GP Funding: South-west England

Luke Evans Excerpts

Wednesday 25th June 2025 Westminster Hall

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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?