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Esther McVey (Tatton) (Con)
I beg to move,
That this House has considered GP funding in rural areas.
I am pleased to have the opportunity to talk about this important topic. Statistics show that, as of 2024, 17% of England’s population, equating to 9.6 million people, live in rural areas. For these communities, accessing healthcare can be challenging. The challenges are well known: rural GP practices serve elderly and often isolated populations, and are tasked with delivering complex care in large and often sparse geographical areas. The demands have long been accounted for in our funding formula for GPs, the Carr-Hill formula. The model was introduced in 2004 and was designed to ensure that GP funding reflected variations in workload and local population characteristics, including a measure of rurality.
Dr Roz Savage (South Cotswolds) (LD)
Sherston in South Cotswolds is in imminent danger of losing its surgery. There is an enormous local strength of feeling, with 2,850 out of 3,000 patients signing a petition. As the right hon. Lady mentioned, people who need doctors’ surgeries by definition tend to be elderly, ill or parents with small children, so does she agree that the NHS should prioritise the provision of GP surgeries for small rural communities such as Sherston?
Esther McVey
The hon. Lady raises a very relevant point, and I agree wholeheartedly. People in lots of areas in my constituency cannot get to a GP and are bereft of a GP surgery.
Until now, we have had a measure of rurality, but this Government have instructed the National Institute for Health and Care Research to review the funding model and examine how working-class areas could benefit under a new model based on deprivation rather than workload.
Jim Shannon (Strangford) (DUP)
I congratulate the right hon. Lady on bringing this subject to Westminster Hall. I am always glad to come along and support her, because she leads great and very pertinent debates. I am a resident of a rural area, and the pressure that my local GPs are under has to be seen to be believed: only three practices cover the whole Ards peninsula, which has a growing population. Does the right hon. Lady agree that funding must be available to give surgeries the potential to have physio rooms, nutrition advice and perhaps even pharmacies that provide first-stop medical advice? The cost of such facilities needs to be met by Government, because there will be savings in the long term.
Esther McVey
It is always good to have my hon. Friend—and I do call him my hon. Friend—intervene on me. He makes very good points. It is also important that a local GP chooses, and can see what their local constituents require and what is best for their health outcomes.
The move to a new model based on deprivation rather than workload is, at best, an act of ignorance that fails to acknowledge the significant challenges of running GP practices in rural areas; at worst, it represents yet another example of Labour’s assault on rural life. Measuring pressures on GPs solely through the lens of deprivation would ignore the complex, distinct demands faced by rural practices. Rural communities have older populations. In 2019, the House of Lords Rural Economy Select Committee found that the average age in rural areas was almost six years higher than in urban areas, and a quarter of the rural population were over the age of 65.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I am grateful to the right hon. Member for securing this important debate. Dr Richard West MBE and Dr Daniel James, general practitioners in Woolpit in my Suffolk constituency, have been awarded the Royal College of General Practitioners East Anglia Faculty GP prize this year in recognition of sustained contribution to rural mental health and community-focused general practice. Does she agree with me that we must do all we can to look after the mental health of the rural population, particularly isolated farm workers?
Esther McVey
The hon. Member raises a very good point indeed. I congratulate his constituents. The pressure that I know the farming community is under and the impact that the family farm tax has had on the mental health of the rural community and farmers has been significant.
Life expectancy is longer in rural areas, placing greater demands on GP practices. Statistics published by the Department for Environment, Food and Rural Affairs suggest that people born in mainly rural areas in 2018 to 2020 were expected to live two and a half years longer than people born in urban areas. Older populations place greater demands on GP surgeries, presenting with complex healthcare needs and higher levels of chronic illness and frailty. The Rural Services Network analysis shows that GP-registered patients over the age of 75 account for 11% of rural GP patients, compared with just 7.5% in urban settings.
Aphra Brandreth (Chester South and Eddisbury) (Con)
My right hon. Friend and constituency neighbour is making a wonderful speech. Is she going to come on to the pressures of house building? There is huge pressure for new homes, and many of our rural areas already struggle with insufficient infrastructure. I am working with our GP in Handbridge, where their site is now too small and not fit for purpose given the larger population that the practice now has. Does my right hon. Friend agree that as pressure for more homes is put on constituencies like ours in Cheshire, it is vital that existing residents have access to GPs that are in suitable premises, fit for the numbers and the older population that often use them?
Esther McVey
I thank my hon. Friend and constituency neighbour for raising that point. She is absolutely right that the number of new homes that are going to be built in rural areas, putting more pressure on GP surgeries, is significant. Without new GP practices, I am not sure where our residents will go when they need a doctor and need to see somebody about their health.
Edward Morello (West Dorset) (LD)
In a similar vein to the previous intervention, one in five GP buildings predate the NHS itself, which is a quite staggering fact, and over a third of GPs say their premises are no longer fit for purpose. In places such as West Dorset, outdated buildings struggle to deal with the current population, let alone the projected future growth as a result of house building, and fewer than a third of practices that applied for capital funding last year were granted funds. Does the right hon. Member agree that GP estate funding must also be expanded to help rural areas deal with the increased population?
Esther McVey
I agree with the hon. Member. I will come on to my surgeries that are indeed in Victorian buildings—spread across four—and need to be brought together and modernised. That is in Knutsford in my constituency. I know that there will be many other places like that across the country. The hon. Member raises a valid and pertinent point.
We know that GP services in rural communities are spread across a large geographical area, and many elderly residents in Tatton live alone. Although such independence is cherished, travelling long distances to access healthcare is more difficult. Public transport is often limited or non-existent. Community transport schemes exist in Tatton, but they cannot always accommodate short-notice or urgent medical needs. Often, elderly residents do not drive, so they are left reliant on costly taxis or GP staff taking the time to travel to a patient’s home. That places additional pressures on already stretched services. In Lostock Gralam, despite a population of about 2,800 people, there is no GP practice. That forces patients to make a lengthy journey to Northwich, and without a direct bus service many are left to rely on taxis to make their appointment.
For those communities, recruiting and retaining staff becomes more difficult and more expensive. The Rural Services Network reports that 59% of hard-to-recruit GP speciality training posts are located in rural areas. There is less access to specialists and consultants, which makes their services more expensive. Community services and provision are sparser in rural areas, too. Pharmacies, which help to relieve pressure on GPs in urban areas, are not as common in rural areas. When I secured this debate, I was contacted by the Dispensing Doctors’ Association, which provides an essential role in dispensing medicines to patients who live more than 1.6 kilometres from a pharmacy. It delivers to about 10 million patients across England, but is facing increasing challenges due to its reliance on manual delivery.
In addition, while urban pharmacies move ahead with digital efficiency, rural pharmacies often struggle to keep pace because broadband coverage is often unreliable, rendering remote consultations near impossible and service delivery more difficult. The benefits of digitisation in healthcare are well understood across this House, but they rely entirely on having the right infrastructure in place. Without connectivity, rural practices are simply unable to access or benefit from Government investment in that area. There are lots of people from rural areas here, and we know how unreliable our broadband infrastructure is.
In 2022, the all-party parliamentary group on rural health and care published an inquiry into healthcare in rural areas. It concluded:
“Rurality and its infrastructure must be redefined to allow a better understanding of how it impinges on health outcomes”.
No progress has been made on achieving that. Removing the rurality measure of GPs’ funding entirely would be a step backwards in understanding how settings impact GPs’ ability to provide healthcare.
There is little transparency about who exactly will be consulted in the funding model review. In a written answer to a parliamentary question, the Government confirmed that the review
“will draw on a range of evidence and advice from experts,”
such as the Advisory Committee on Resource Allocation and the British Medical Association general practitioners committee, but there is little information beyond that. There are GPs in Tatton who are keen to contribute but, as of yet, have not been able to.
Peter Prinsley
There is obviously a problem with funding the recruitment of additional GP partners in rural surgeries. Does the hon. Member agree that we should think carefully about how the partnership model itself might be improved?
Esther McVey
The hon. Member raises another good question, and we can ask the Minister to look into that.
The logical conclusion of not having GPs from rural areas take part in this review is that the Government do not want to listen to them. They are intent on rewriting the formula without acknowledging the realities of delivering rural healthcare. A broadbrush measure such as deprivation cannot take into consideration the very close link between the ability to deliver healthcare and the rural or urban settings in which GPs exist. It comes as little surprise. Whether selling off our family farms or introducing a devolution agenda that pits rural against urban areas, time and again the Labour Government have shown that they are not willing to listen to rural areas, but are quick to sell out rural Britain at the first chance.
As is typical, Labour’s response to pressure is to level down some areas, which serves only to create additional pressures elsewhere, rather than acting to fix them. The pressure faced by rural healthcare will not disappear soon. The NHS long-term workforce plan, published under the previous Government in 2023, recognised that the increased demand from an ageing population is not uniform in the UK. It estimated that
“In 2037, a third of people aged over 85 will be living in rural communities”
compared with just a quarter now. The Government must act to address that trend.
I have been campaigning for a new medical centre in Knutsford, as was acknowledged before, where doctors desperately need more space and modernised facilities to meet patients’ needs. The current surgeries in Knutsford do not do that; they are all Victorian buildings and are not suitable. I have been pressing for that for a long time. I have met with the Minister—I thank her for that—and I would be grateful for an update on the progress of the practice in Knutsford.
GP practices deliver community care and their ability to deliver is reliant on the environment in which they serve the patients. We must have a funding formula that acknowledges the challenges of delivering healthcare in rural areas. I would be grateful if the Minister could answer the following questions. Who is being consulted in the review, and will it include those with first-hand experience of delivering healthcare in rural settings, like my GPs in Tatton? What assurances can be provided that rurality will remain a factor in a new funding formula? Given the specific challenges they face, will the Department commit to publishing an assessment of the impact on rural communities ahead of any change to the funding formula?
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Ms Lewell. I thank the right hon. Member for Tatton (Esther McVey) for securing the debate and raising a critical issue that I know is important to many hon. Members. I am pleased to be here on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who is working hard on the issue.
This Government have made primary care a pillar of NHS reform, to make the left shift and put more healthcare into the community. In our 10-year plan, we specifically highlighted our commitment to people in rural and coastal areas, because they have been left behind. As the hon. Member for Chester South and Eddisbury (Aphra Brandreth) highlighted, the infrastructure is appalling in many places, and some of those areas have the worst deprivation in the country. Last week, I was pleased to visit Redruth in Cornwall and talk to a GP practice about the deprivation it faces and the work it is doing. We do understand that, which is why we highlighted it in our 10-year plan.
Over the last 18 months, we have taken a number of measures to increase funding, support our workforce and improve patient access, so that we can rebuild the front door to the NHS and create a neighbourhood health service. It is important to remember that when we came into office 18 months ago, we found GP services in an appalling state: underfunded, understaffed and in crisis. First, we inherited an absurd state of affairs where patients could not book appointments, while GPs could not find work. We took immediate action to put GPs to work so that patients could get the care they need. We promised to recruit 1,000 more GPs through the additional roles reimbursement scheme, and we recruited not 1,000 or 2,000, but 3,000. In the right hon. Lady’s ICB area of Cheshire and Merseyside, there were 102 more GPs on the frontline at the end of last year compared with when we took office.
Secondly, for the first time in more than a decade, we have agreed a GP contract, which means more than £1 billion extra for general practices, bringing total spend on the contract to £13.4 billion this financial year. That is the biggest cash increase in more than a decade. Thirdly, the previous Government left GP surgeries across the country with leaky pipes, falling roofs and buckets catching rainwater. We are investing £102 million to fix GP surgeries this year, and over the next four years, we are committed to investing another £426 million on GP estates and refurbishing neighbourhood health centres. On top of that, ICBs will have £195 million every year to support strategic primary care investments, with a focus on replacing crumbling infrastructure —an issue that many Members have raised today.
I am proud to say we can now see some green shoots of recovery in primary care. According to the Office for National Statistics, patient satisfaction has gone from 60% to 73% since this Government took office. A lot has been done, but we absolutely recognise that there is a lot more to do, especially as GPs become the cornerstone of our neighbourhood health services. Over the course of this Parliament, we will train thousands more GPs. We have already made an additional 250 training places available this year, taking the total to 4,250 places, with plans to expand that further.
Let me turn to the specific points raised by the right hon. Member for Tatton, starting with Knutsford—as she said, we met about that last year. On the medical centre, East Cheshire trust is working on the outline business case, which it needs to submit to the ICB. The ICB needs to be satisfied with the submission, which would progress to a full business case, which would take some time to secure the necessary planning permissions. It also needs to look at how the clinical services work for both the general practice and the trust, and how they will be delivered, while ensuring that it is value for taxpayers’ money and lines up with the overall development that we want to see towards neighbourhood health services.
As I have said to the right hon. Lady and many hon. Members, we expect ICBs to be collaborative and to keep their local MPs up to date and in the loop regarding plans for their constituencies. That is the situation at the moment: the trust is working on the outline business case with the medical centre, which is where that conversation needs to progress.
On the main subject of the debate and the Carr-Hill formula, I must confess that I have seen this over many years in my time working as a manager in the NHS. It is a difficult issue, and one we are taking seriously, particularly when it comes to wider access in rural areas. Rural and remote areas face specific pressures, whether that is recruitment challenges, longer travel times or population fluctuations for various reasons, including tourism in some places. That is why the previous Labour Government introduced the formula in 2004, but we believe the formula is no longer fit for purpose today.
A lot has happened in those 20 years and the research underpinning the formula was done in the 2000s, which means that so-called workload coefficients were estimated on the basis of data that may reflect clinical practice, such as patterns of home visits, from as far back as the early 1990s. Clinical practice and population health have changed markedly since that time. GP practices serving more deprived areas receive 9.8% less funding on average per needs-adjusted patient than those in less deprived communities. That is despite having greater health needs and significantly higher patient-to-GP ratios.
We are asking experts to help us to design a formula that reflects patient need more accurately, working on the principle that funding for core services should be distributed equitably between patients across the country. Deprivation is a factor, but not the only one. Let me be clear, this is not about taking GPs away from urban areas or robbing Peter to pay Paul. It is about ensuring that funding is fairly distributed.
The right hon. Lady rightly said that the review is being conducted by the National Institute for Health and Care Research. The review team has already engaged with partners at the Royal College of GPs, the general practice committee of the British Medical Association and the NHS Confederation, among others. Although I cannot pre-empt the review, the point is to ensure that funding is targeted towards areas that need it most. That means considering a broad range of factors relevant to the delivery of primary care services, including difficulties delivering services in rural areas, as she and others have outlined. We expect the first phase of that to conclude in March.
We will then see whether there is a need for further work to technically develop and model any proposed changes to the formula. In response to the right hon. Lady’s question, we will of course look to understand the impact of any changes to the current formula on practices across the country ahead of implementation. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg, will update the House on the progress and outcomes of the review in the normal way.
Lastly, although many hon. Members will know this, it is worth highlighting that some 40% to 50% of GP practice funding is currently not determined by this formula. The income into GP practices is based on a number of other areas as well. We will obviously develop our neighbourhood health services in future, so we need to take notice of all those factors.
I want to comment on the point that the right hon. Lady raised about analogue and digital. That is a key part of our 10-year plan. As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), said last week, wherever people live in our country, they deserve the same access to healthcare as everyone else. Wealth should not determine health, nor should a postcode.
I understand the point that the right hon. Lady and others have made—it has been made to me very often—about infrastructure and access, particularly digital. However, using digital based on geography offers huge potential to fight inequalities. For example, because of the online services for GPs that we launched in October, patients can now contact GPs through online services to request an appointment or raise a non-urgent query, which is in addition to telephone and in-person requests. That is tackling the 8 am scramble that we committed to addressing when we came into power, so that patients no longer have to wait by their phone to call GPs at a time of day when many go to work or get their kids ready for school.
The right hon. Lady correctly says that rural communities largely have older populations. We want to be digital by default—and many older people are very digital—but human where it matters. That means that people in rural areas and elsewhere will still be able to use the phone if they want to, and they will not be waiting nearly as long because the other phone lines are being freed up. We are seeing real progress in that area.
When we came into government, the front door of the NHS was hanging off its hinges. In these 18 short months, we are seeing the green shoots of recovery in general practice and recovery and reform in primary care. Our plan for change is creating a neighbourhood health service that puts GPs at its heart, so that the NHS is there for everyone, wherever they need it. We know that is not going to be easy and we want to work with it to develop that. I hope that today we have set out how we are trying to get there. Yes, there is more investment, but there is also fundamental reform, and my hon. Friend the Member for Aberafan Maesteg will be happy to keep in contact with Members as we progress this issue.
Question put and agreed to.