GP Funding: South-west England

Martin Wrigley Excerpts

Wednesday 25th June 2025 Westminster Hall

[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—]

--- Later in debate ---

[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—

[Stephen Kinnock]

Will the hon. Gentleman give way?

[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.

--- Later in debate ---

[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.