Cancer Outcomes in the UK

Baroness Gerada Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Gerada (CB)]

My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients with cancer. We currently use AI to help us: we use it with our e-consultation system, which can identify red flags. Together with our electronic medical records, that explodes at us and asks, “Have you thought of cancer?” We already have the brightest and the best; they are just located in general practice. As has been alluded to, I disclose that I am a former chair and president of the Royal College of General Practitioners.

I agree with many of the contributions that have already been made. In the contributions that I have made already in my short time here, I have drawn attention to the mounting pressures facing general practice and the implications for patients and the wider NHS, and I will focus briefly on that. I worry that initiatives such as the national cancer plan, which rightly place primary care at the forefront of early diagnosis and referral, are in danger of overestimating what general practice can realistically deliver in its current state for the patients we serve.

Without addressing the underlying constraints in the workforce, funding and capacity, we risk placing further pressure on a system that is already under real strain, as has been mentioned. In so doing, we may undermine the very ambitions that the plan is trying to achieve. These pressures are compounded in some areas by outdated or inadequate premises, which further restrict GPs’ ability to expand capacity and to do what is expected of us.

The Royal College of General Practitioners has repeatedly warned that general practice has not received a sufficient share of NHS funding to match rising demand. Without increased investment, the shift of care into the community will not be sustainable. The King’s Fund, which has been mentioned several times today, has highlighted a persistent structural imbalance in the NHS, with a higher proportion of funding and staff allocated to hospital services than to primary and community care.

Despite general practice being the front door of the NHS, the workforce remains heavily concentrated in hospital services. As highlighted in the Health Service Journal—HSJ—last week, the proportion of NHS doctors working as GPs has fallen significantly, from one in five a decade ago to closer to one in seven today. Less than 15% of the workforce—GPs and nurses—are now located in primary care, with 80% of the nursing and medical workforce now working in hospital settings. This cannot be right, given that evidence published over the past 70 years, both in this country and across the water, shows that placing GPs at the front door of any health service results in more accessible, higher-quality and more cost-effective care, including cancer care. Moreover, evidence from the Royal College of General Practitioners shows that strengthening continuity of care—the bedrock of my profession—can reduce avoidable hospital admissions and improve cancer diagnosis, treatment and prevention. Patients prefer continuity of care.

Recent figures published in Parliament, and highlighted in the Health Service Journal just last week, show that the share of NHS spending on general practice has fallen to about 8%—its lowest level in the past decade, down from 9% around five years ago. It always amazes me that there are currently 360 million consultations per year—GPs are about 180 million of those—for an average cost of £150 per patient per year. Noble Lords can do the maths: every man, woman and child on average consults six to seven times per year with their GP for £150. These figures reflect a long-standing structural imbalance in how care is resourced and delivered, and it is becoming increasingly difficult to ignore. To me, that raises a very clear implementation risk for the cancer plan, which relies heavily on GPs for early diagnosis and cancer pathways. Without adequate investment in primary care capacity, we will not be able to do that.

We need more GPs. Health Foundation modelling indicates that we need an additional 6,500 GPs by 2030 to meet the needs of our ageing, increasingly complex population. We need more GPs spending longer with their patients and communities to achieve the ambitions laid out in the cancer plan. I would be grateful to hear from the Minister how the Government intend to address the current imbalance, whereby general practice receives a relatively small share of NHS funding while delivering a substantial proportion of patient contacts.

Delays in accessing primary care risk translating directly into delays in cancer detection, where, as we have heard, earlier diagnosis is often critical to outcomes. Ultimately, if we expect earlier cancer diagnosis to be delivered through general practice, we must ensure that general practice has the capacity to deliver it.