GP Funding: South-west England

Brian Mathew Excerpts

Wednesday 25th June 2025 Westminster Hall

[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?