PARLIAMENTARY DEBATE
Access to Primary Care - 7 January 2025 (Commons/Commons Chamber)

Today there are 1,399 fewer full-time equivalent GPs than in 2015, and NHS dentistry is at death’s door. This Government will fix the front door to the NHS. We have announced an additional £889 million in funding for general practice in 2025-26—the biggest boost in years—and we have already started hiring an extra 1,000 GPs on the frontline. Our 10-year health plan will shift the focus of healthcare out of hospital and into the community.

I thank the Secretary of State for his answer on the critical issue of access to GPs in primary healthcare. My constituency of Barking is woefully under-served by primary healthcare, and especially by GPs. On average, each GP looks after 2,000 patients; the national average is 1,600. In particular, the area of Barking Riverside has no GP services. Will the Secretary of State meet me to discuss this matter, so that the thousands of homes that are being built will also have a primary healthcare facility on site?

Order. I remind Members to look towards the Chair, because I cannot hear what is being said. I call the Secretary of State—I hope he heard the question.

Thank you, Mr Speaker. I would be delighted for my hon. Friend to meet me or the relevant Minister. The NHS has a statutory duty to ensure sufficient services in each local area, including general practice, and it is vital that we also take into account population growth and demographic changes. I strongly support the Deputy Prime Minister’s commitment to delivering 1.5 million new homes, and she and I know that that must be accompanied by local healthcare facilities. We are working together to achieve just that.

I really welcome this Government’s focus on making sure everyone can see a GP when they need one. The crisis in GP provision nationally has been exacerbated by the failure under the last Government to ensure that primary care investment has kept pace with housing growth. With such a low share of integrated care board capital funding allocated to primary care by the last Government, how can we make sure we do much better in ensuring that GP capacity expands at the same time as local growth?

My hon. Friend has been raising these issues with me since before he was elected to this place on behalf of the communities he represents. As I said to my hon. Friend the Member for Barking (Nesil Caliskan), we must make sure that additional housing—which is desperately needed—is accompanied by health and care services. The Deputy Prime Minister and I are working together to achieve just that, and thanks to the decisions taken by the Chancellor in the Budget, we are able to invest in the health and care services that this country needs and deserves.

Woodstock surgery in my constituency is not fit for purpose. In September, heavy rain fell and caused the roof to collapse, causing the surgery to close. The nurse literally sees patients in a broom cupboard. The GPs want to increase their capacity to see more patients, but have been unable to access sufficient capital from the integrated care board. Will the Secretary of State meet me and the Woodstock GPs to discuss how the reforms announced yesterday will help them build a new surgery, so that they can see patients faster?

I am grateful to the hon. Member for that question. I am incredibly sorry about the awful conditions in which staff in that practice are having to see patients and in which the patients it serves are having to be seen—that is the epitome of the broken general practice system that we inherited. Thanks to the decisions taken by the Chancellor in the Budget, we are able to invest in the capital estate need in the NHS. That will take time, and we would be delighted to hear more about that individual case to see how the ICB and the NHS can assist.

I call the Chair of the Select Committee.

Following the theme raised by my hon. Friend and neighbour, the hon. Member for Bicester and Woodstock (Calum Miller), may I make a plea for Summertown health centre? They are my doctors, by the way, so I declare an interest. They operate in an old Victorian building and are desperate to move to new premises. That health centre was at the top of the priority list, but the ICB says that there is no money, and the doctors say that there is no pot that they can bid into in order to get this seen to. Will the Secretary of State meet me as well? Clearly, £102 million spread across 50 projects in the country is not going to be sufficient. Can we get creative about how we can get new premises built for Summertown health centre?

Of course I will meet the hon. Lady. It would be daft of me to say no to the Chair of the Select Committee; otherwise, she will see me in less pleasant circumstances. In all seriousness, we are looking creatively at this issue. There are enormous capital pressures right across the NHS estate. We are regularly lobbied on new hospitals, for example, but we are also lobbied on general practice, the mental health estate and the rest. We will do as much as we can as fast as we can, thinking creatively about how we can get more capital investment in, and I would be happy to discuss that further with the hon. Lady.

When I am out regularly knocking on doors and listening to people across the constituency, one of the issues residents raise with me most frequently is the challenge in even being able to book a GP’s appointment. Could the Secretary of State please set out what his plans are for ending that 8 am phone scramble, including for those who do not use apps and websites as confidently?

I am grateful to my hon. Friend for that question. As the Prime Minister set out in our elective reform plan yesterday, we are determined to make sure that accessing NHS services, including general practice, dentistry and other primary care services, is as easy and convenient as accessing any other services at the touch of a button via our smartphones. We have committed to that in the elective reform plan, which will bring benefits right across the NHS as we modernise. Of course, she is right to mention those who may not be digitally connected or may not want to access services in that way. That is why I believe very strongly in patient choice—different courses for different horses. People like me booking via the app will free up telephone lines for those who prefer to access services that way.

Is the Secretary of State aware that the increase to employer national insurance is actually reducing patient access to primary care? I met GP representatives in Aberdeenshire and Aberdeen recently, and they told me of two ways in which that is happening: first, they are having to let staff go; and secondly, some GPs are considering meeting these costs from their own pockets. Will he consider an exemption for GP practices from these charges?

That was a rare admission of failure in this House by the SNP. I am very sorry to hear that general practice in Scotland is in such a sorry state, because here in England we are investing £889 million in general practice, the biggest uplift in years. That is in addition to the funding I have found to employ 1,000 more GPs on the frontline before April, because we are prioritising general practice. As for the decisions the Chancellor took in the Budget, as I said before the election, all roads lead to Westminster. Thanks to the decision a Labour Chancellor has made here in Westminster, coming down that road from Westminster to Holyrood are the resources the SNP Government need to deliver the priorities of the Scottish people. If they cannot, Anas Sarwar and Jackie Baillie stand ready to deliver.

I call the shadow Minister.

To improve access, the Government have announced a planned expansion of advice and guidance, and GPs will be paid £20 per advice and guidance request they make for further expert advice from consultants. How do the Government expect this expansion to take place? Will they be mandating it given that the current position of the British Medical Association, under its collective action, is that GPs should

“Stop engaging with the e-Referral Advice & Guidance pathway”?

I think the shadow Minister will find that GPs welcome the £889 million uplift announced just before Christmas. That is the biggest boost to general practice in years. It is part of this Government’s agenda to fix the front door to the NHS and recognise the dire state that GPs were left under. Of course, with that investment comes reform. I think GPs would be delighted to manage more of their patients in the community if given the tools to do the job, and that is something this Government are committed to doing.

Going back to advice and guidance, GPs use advice and guidance when they have come to the summit of their knowledge and need specialist input. For example, as a GP, I may see a rheumatology patient and ask for advice from a rheumatologist, who may advise specialist blood tests. The problem is that, as the inquiry clinician, I am legally responsible for those blood tests and have to pay for them out of the primary care budget. Do the Government propose that the £20 will cover subsequent follow-ups and the cost of suggested tests? Given the expansion of advice and guidance, will the Government be looking at a legal framework change in accountability for clinicians making requests?

First, as the shadow Minister has said, advice and guidance happens in general practice, and we want to see more of it. We have to give GPs the tools to do the job, and that is what we are doing. My hon. Friend the Minister for Care will be talking to the BMA shortly in the context of contract negotiations in the usual way. What the shadow Minister neglects to mention is that these reforms and improvements to general practice are made possible thanks to the £889 million we are putting in, which is investment that he and his party oppose.

I call the Liberal Democrat spokesperson.

Dentistry is a key part of primary care, yet an estimated 5 million people in England have been left without an NHS dentist. That is why today a petition is being handed in at Downing Street signed by more than a quarter of a million people. We have moved on from the election, but we do not yet have a timetable for when the negotiations for a new NHS dental contract will begin and when another 700,000 extra urgent appointments will be rolled out. Can the Secretary of State confirm the timetable for those improvements? What specifically are the Government’s plans for the new patient premium, and will he offer assurances to dentists that any changes to the current model will be outlined in detail to them as soon as possible?

We are looking at two things, the first of which is making sure we deliver what we said in our manifesto, including the 700,000 urgent appointments. We are determined to deliver those as fast as we can and my hon. Friend the Minister for Care is having discussions with the British Dental Association to that effect. He is also looking closely, as am I, at the money that is already going into NHS dentistry—how that money could be better spent and how it is that year after year, despite people’s teeth rotting to the extent that they are having to pull them out themselves or children having to attend A&E to have their teeth pulled out, we saw consistent underspends in the dentistry budget under our predecessors. We are determined to give dentists the tools to do the job so that patients can see a dentist when they need one.