough.
On average, we are £13.6 million short across the country, and public health desperately needs reforming. I hope the Minister takes on board our calls to ensure that GPs in the south-west get the funding they deserve and desperately need to support our residents. Without our fantastic GPs, there is no future for our NHS.
Brian Mathew (Melksham and Devizes) (LD)
It is an honour to serve under your chairship, Dame Siobhain. I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing this important and timely debate.
I will quote a GP in Melksham and Devizes who also covers part of the neighbouring constituency. He wrote in an email to me this week:
“Without a significant improvement in GP contract payments, the ICB will push us into a position where we have to reduce the hours our surgeries are open. This for us at best means closing sites 1-2 days per week to try to minimise our staff wage bill which is our largest expense. Depending on what happens in 1-2 years, one or more sites would have to close.”
Claire Young (Thornbury and Yate) (LD)
My hon. Friend is making a strong case for Three Shires medical practice, which has three surgeries in my constituency. Does he agree that if any of the surgeries were to close, it would be a disaster for patients because of the poor public transport links? Does he agree more generally that it is more expensive to deliver GP services in rural areas because we cannot centralise to save money without dramatically reducing patient access?
Brian Mathew
I totally agree with my hon. Friend.
On funding, although the general medical services baseline is around two thirds of our income, it has gone up by 7.2%, with 6% eaten up by the increases in employer national insurance contributions and the national living wage. Our other income streams—dispensing, QOF and enhanced services—have gone up very little. Our emergency section 96 one-off funding has helped us to postpone that decision, and further tightening our belts has stabilised our financial position. However, partner income remains lower than it was two years ago, and it is little more than that of salaried GPs, making reappointment difficult.
Most of the new money is tied to the primary care network, so it is centralised, or it is delivered via the additional roles reimbursement scheme, which is mainly restricted to non-GP roles such as pharmacists. There has been a scheme to allow PCNs, not practices, to employ newly qualified GPs in a temporary capacity—for example, at a central hub practice. That arrangement disadvantages rural practices, as resources are centralised towards urban centres.
At Three Shires, we have reduced our use of locums to cover GP absences by about 60%, resulting in fewer appointments overall. We have allowed retiring nurses and salaried GPs to leave without replacement, or only be partly replaced, to make savings. That has meant offering fewer appointments and greater work for remaining staff. Our patient participation group has been amazing. It formed the Friends of Three Shires, which has fundraised for new equipment, such as ECG machines and examination couches, helping to keep facilities up to scratch for patients.
The integrated care board has effectively imposed a deadline at the end of September for us to demonstrate that we can continue. Would the Minister be prepared to meet me and GPs from my constituency to hear directly from them about the stark realities of rural GP practices, so that they can help?
Jess Brown-Fuller (Chichester) (LD)
It is a pleasure to serve under your chairmanship, Dame Siobhain. I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing today’s important and timely debate. He is a tireless advocate for his local community, and I commend him for shining a spotlight on GP funding and the broader state of healthcare in the south-west. He spoke about the funding model for GPs, which is complex, obscure and outdated, and does not account for rurality.
As the Liberal Democrat spokesperson for hospitals and primary care, I hear all too often from my constituents and from people across the country who are struggling to access the care they need. Our NHS is the pride of the nation, but years of underfunding and mismanagement under the last Conservative Government have left services in crisis.
Nowhere is that more apparent than in general practice, with patients facing increasingly long waits to see a GP, as highlighted by my hon. Friend’s statistics. In 2019, the average GP had 1,900 patients on their books; today, they have 2,400, and some people cannot get an appointment at all. People rightly tell me that they are not included in the Government’s waiting list statistics because they have not managed to get on a waiting list in the first place—or even speak to a doctor.
Those are not isolated complaints. I am sure many hon. Members will recognise those concerns from their own constituency surgeries, or from spending a morning with their local GP, as my hon. Friend the Member for Mid Dorset and North Poole (Vikki Slade) described. We also need to be honest about the scale of the problem. In 2024 alone, more than 2 million people in the south-west waited over 28 days for a GP appointment, and that pattern is repeated across the country. Chichester is not in the south-west, but nearly 30% of patients in my constituency had to wait more than two weeks, and around 8% waited more than a month. That is not acceptable.
The hon. Member for St Austell and Newquay (Noah Law) made an important point about tourism. The population of my coastal communities such as Selsey, Pagham and the Witterings doubles over the summer months with holidaymakers, which can put additional stress on primary care services.
My hon. Friend the Member for South Cotswolds (Dr Savage) made an important point about the role that planning and ICBs play. Too often, developers come forward with large site proposals that include a GP surgery on the site. However, unless they have buy-in from the ICB, so often those GP surgeries that have been specifically designed for that purpose sit empty without a GP practice to go into them.
My hon. Friend also spoke about her village of Sherston. It might not be the centre of my universe—that is my little rural village of Westbourne—but both Sherston and Westbourne face the exact same problems. My village of Westbourne is about to lose its rural surgery; we are waiting for the ICB’s final decision. Residents of Westbourne do not have a public transport link to the GP that they are being asked to go to, across the border in Emsworth.
The Liberal Democrats believe that everyone should have the ability to live a healthy and fulfilling life, which means they must have timely and local access to healthcare, whether that is from a GP, a dentist, a pharmacist or a mental health professional. We must invest in early access to community care, in order to relieve the burden on hospitals and fix the social care crisis that leaves too many people stuck in hospital beds waiting for help that never comes.
Research by the House of Commons Library that was commissioned by the Liberal Democrats found that funding for GP practices was cut by £350 million in real terms between 2019 and 2024. Those cuts have hit communities hard, and the impact is being felt not only by patients but by the hard-working professionals trying to keep the system going. GPs who I speak to are burnt out and overburdened, and GPs in general are leaving the profession in record numbers. The result is a vicious cycle, with fewer staff, longer waits and growing public frustration. I know some incredible GPs, and New Zealand is really lucky to have them, but I would rather they were here. Despite a 2019 Conservative pledge to hire 6,000 more GPs, by the general election last year there were 500 fewer GPs than when that pledge was made. In fact, the UK has 16% fewer qualified GPs per capita than comparable high-income countries.
It does not have to be that way. Healthcare is not a luxury. It is a fundamental right and not a privilege. Everyone should be able to see a GP when they need to, and that is why the Liberal Democrats are calling for a legal right to see a GP within seven days, or within 24 hours if the situation is urgent. To make this a reality, we are calling for the recruitment of 8,000 more GPs. We would achieve that by supporting junior doctors to specialise in general practice and by introducing new schemes to help experienced GPs to return to the workforce.
As my hon. Friend the Member for Yeovil (Adam Dance) said, we also believe that everyone over 70 and those with long-term conditions should have access to a named GP. Such continuity of care is not only vital for building trust and supporting staff morale; it also improves health outcomes and saves money in the long term. As my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), who is the Chair of the Health and Social Care Committee, has said, continuity of care is key. Patients who have had the same GP for more than 15 years have a 25% lower chance of dying compared with patients who change GPs regularly. Continuity of care builds trust, improves outcomes and reduces hospital admissions. It is good for patients, good for staff and good for the system as a whole.
We must also address the broader picture. Community pharmacies are closing at an alarming rate when they should be playing a bigger role in delivering frontline care. Fairer and more sustainable funding is needed to keep these services open, to relieve pressure on GPs. I am a big fan of Pharmacy First and I know that the Minister is, too; I have heard him talk about his passion for it. But pharmacists in my constituency tell me that with the regular increase in targets, they are struggling to keep up.
Adam Dance
I spent an evening with one of my local pharmacists, and it was so shocking that people were coming 20 or 30 miles to his pharmacy, because it was the only one open near my village of South Petherton. He was struggling so much because he could not get the medication that people needed, despite the fact that they were travelling so far to try and get medication from him. Does my hon. Friend agree that that is just not good enough and that the Government need to support pharmacies a lot more?
Jess Brown-Fuller
I am sure the Minister will talk about the hub and spoke model that the Government are championing, but my hon. Friend is right about the difficulties in rural areas especially. Many constituents have talked to me about the distance they are having to travel to get basic medication that means they can function, go to work the next day or get their children to school.
This is why we have been calling for a fairer and more sustainable long-term funding model for community pharmacies. They play a vital role in relieving pressure on GPs, yet they are being squeezed out of existence. Since 2017, 1,200 pharmacies have shut their doors. Community Pharmacy England has warned of real-terms funding cuts of at least 25% since 2015, leaving the network on the brink of collapse.
This is not just a failing system; it is a broken one. This Labour Government have a responsibility to act. They were elected on a promise of change, but that change must begin with fixing our NHS. I am sure the Minister will celebrate the budget increase, but as my hon. Friend the Member for Melksham and Devizes (Brian Mathew) said, this has been swallowed by the increased costs and national insurance contributions. That is why the Liberal Democrats tabled an amendment to exempt healthcare services from the NICs rise, which the Government chose not to accept.
General practice is the front door to our health system. If we do not invest properly in GP services, everything else suffers. We must not let that door remain closed to so many. As my hon. Friend the Member for Newton Abbot rightly said, we do not have to accept broken systems—we can fix them, and now is the time to prove that we will. Will the Minister commit to the Liberal Democrat proposal of a legal right for patients to see a GP within seven days, or within 24 hours in urgent cases? Does he agree that everyone over 70 and those with long-term health conditions should have access to a named GP?
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your leadership, Dame Siobhain, and to be here. I pay tribute to the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate on a topic that I am all too familiar with, having spent time as a GP. This place may not be so familiar with the inner workings of GP practices, so it is fantastic to have the chance to discuss it. I declare an interest: many of my immediate and wider family are GPs, and it is important to put that on the record.
This debate has allowed us to discuss a huge variety of things, including the Carr-Hill formula and the QOF. We did not touch on DES and LES—directed enhanced services and local enhanced services. Rural dispensing practices are a really important funding stream. We have talked about the partnership model, retention, joining up services, ICBs and their toolkits, the interaction with the planning department and rurality, which has a particular impact on services in my area.
I want to pick up on the comments made by the hon. Member for Mid Dorset and North Poole (Vikki Slade). Fair play to her for going out and shadowing a GP to see what their life is all about. At the heart of what she said was the good care that goes on. If we were to believe the Daily Mail, every GP is on the golf course and only cares about the money. The money is important, but GPs care far more about the patients and the quality of care they give. That is what drives them and gets them out of bed each day. We in this house must not forget that when we discuss healthcare, because it is important. We will get far better healthcare than ever before in the last few decades, and we must not lose sight of that.
I am grateful to the hon. Member for Newton Abbot for giving me my first chance as a shadow Health Minister to debate general practice and ask the Minister some questions. Without further ado, I will turn to those questions. First, what is the Government’s current position on primary care and its models? In an interview in The Times in January 2023, the current Secretary of State for Health and Social Care said:
“I’m minded to phase out the whole system of GP partners altogether and look at salaried GPs working in modern practices alongside a range of other professionals.”
He went on to speak at events held by the King’s Fund and the Institute for Public Policy Research, where he acknowledged that he has
“observed a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs”
and that the
“status quo is not an option”.
Then 18 months ago, just six months before the election, the Secretary of State stated,
“What we were minded to do is to sort of phase it out over time. I’m still not sure whether or not the GP partnership can survive in the longer term. But I haven’t reached a sort of firm conclusion that says that it shouldn’t.”
In the light of that, and given the importance of the partnership model, could the Government clarify their position with regard to the partnership model and any other models that are being considered?
Vikki Slade
I thank the hon. Member for his comments about my visit to the GP, because it was an absolutely wonderful experience. If the proposal is to phase out the partnership model and move to a salaried model, how would that work, given the severe cuts that ICBs are facing? With 50% cuts to most of the ICB funding, somebody will have to pick up the costs of running these organisations, rather than the clinical side of it.
Dr Evans
The hon. Lady is spot on. I posed my question to the Government because we know that primary care is one of the most efficient parts of the NHS. Why? Because the people running those businesses—they are businesses, and we have to be open and honest about that—pay attention to where the money comes in and goes out. They take full pride in it, first, because they care, and secondly, because their salaries are paid from the profit that comes out of that. Again, “profit” is a dirty word that people do not like to use, but it is the reality of what we are dealing with when it comes to how we break down the funding.
The Government have proposed to get rid of NHS England, and it is still unclear not only how much that will cost, but how much it will save and where the administrative burden will fall. On top of that, we do not know what will replace the partnership model if we lose it, and this is the question to be asked. Given that it was only six months before the election that the Secretary of State stated his intent, I too am keen to find out the answer.
I have a second question to pose to the Government. There are concerning reports this month in the Health Service Journal, which has had sight of a leaked version of the Government’s 10-year plan to improve the NHS. It says that the plan will push back the Government’s ambition to increase the share of NHS spending on primary and community care to 2035, rather than 2029 as originally promised. Can the Minister confirm or deny those reports?
When it comes to funding, the Government raised taxes directly on GPs as part of the national insurance increase. Has the Department made any assessment of how much of the £886 million uplift that has been allocated to GP practices will be needed to meet the increase in employer’s national insurance contributions?
I turn to the figures for the ARR scheme. The Government announced in April that they thought they had reached 1,500 new GPs, but as the RCGP pointed out at the time, although having
“more GPs employed in the workforce is encouraging, when considering full time equivalent GPs—which gives the most accurate picture of the GP workforce and the care and services GPs are able to deliver for patients—the numbers published today are lower, at 851 GPs”.
The increase is encouraging, but when we dig into the data, it appears that we are simply seeing more locum doctors coming back into the scheme. I would be grateful to understand exactly how the numbers are made up, and where the inference of 1,500 GPs comes from.
More importantly, where is the scheme going in the future? Is it time-limited? Will it continue? Will it be expanded and, if so, what does that look like? Although it is an important part of addressing provision, we also need to understand exactly what is going on. Initial reviews of the data suggest that appointments have not kept up with the pace of the introduction of GPs, so I am interested to understand from the Minister why, despite the supposedly new GPs coming in, the number of appointments has not increased proportionately. I would be grateful for any comment on that.
Finally, I turn to recruitment. Training new GPs has understandably been seen as the priority when it comes to solving the long-term workforce problems in England. As Pulse magazine puts it:
“This is probably one of the areas of workforce planning that could be considered a success. Health Education England, which has been incorporated into NHS England, has been able to meet its target of over 4,000 new GP trainees a year.”
The NHS workforce report, launched under the previous Government in 2023, made commitments to increase that. It set goals to increase the number of GP specialist training places to 6,000 by 2031, ensure that all foundation-year doctors do a rotation in general practice, and require GP registrars to spend the full three years in general practice.
There has been progress, but along with progress come new problems. The British Medical Association has warned that up to 1,000 GP registrars could face difficulty when qualifying in summer 2025 without funding for GP practices to recruit newly qualified, unemployed or underemployed GPs. What active steps are the Government taking to avoid that, and what support will they be offering newly qualified GPs?
Dr Simon Opher (Stroud) (Lab)
The ARR scheme in my practice at May Lane surgery in Dursley is employing newly qualified GPs who provide a lot of extra appointments for the surgery, so the scheme is working quite well for newly qualified GPs.
Dr Evans
I am pleased to hear that the scheme is working well, but the question is—as the hon. Member would know if he had been here for the start of the debate and all the way through it—what does it look like going forward?
In other places, are locums simply being stepped into the ARR scheme because there has been a shift in the way that GPs commission their work and PCNs are looking to deal with that? That is the question at the heart of it. We seem to be training more GPs than ever, yet at the same time, we have a disproportionate number of people at the top end who are not able to find work.
It is important to build up multidisciplinary teams that take account of the pharmacists, nurses and mental health workers around GPs, and I welcome the fact that the ARR scheme allows that. It has been widened to get more funding but, as the hon. Member will know, there is a discrepancy in how much doctors are funded for and there are limitations on how long they can work in the scheme. If I were to return to practice, I would not qualify under the scheme. The Government need to pose these questions; although the scheme is welcome, does it solve the whole problem? I do not think so, and my final set of questions relates to that.
We have seen a trend in international medical graduates coming to work in the UK, with the number of international medical graduates overtaking domestically trained medics for the first time in 2023. Have the Government considered something similar to the Australian scheme? Australia classifies locations using the modified Monash model or the Australian statistical geography standard to rank areas from major cities to remote regions, and then prioritises overseas doctors into the areas of most need. That could help to deal with the disparities across different parts of the UK. Will the Government consider that model in attempting to address those disparities? Whether it is right for the UK is for the Government to decide.
Hospitals might save your life, but your GP has been quietly guarding it for decades. That fact is often lost in our debates, so it has been a privilege to remind the Government, the House and the public of that fact today. I look forward to the Government’s response.
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Dame Siobhain. I thank the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate and raising this important issue. I pay tribute to every hon. Member who has taken part in the debate for their insightful contributions.
The health and wellbeing of constituents across the south-west remains a top priority for us all; I welcome the opportunity to address the concerns that have been raised today. The issue strikes at the very heart of the NHS and its ability to serve our communities effectively. General practitioners are the cornerstone of the NHS. They provide the first point of contact for millions of patients, enabling access to specialist services, managing long-term and chronic conditions, and delivering preventive care.
The south-west is a unique part of our country with a population that faces distinct challenges, from its rural geography and dispersed communities to an ageing demographic and areas of health inequality. The dedication of GPs and primary care teams, often working under difficult conditions, is a testament to the NHS’s commitment to accessible healthcare. I thank those professionals for their invaluable service.
I was pleased to see the fantastic interest and engagement that we had from the south-west in our 10-year health plan consultation. The hon. Member for Newton Abbot and his colleagues from the area will be pleased to note that the south-west had a higher than average response rate compared with the rest of the country on our change.nhs.uk platform. We also saw that 126 community-led events were run in the south-west using our “workshop in a box” toolkit, which demonstrates just how important reforming the NHS is to people in the region.
The Government recognise that GP practices in rural and remote areas face specific pressures, including recruitment difficulties and population fluctuations due to tourism. We also acknowledge the demographic reality. The south-west has a higher proportion of older residents, which increases the demand on primary care for managing complex, long-term conditions. These challenges require tailored and effective responses.
Since taking office, the Government have made primary care a central pillar of NHS reform. We have committed to strengthening GP services nationwide through a series of measures designed to increase funding, support workforce growth and improve patient access. These measures support progress towards a neighbourhood health service, with more care delivered locally to create healthier communities, spot problems earlier, and support people to stay healthier and maintain their independence for longer.
Edward Morello (West Dorset) (LD)
The Minister mentions the ageing demographic of the south-west. I do not know if it is actually a fact, but one of my favourite things that I have ever been told about the population of West Dorset is that if we were a country, we would have an older population than Japan—we would be the oldest country in the world. The only things older than our population are some of our GP buildings; about one in five predates the NHS itself. Can the Minister outline how the Government intend to help GP surgeries to upgrade their facilities?
Stephen Kinnock
I thank the hon. Gentleman for his intervention and for that fun fact. I will come on to it a bit later in my speech, but the £102 million primary care utilisation fund will make a major contribution to upgrading the creaking primary care estate. He is right to identify that as a major challenge. It is also major drain on productivity. We must ensure that our GPs have the tools at their disposal to do the work they need to do.
Adam Dance
Will the Minister visit Ariel Healthcare in Chard in Somerset, where the building is really not fit for purpose, and meet the GPs to talk about their concerns?
Stephen Kinnock
I am impressed by the way the hon. Gentleman did that and I congratulate him on it. If he would care to write to me to set that out, I will have a look at it and get back to him.
I want to take this opportunity to briefly outline what we have done since July 2024, and what we intend to do, to ensure that GP funding and services in the south-west are fit for purpose and capable of meeting the needs of the local population. In February, we concluded the annual consultation between the Department of Health and Social Care, NHS England and the general practitioners committee of the British Medical Association. For the first time in four years, GPC England voted in favour of the GP contract package, which illustrates the progress we are making to rebuild our relationship with the profession.
The 2025-26 contract is already improving services for patients and making progress towards the Government’s health mission. It supports the three key shifts the Government want to achieve: from analogue to digital; from sickness to prevention; and from hospital to community care. Patients across the country can expect online GP services to be available throughout the day, and better continuity of care for those who would benefit most. Patients can also expect a stronger focus on prevention, in particular to tackle the biggest killers, such as cardiovascular disease.
In 2025-26, we are investing an additional £889 million into the core GP contract to fix the front door of the NHS. Despite the difficult financial situation this nation faces, we are backing our health workers with above-inflation pay rises for the second year running. We are accepting the Doctors and Dentists Review Body’s recommendation of a 4% uplift to the pay element of the GP contract on a consolidated basis.
Dr Luke Evans
The Minister talks about contracts, which is an appropriate point to question him again on his Government’s position on the GP partnership model. It is not clear what that looks like from any of the documentation, so I would be grateful to understand that or, if the Secretary of State is considering new models, what they are and when we can see them.
Stephen Kinnock
We recognise that the partnership model has many strengths. It is a very important part of the system, and it helps to drive efficiency, innovation and a kind of go-getting approach to general practice. That is what we want to see—innovative approaches.
We are committed to substantive GP contract reform. We see the partnership model as a really important part of that, but we also recognise that fewer GPs are interested in going into partnership. The partnership model is not the only model delivering general practice; GP practices can and do choose to organise themselves in different ways. Many practices cite evidence of good outcomes on staff engagement and patient experience through the partnership model. I do not think it is right to say that there are any specific plans to change the partnership model, but we recognise that there are a number of other ways, and we will always keep the way in which the contract is delivered under review.
Vikki Slade
For some leasehold properties, there is a requirement that practices have partners. How is the Minister ensuring that such practices can be taken on, either by the ICB or the DHSC? Somebody has to take responsibility for those practices, and if we are moving to a model of having more salaried people, who will do that?
Stephen Kinnock
In debates about how we deliver health and care in our country, the question often comes up about the balance between the role of the DHSC at the centre, the role of ICBs and the role of those who are at the coalface delivering services. I do not think there is a single answer to that question. What is important is that we commit to devolution and to empowering those who are closest to their communities, because they are in the best position to make the decisions that work for their communities.
It is vital that we at the centre agree on and set desired outcomes for health, access and quality that the entire system is expected to meet. We have to set a framework, and it is then up to those at the coalface to decide how best to deliver it. It would not be right for me to say, on specific leasehold cases for example, that case A should go this way and case B should go that way; to try to dictate that from the centre would be a recipe for disaster. We do need to hold the system to account, however, and the system needs to hold us to account. That is the way to deliver true political and strategic leadership.
Jess Brown-Fuller
It is interesting that the Minister mentioned devolution, because the effect of the cuts to ICBs has meant that Sussex ICB is now having conversations with Surrey ICB about a merger. The cuts are therefore achieving the exact opposite of devolution, because such a merger would move power further away from communities. Does he have any thoughts on that?
Stephen Kinnock
Integrated care boards in the south-west have received almost £1.3 billion in their primary medical care allocation for ’25-26, which is an increase of nearly 13% compared with ’24-25, so I am not quite sure where the hon. Lady is getting her figures. For me, a 13% increase is not a cut.
That growth in local resources includes the south-west’s share of the additional £889 million agreed for the GP contract, as well as the transfer of some additional roles reimbursement scheme funding that had previously been held centrally by NHS England. Those funding allocations will be further uplifted to fund in full the pay recommendations of the DDRB and the NHS Pay Review Body.
Rachel Gilmour (Tiverton and Minehead) (LD)
I appreciate that recruitment, including of GPs, is extraordinarily difficult in the south-west. In Minehead, there is one GP practice and just one doctor. He is outstanding, and everybody knows him—to that extent, he fits the named GP pledge—but he serves 11,000 people. Rural premium or not, would the Minister agree that that is simply unacceptable and unsustainable, irrespective of where in the country one might be?
Stephen Kinnock
That is an extraordinary statistic. There are clearly major imbalances in the way the system works and general practice is funded in our country. A little later I will come to the Carr-Hill formula; I am sure hon. Members will have seen announcements trailed in the media today about what my right hon. Friend the Health Secretary will say shortly in a speech in Blackpool. The issue raised by the hon. Member for Tiverton and Minehead (Rachel Gilmour) is directly pertinent to the work we are doing around the formula for funding GPs, to ensure that it is needs based, unlike the current, deeply anachronistic and dysfunctional funding system.
On funding, general practices are funded through a range of streams, the majority from core payments known as global sum payments. The rest is made up of incentive schemes, premises payments and enhanced and additional services. The Carr-Hill formula is applied as a weighting of 50% to 60% of GP funding allocated through the core contract, and is a workload-based formula designed to reimburse practices for their expected workloads.
The formula takes into consideration patient demographics, such as age and gender, and factors such as morbidity, mortality, patient turnover and geographical location. I am truly proud that today my right hon. Friend the Health Secretary is in Blackpool to announce that we are reviewing the Carr-Hill formula, which is outdated and not fit for purpose. Currently, GP surgeries that serve working-class areas receive on average 10% less funding per patient than practices in more affluent areas, and that needs to change.
Politics is about choices. For 14 years, the Conservatives —propped up for five years by the Liberal Democrats, I am afraid to say—chose to favour the richest. Who can forget the right hon. Member for Richmond and Northallerton (Rishi Sunak) boasting about how he had deliberately redirected funding from deprived urban areas to leafy suburbs? This Labour Government are reversing that ethos. Our decision to reform the Carr-Hill formula is a clear example of how we are putting our Labour values into practice.
We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. In our upcoming 10-year health plan, that is what we will do, through our review and reform of the Carr-Hill formula. Alongside that work, the Advisory Committee on Resource Allocation—ACRA—will be asked to advise on how the setting of ICB allocations can better support the reduction of health inequalities, to ensure that resources are targeted where they are most needed.
On workforce and recruitment, we recognise the difficult situation whereby patients have been unable to get GP appointments and recently qualified doctors have been unable to find jobs. That is why, in August last year, we announced £82 million in ringfenced funding, allowing primary care networks to recruit newly qualified GPs through the additional roles reimbursement scheme. More than 1,700 GPs have now been recruited through that scheme.
As part of the 2025-26 GP contract package, we made the additional roles reimbursement scheme more flexible, to allow PCNs to accommodate local workforce needs better. That includes removing restrictions on the number or type of staff covered, including GPs and practice nurses. When I took up my ministerial responsibilities in July, I was astonished to find that it was not possible to recruit GPs through the ARRS. We have bulldozed that red tape, which has resulted in a dramatic increase in the number of GPs on the frontline.
Dr Luke Evans
On that point, what would the Minister say to junior doctors, now coming to be registrars, who will be looking for a job? Should they look to the ARRS as the way forward when they qualify? What will he say to them if they do not get a job? Should that be the route they look to? Is it an expansion he is asking for? What are the alternatives for those graduating in August?
Stephen Kinnock
We have been really pleased with the take-up under the ARRS. It is a rapid and clear way of recruiting, particularly because it has the ringfence and the reimbursement system underpinning it. We absolutely encourage newly graduating GPs to take up opportunities through the ARRS; it is an important tool for bringing more GPs on to the frontline. The challenge is not so much the number of qualifying and graduating GPs in the pipeline, but getting them to the parts of the country that need them most. That variation in provision is the No. 1 priority. The review of the Carr-Hill formula will also have important synergy with the issue of recruitment and workforce.
Dr Luke Evans
It seems pertinent to ask this question now: the Australian scheme I mentioned is one way that another country has dealt with the issue. Would the Government consider placing overseas doctors in the areas of most need? Is that something under consideration?
Stephen Kinnock
The hon. Member raises an interesting point. We are thinking strategically about the whole way that recruitment and workforce function. Similarly, on another part of my portfolio, we have several thousand international dentists who are waiting to do the overseas registration exam. We need to get that sorted out, because we have issues with capacity and there are ways of addressing them. We are absolutely committed to prioritising the training and appointment of our home-grown talent, but we also need to look at other options and solutions. We are going into this with eyes open, and I thank the hon. Member for that suggestion; it is definitely something we are looking at.
In addition, the newly launched £102 million primary care utilisation and modernisation fund will help create much-needed additional clinical space in more than 1,000 GP practices across England. The investment responds directly to findings from Lord Darzi’s independent review of the NHS, which highlighted how outdated, inefficient premises can hinder the delivery of high-quality patient care and negatively impact staff productivity and morale. This is the first dedicated national capital funding stream for primary care since 2020, and a clear demonstration of the Government’s commitment to strengthening primary and community care infrastructure.
Once again, I thank the hon. Member for Newton Abbot for securing this debate and thank all Members who have spoken for their passionate and insightful contributions. The Government remain fully committed to ensuring that GP funding in the south-west reflects the region’s particular challenges and needs. Through investment in the workforce and infrastructure, we aim to deliver a sustainable, high-quality primary care service for all. We also remain committed to delivering a neighbourhood health service that will improve people’s experience of health and social care and will increase their agency in managing their own care, health and wellbeing.
As we get our NHS back on its feet, and as we build an NHS fit for the future, we need more care closer to people’s homes and in people’s homes. For too long, NHS resources have been tilted towards hospitals and away from communities. The result is poorer services for patients who would benefit from care closer to home and in their communities. Moving care from hospitals into the community will be at the heart of the 10-year health plan, which will set out how we will continue to transform the NHS into a neighbourhood health service. The full vision will be set out in the plan, which we will publish very shortly.
We recognise the pressures on GPs and the impact on patients, and I assure hon. Members that addressing those challenges is a top priority for the Government. The NHS is evolving, but its founding principle remains: healthcare free at the point of use, accessible to everyone, everywhere.
Martin Wrigley
I am not quite sure what to say now that the Minister has actually said that my prime ask will be delivered. That is fantastic, and shows the emphasis of these debates.
I thank colleagues from across the House for their contributions. We all agree on the importance of GPs and the need to fix their funding. It is vital to recognise the many good things that GPs and GP practices have been doing in what have been difficult circumstances for a good number of years.
It has been delightful to hear that MPs have been interacting with their local GP practices to understand the problems with the funding formula. Delighted as I am to hear the Minister announce changes to the Carr-Hill formula, GP funding is still complex. I tried to show how complex it is by focusing on just on two of its elements, but we have heard from other hon. Members that the extra funds are even more complex. The fact that the 7% increase is eaten up by the 6% increase in wages, NICs and so on shows that it is not simple.
I thank the Minister for being here—
Martin Wrigley
I have never been interrupted by a Minister before—I would be delighted.
Stephen Kinnock
I do not even know whether an intervention is allowed here, Dame Siobhain—this is a revolutionary step—but the hon. Gentleman raised some concerns about the quality and outcomes framework, and I wanted to say that we have retired 32 out of the 76 quality and outcomes framework indicators, reflecting the fact that we agree with him: it was way too complex and there were too many indicators. By retiring those, we freed up £298 million, £100 million of which will go into the global sum, maximising the flexibility for practices to do what is right for their patients. The remaining £198 million will be repurposed to target cardiovascular disease prevention.
Martin Wrigley
I thank the Minister for the intervention. I am not quite sure what the protocol is; I do not think that that has ever happened. This is a most fantastic debate.
Capital investment in GP practices and buildings is welcome, but we have heard from across the Chamber that we need more. The problems with ICBs and the difficulties with trusts that are in NHS oversight framework segment 4 still impact GPs and how their funding works.
I will push my luck, because the Minister has been very generous with his time and very patient with us all: will he meet me and some practice managers to talk about the complexities of managing the practices with such a level of complication in funding, and to see whether the Government can identify further ways of making it easier to run these businesses, so that they can get on with delivering what they are there to deliver: healthcare for the greatest number of people with the maximum possible benefit? That would be helpful. I thank all hon. Members for their contributions.
Dame Siobhain McDonagh (in the Chair)
I respectfully say to Members that, while I do not have the power to stop interventions from people who turn up 45 minutes, an hour, or an hour and three quarters into a debate, speaking on a personal level—I am not the most formal of Chairs—I think it very impolite to make an intervention when you have not had the opportunity to hear from other Members. I do not have the power to enforce that, but if I could, I would.
Question put and agreed to.
Resolved,
That this House has considered GP funding in the south-west.