PARLIAMENTARY DEBATE
GP Contract - 16 March 2026 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the changes to the GP contract in 2026-27.

When we came into office, we found GP services in an appalling state—underfunded, understaffed and in crisis. Since July 2024, this Government have been fixing the front door to the NHS, investing more than £100 million to fix up GP surgeries this year, making online booking available to patients across the country and recruiting 2,000 more GPs who are now serving patients on the frontline. Following investment in advice and guidance, we have seen 1.3 million diverted referrals since April 2025. Those are people who would have otherwise been added to the electives waiting list. A lot has been done, but there is a lot more still to do. We are determined to make the system fairer for coastal communities and deprived areas, so we have launched a review into the Carr-Hill formula to close the gap on health disparities and ensure that funding is targeted on the basis of need. We will shortly update the House in the usual way on our Carr-Hill review.

Last year’s GP contract saw the biggest cash increase in more than a decade, and this year we are investing an additional £485 million, taking the total investment made through the contract to more than £13.8 billion this financial year. Investment must always be combined with reform, so the new contract will improve access for patients by requiring that all clinically urgent requests are dealt with on the same day. It will provide a mechanism to hire even more GPs via a new practice-level reimbursement scheme, and it will support the shift from treatment to prevention, as set out in our 10-year plan, through incentives to boost childhood vaccination rates, better care for patients living with obesity and requiring GPs to share data with the lung cancer screening programme.

These ideas were not cooked up by someone sat behind a desk in Whitehall. What is happening is that we are taking the best of the NHS to the rest of the NHS, working with pioneering practices that have been doing these things for a long time. Today we can see that our policies are working, and after years of decline in general practice, we are getting the front door back on its hinges. Patient satisfaction with general practice is finally moving in the right direction. According to the Office for National Statistics, almost 77% of people described contacting their GP as easy in January this year, up from just 60%, where it was languishing in July 2024. I know that when he gets up, the hon. Member for Hinckley and Bosworth (Dr Evans) will hugely welcome, as will his hon. Friends, the progress that we are making.

I call the shadow Minister.

The Health Secretary and his team have perfected the sales pitch for NHS reform. The problem is that the detail never seems to arrive. We have seen a 10-year health plan with no delivery chapter, and a plan for the abolition of NHS England with no price tag; the Health Secretary has announced 10 new “straight to test” referral pathways, but could not name a single one; and now we are seeing a new GP contract with more questions than answers.

Calling something modernisation does not make it reform. If the rules and the delivery are unclear, it is simply confusion with branding. “Advice and guidance”, for example, appears in practice to create a single point of access for referrals. GPs will no longer be able to refer patients directly to a consultant, even when they believe that it is clinically appropriate. Will the Government publish the clinical evidence supporting that approach? Who will carry the legal responsibility if, in a GP’s professional judgment, a patient needs to see a consultant but must first go through “advice and guidance”? If advice and guidance becomes mandatory as an extra layer before referral, are the Government not, in essence, managing the waiting list by keeping patients in primary care rather than treating them in secondary care? Waiting lists will look shorter on paper, but patients are simply waiting elsewhere in the system. Can the Minister clarify exactly where those patients will appear in the official waiting list figures? The contract also requires patients whose cases are deemed “clinically urgent” to be dealt with on the same day, but it does not define “urgent” or explain what “dealt with” means, and that really matters.

Let me therefore ask the Minister three clear questions. First, when will the Government publish the clinical definition of “urgent”—a patient’s sick note is urgent for the patient, but not clinically urgent—and what counts as a patient’s being “dealt with” on the same day? Secondly, the Minister has talked about access, but how can practices guarantee same-day responses when demand is uncapped and definitions are not published? Finally, with advice and guidance being required as a mandate beforehand, how will we ensure that patients are protected, and where will they appear on the waiting lists?

I thank the hon. Gentleman for the GP-related questions, for which I was grateful when he finally got to them.

On clinical evidence for advice and guidance, I think that the evidence speaks for itself. We introduced advice and guidance in the last contract with an £80 million investment, and it has been a stunning success. Take-up across the country has been huge, and—this is the statistic that matters most of all—1.3 million referrals that would otherwise have gone to electives have been dealt with by GPs. [Interruption.] The hon. Gentleman, who is chuntering from a sedentary position, seems not to care about what actually matters for patients, but through advice and guidance they are able to get a response from their GPs within about 48 hours. I can assure him that it takes a great deal longer to secure an out-patient appointment. If he is looking for statistics on advice and guidance, let me give him that one again: 1.3 million referrals have been taken off electives and dealt with by GPs. That is part of the hospital-to-community shift.

The hon. Gentleman asked for a definition of “urgent”. We trust our clinicians. We know that general practitioners are experts in their field. They know when they see an urgent issue, but they also know that that the symptoms might be a more acute manifestation of chronic obstructive pulmonary disease, or that a child’s rash suddenly looks more dangerous than it did the day before. We trust our GPs to make those decisions, and it is a real pity that Opposition Members do not seem to do the same.

The hon. Gentleman also wanted a statistic in relation to access. In July 2024, patient satisfaction with access to a GP was languishing at a miserable 60% after 14 years of Tory neglect and chaos. Today it stands at 76%, which is a 16 percentage point improvement. The hon. Gentleman asked for statistics; perhaps he should take that statistic and deal with it.

My hon. Friend the Minister mentioned the Carr-Hill formula. York had the lowest funding under the primary care groups, the primary care trusts and the clinical commissioning groups, and it now has the lowest funding under the integrated care boards. It is because it is not the most affluent place that it is really important that the new funding formula works for areas such as York. Could the Minister say a bit more about how that will be determined, so that my community gets the health spending that it deserves?

The Carr-Hill review is happening as we speak, and I expect to get a submission from officials on the first round of analysis that is being conducted by the National Institute for Health and Care Research. That will be the first step towards agreeing on how we make the formula work, with a view to implementing the new Carr-Hill formula from 1 April 2027.

I call the Liberal Democrat spokesperson.

I welcome the fact that the Government have adopted our policy of seeing clinically urgent patients on the same day, but patient safety has been put at risk by increasing workloads, according to members of the Royal College of General Practitioners. One in five patients has been forced to wait at least two weeks for an appointment. Although the Government’s funding of 1,600 new GPs is welcome, it is insufficient to deliver the required shift to community care. The Health Foundation says that an additional 6,500 GPs will be needed by 2031, and the Liberal Democrats would provide 8,000. What is the Minister doing to address the shortfall? Residents in Epsom and Ewell, who already struggle to get a GP appointment, are concerned that increased housing will make it even harder. What is the Minister doing to ensure that there is funding for GP buildings, as well as GPs?

I welcome the Government’s focus on the obesity crisis, but it does not fix the root cause. Aside from the junk food ban, what steps are the Government taking to encourage children and young people to create active and healthy habits for life from an early age?

On buildings, we have the £102 million primary care utilisation fund, which will be very important in refurbishing GP practices. We are committed to delivering 120 new neighbourhood health centres by the end of this Parliament, and 250 by 2035.

The hon. Lady asks about GP numbers. In our manifesto, we pledged to bring back the family doctor, and that is precisely what we are doing. We said that we would deliver 1,000 new GPs to the frontline, but we are delivering 2,000, so we have smashed through our manifesto pledge. There will be more to come, because we are making the practice-level reimbursement scheme more flexible so that it does not apply only to GPs who have just come out of training; we are now enabling practices to hire more experienced GPs. That will also help with under-employment. Many GPs across the country practise only three days a week, and this is an opportunity to boost that to four or even five days a week.

When this Government took office, the number of registered patients per GP in Calder Valley was much higher than the national average, with one GP surgery in Brighouse having 600 additional patients per GP. Given the new GP contracts and the new Carr-Hill formula, will the Minister confirm that the funding will help practices in my constituency to recruit the GPs they need, so that people can see a doctor when they need one?

I am not able to pre-empt the Carr-Hill review, but we have had a system based on data that is often 25 years old. Of course, we know that the Conservatives have the Tunbridge Wells philosophy. We will always recall the former Prime Minister standing in front of Conservative party members and proudly proclaiming the fact that he had been taking money out of parts of the country that needed it most and pumping it into those parts of the country that were delivering his pork barrel politics.

The nod to the pressures on rural general practices in the Carr-Hill process is to be welcomed, as is the improvement to many GP practices, but so many principals in general practice are throwing in the towel in the prime of their professional lives because of the bureaucracy, which many of them tell me burdens them well after the last patient has left their clinic. What are we going to do to reduce the administrative pressure on general practitioners, and to prevent the haemorrhaging of our most experienced doctors through early retirement or going part time?

The right hon. Gentleman makes a very important point about bureaucracy. Many of the reforms that we are pushing for in the contract are designed to reduce bureaucracy. For example, by moving to a single point of access and embedding advice and guidance in the contract, we will reduce the number of transactions. In the current system, the practice needs to put in a request for a £20 payment each time it provides advice and guidance; we are embedding that and streamlining it.

The other point to make is that at the heart of our 10-year plan is the shift from analogue to digital. I have seen some extraordinarily effective artificial intelligence technology around ambient voice services, which enable an entire consultation to be recorded and put directly into the system, thereby saving the GP hours at the end of the day in writing up notes.

I declare an interest as a working GP in the NHS. I probably would not be standing here if general practice had not been decimated over the last 14 years. I welcome the £485 million of extra funding, and I also welcome the fact that the capacity and access money is being channelled back into emergency GP action, so increasing the number of appointments, and increasing continuity of care by bringing back the family doctor. May I have some reassurance that the processes of advice and guidance and the referral mechanisms will not get in the way of Jess’s rule, which is about referring patients on their third presentation without any particular diagnosis?

My hon. Friend is absolutely right. The £292 million we have made available for advice and guidance is repurposed funding from the capacity and access improvement payments, so it is part of incentivising improved access and better patient outcomes. I can absolutely assure him that Jess’s rule remains fixed as a really important part of ensuring that it is three strikes and a referral. Whatever happens, that will be a top priority throughout the embedding of this contract.

My constituents will welcome some of these headlines, such as clinically urgent cases being seen on the same day and more GPs, but what is being done to help accommodate them? Stubbington surgery in my constituency has excellent staff, delivering really great patient satisfaction, but they are hampered by really suboptimal buildings. They have expanded to fill every inch of available space, and the former cupboard under the stairs is now the phlebotomy room. They need a new site, but that is proving very difficult to find—not only the place, but the capital funding to deliver it. Can the Minister give them any hope from this announcement?

I am not familiar with the details of that specific case, but if the hon. Member writes to me, I will be more than happy to furnish her with a response. There is a real concern in some parts of the country, particularly where there have been new developments or populations moving into the area, that the GP practice does not have the required capacity. I am not sure whether that has happened in the case she refers to, but in such cases we also look to developers, including to section 106 and the community infrastructure levy as an opportunity. We have the primary care utilisation fund, and with neighbourhood health centre funding coming on stream, that may also be an opportunity. If she cares to write to me, I will furnish her with a response.

The welcome funding, alongside the contract, to hire 16,000 more GPs will be really encouraging news for my community. However, in high-growth areas such as mine, all too often it is physical space rather than funding for GPs that constrains practices. I am really glad that, after getting involved, we have been able to help move forward crucial expansion projects at Shefford health centre and Lower Stondon GP surgery in my constituency, but we should not need the MP to get involved in such situations to help our GPs. Will the Minister meet me to decide how we can work with our ICBs better to ensure that, where we have areas of significant housing growth, we will automatically see growth in the number of GP surgeries in the future?

Very much along the lines of what I said to the hon. Member for Gosport (Dame Caroline Dinenage), we need to ensure that the social infrastructure is there in such areas of population growth. I would be more than happy to meet my hon. Friend to discuss that further.

In this country, we have an immense wealth of talented young people who would love to train to be doctors, but over many decades we have not recruited enough. I appreciate that this is not just an issue for the Department of Health and that it spans the Department for Education and the Treasury, but what more could be done to increase the number of doctor placements so that we can train more and rely less on recruiting doctors from overseas who often come from countries much poorer than our own?

I thank the right hon. Gentleman, but that is precisely what we have been doing. We said in our manifesto that we would bring back the family doctor. We said we would hire 1,000 more GPs to the frontline and we have delivered 2,000. When we came into office in July 2024 there was a bizarre situation where demand for access to GPs was spiralling, yet the additional roles reimbursement scheme, designed under the previous Government, was not for GPs. It was for physician associates and anybody else in the practice, but not for GPs. We have bulldozed that bureaucracy and invested £82 million in getting the ARRS up and running and fit for purpose. As a result, we have 2,000 more GPs and 1,600 more full-time equivalents through this contract.

I recently met people from Byron Primary Care Network, who were clear about the pressures facing primary care. How will reforming GP contracts ensure that communities in my constituency with a growing population can better access GP services? We have been waiting over 14 years for a GP practice in Hucknall.

A number of things have happened which will help with access to GPs. One is the very significant increase in the number of GPs we have put on the frontline and another is online access. We are now dealing with the 8 am scramble by ensuring we do not have a choke point on the telephone lines because more and more people are able to use online access. On capabilities in terms of physical infrastructure, a very important part of that is our commitment to neighbourhood health. There will be 120 new neighbourhood health centres by the end of this Parliament, which will really help to deliver the hospital-to-community shift that I am sure my hon. Friend’s constituents are looking forward to.

GPs truly are the frontline of our NHS. I recently had the pleasure of meeting representatives from the Chilcote practice in Torquay. They shared with me their concerns about the global sum payment. Their calculations suggest that it should be a little in excess of £200, yet the recently announced payment is £128 a year. Will the Minister please advise on how he plans to bridge that gap?

The very significant uplift we have made to the contract—the £1.1 billion last year and the £485 million additional investment we are making this year—will go some way to address the hon. Gentleman’s question, but there is, of course, always more we can do. We have to deal with very many competing priorities across the Department of Health and Social Care, but general practice is right at the top of the list. That is demonstrated by the fact that we have invested in more GPs, better online access and more physical infrastructure for general practice.

I recently met those from Stenhouse medical practice in Arnold. They talked to me about the need to invest in primary care to alleviate pressure on our hospitals. May I take this opportunity to thank all GPs and GP staff across Gedling? Will the Minister explain to me what actions the Government are taking and how they will improve GP services for my constituents in Gedling?

My hon. Friend makes such an important point about paying tribute to the incredible work that our GPs and their teams do right across the length and breadth of our country, including in Gedling; he is an excellent champion for his constituency. This is about marrying investment with reform. In addition to the £1.1 billion in the previous contract, the £485 million this year and the measures I mentioned to recruit more GPs to the frontline, there is also very important work happening around the shift from treatment to prevention in the 10-year plan. We are boosting childhood vaccination rates, providing better care for patients living with obesity and requiring GPs to share data with the lung cancer screening programme. This is about incentivising GPs, working with them as partners as we move forward into the modernisation of our health service.

The new contract has stated that GPs must offer on-the-day appointments for urgent requests—which they already do—and unlimited access during opening hours up to 6.30 pm, with no definition of “urgent”. Katrina, a constituent who messaged me today, said, “This will mean that those with complex needs, like me, will wait longer for appointments.” What reassurance can the Secretary of State offer constituents such as Katrina that this new system will work for everyone, not just those self-diagnosing their sick note as urgent?

The key point here is that GPs are the clinicians whom we trust to define what urgent means. There are, of course, a number of criteria and conditions that will ring an extra alarm bell and ensure that the patient is registered as urgent. It is worth mentioning that 46% of all GP appointments already take place on the same day as contact is made with the surgery—with the majority of those classified as urgent—so performance is already good. This is not something new that we are landing on general practice; it is much more about ensuring that we have a clear line of sight into who the urgent patients are and ensuring that they get treatment on the first day.

I welcome these reforms. However, on the issue of accountability, despite years of failure documented in multiple inspection reports by the coroner and the Care Quality Commission, the integrated care board has not yet removed the contract from Cockermouth’s Castlegate and Derwent partnership. What else do Ministers believe I can do to ensure that a failing partnership is held to account, other than calling for the resignation of the senior partner, Dr Desert?

My hon. Friend is a doughty campaigner for his constituents. I am not familiar with the details of the case that he mentions, but I would be happy to look into it; if he would write to me, we can take that further.

Local doctors tell me that they were hoping the new contract would be focused on family medicine, with detail about the 10-year plan and neighbourhood health centres that the Minister has just touched on. I ask when the Secretary of State will be releasing the detail of the neighbourhood contract, which is really vital as I work with local health authorities to try to secure a second practice for residents in Stamford.

The guidance on neighbourhood health will be published very soon indeed; it is almost complete, and is coming soon. We recognise that general practice will be right at the heart of neighbourhood health, so we have to ensure a single neighbourhood provider contract and a multi-neighbourhood provider contract that are aligned with the best value that we can deliver, both for the taxpayer and in terms of patient outcomes. We will also be consulting on the single neighbourhood provider and multi-neighbourhood provider, with the consultation process starting some time after the overarching neighbourhood guidance, which is coming out very soon.

It has been really hard to get a GP appointment in Hastings and Rye, so I welcome the bold action that this Government are taking to tackle that 8 am scramble to get a GP appointment: more funding for GPs; changing the funding formula to better support coastal towns, like ours; and requiring GPs, as part of this new contract, to have online booking and same-day appointments for urgent cases. However, I want to ensure that all the people I represent are benefiting from the reforms this Government are introducing, so this spring I will be launching a GP survey for all my constituents to fill out. What work is the Minister doing to ensure that we feel the benefits of these reforms everywhere in the country, and will he, alongside NHS officials at the integrated care board, meet me later this year to discuss the findings of my GP survey?

My hon. Friend and I have had some discussions about GP practices in her constituency, and I know she is doing excellent work to ensure that performance is always being driven in the right direction. She asks what we are doing right across the country; the Carr-Hill formula will be a nationwide initiative, and the contract itself is also nationwide. It is important that the Government do not try to micromanage and that ICBs and trusts work together. We are there to set the framework and ensure that everybody is clear about the outcomes; it is then up to the people at the coalface to deliver those outcomes. We do need to know where that is not working, so perhaps we could look at my hon. Friend’s survey once she has it; it would be a good way of checking in and ensuring that there is a golden thread between the outcomes that we want to see and the delivery on the ground.

I recently visited the Spa surgery in Harrogate and spent half a day with practice managers, GPs, partners, receptionists and nurses, and I am grateful to them for that opportunity. The Minister said earlier that he trusts GPs to make decisions, and just a moment ago he said that the Government should not be in the business of micromanaging, but the new contract outlines specific directions for spending. How does the Minister reconcile that with the fact that local GP partners tell me that the contract will remove the flexibility to manage and meet local service need, and that the uplift in funding will not cover the cost of these additional obligations?

I thank the hon. Member for his question, but it is pretty clear to us, based on the experience of advice and guidance—I think it is advice and guidance that he is referring to specifically—that the £80 million we invested in advice and guidance under the last contract has been extraordinarily successful, with very high take-up right across the country. As a result, we have kept 1.3 million people out of electives who did not need to go to those out-patient appointments. What we are doing now is embedding that in the contract, because it has been such a success.

By embedding it in the contract, we are giving more flexibility and less bureaucracy, because there will be a single point of access in the trust. GPs will be able to access the high-level consultant expertise and specialism that they need in order to assess whether or not a particular patient needs to go to an out-patient appointment. It will mean more flexibility, high-level triage and much better outcomes for patients.

My dad was a GP in Hartlepool for 33 years. He worked through the improvements brought in by the last Labour Government and, until his retirement, through the destruction that the last Conservative Government oversaw—most notably the inability to get a same-day urgent appointment, which saw far too many patients ending up at the door of their local hospital. Does the Minister agree that ensuring that people can access same-day urgent appointments gets treatment out of hospitals and back into communities, where it belongs?

I thank my hon. Friend for that question; I can feel the passion with which he asks it, particularly because of his family connection. It is vital that clinically urgent patients get treatment on day one. We are confident that that is happening in many cases, but embedding it in the contract means an additional level of transparency and commitment from all sides of the equation. That is really important, because it recognises the good performance that is already happening in many cases but will also drive up performance in areas where it is not at the level at which it should be.

Cambridgeshire receives an increasingly raw deal from the Carr-Hill formula, due to the fact that the population demographics have changed so dramatically over the past 25 years. I therefore welcome the announcement that the Carr-Hill formula will be reviewed and that a new formula will be in place by 1 April next year. Cambridgeshire is about to move into a mega-ICB with Bedfordshire and Milton Keynes, so could the Minister allay the concerns in my constituency about how that will affect Cambridgeshire? We are about to see a change in the Carr-Hill formula, and we are about to move into one of the biggest ICBs in the country, which will undoubtedly have an impact on local services.

Clearly, a lot of change is happening in the system, but that is because a lot of change was required. Frankly, we have to do what we are doing if we are going to get the NHS back on its feet and fit for the future, with the three big shifts set out in our 10-year plan. Part of that is about the structure. Our view is that we can consolidate more of the back-office activity, which will free up more resources and allow us to do more on the frontline. ICBs play a vital role in that, particularly in commissioning. We want to see more strategic commissioning and more resource and expertise put into the parts of the ICB that are delivering better outcomes in population health. We must also see less duplication and more streamlining of back-office functions. It is about getting more efficiency but also being more responsive to patients and practitioners on the frontline.

I warmly welcome the Government’s reforms, which will ensure same-day access for GPs in urgent cases and will also make it easier to get an appointment online, finally moving towards ending the 8 am scramble. I recently visited Swanscombe health centre, where the brilliant team is under significant pressure because of the large number of new families moving to the area, particularly neighbouring Ebbsfleet, which has seen 5,000 very welcome new homes built so far. Will the Minister visit Swanscombe with me to see the work that the practice is doing and look at how we can get GP services designed into developments much earlier in the process in areas such as Ebbsfleet Garden City?

Hon. Members raise this issue with me regularly. There seems to be something of a disconnect when new developments are being built, whereby the section 106 agreement or the community infrastructure levy just do not seem to be delivering the social infrastructure that they should be delivering. I would be happy to meet my hon. Friend to discuss that in relation to the specific case he raises. Then, of course, we could discuss the possibility of a visit.

I think the first part of the hon. Member’s question is connected to the second part, because, as he correctly points out, thanks to the 14 years of neglect and incompetence that we saw, the Carr-Hill formula became a very anachronistic way of sharing funding. It should be based on need, but it was based on very outdated statistics and data. We are fixing that, and the changes that we are making will be felt by his constituents. It is disappointing to hear that he has had that feedback, because it does not reflect the nationwide polling from the Office for National Statistics, which shows that satisfaction with access, which was languishing at 60% in July 2024, now stands at 76%.

I hugely welcome the investment into general practice, particularly the flexibility to employ often under-employed GPs who want additional hours and shifts. I also welcome the Minister’s comments about innovation and AI. Sadly, I have had representations from Grange Park surgery in Burley-in-Wharfedale in my constituency, which finds that it is unable to deliver high-quality care because of unreliable and outdated IT systems that are provided across the Bradford area. Frequent outages directly impact access and patient care, so will the Minister set out what investment is available to ICBs to ensure that shift from analogue to digital?

Thanks to the decisions that the Chancellor of the Exchequer has made, significant additional funding has been made available for capital investment in our NHS, and a big part of that is about driving the shift from analogue to digital. The other shifts—hospital to community, sickness to prevention—are not going to work otherwise; they all rely on this pivotal shift from the analogue age to the digital age. It is disappointing to hear the specific feedback that my hon. Friend has heard from the practices in her constituency. If she would like to write to me, or grab me in the Division Lobby, we can talk about the specifics of those cases. But overall the capital budget has been significantly boosted by the decisions that our Chancellor of the Exchequer has made.

Serious concerns have been raised about GPs being offered incentives to prescribe particular branded drugs. We cannot have a situation where prescribing decisions are made to balance the books; they should be made on a purely clinical basis, as I am sure the Minister agrees. With many GP practices seriously strapped for cash, does the Department of Health and Social Care have a clear picture of the situation, and what consideration has the Minister given to banning incentives so that the very best drugs are prescribed, not those produced by the most influential companies?

The hon. Member raises an important point. It is important that we at the Department of Health and Social Care work closely with the NHS regions and the ICBs to keep a close eye on that issue. It is vital that GPs are aligned with the highest professional standards. If we see those standards not being observed in any case, action must be taken. If she has specific evidence to suggest that such practices are going on, she is more than welcome to share it with me.

We all welcome the work being done to get our national health service back on track. What engagement does the Department have with, and what guidance does it provide to, ICBs about what happens when a practice closes or a GP returns their contract in rural communities, like in Betley in Newcastle-under-Lyme? We need to do whatever we can to ensure that people in rural communities such as mine do not get left behind and can access the GP services that my hon. Friend the Minister outlined in their own communities.

My hon. Friend is right that it is vital that ICBs have a clear understanding of their population health needs and their demographics. It is important that the ICB is ahead of that curve and taking decisions well in advance of a practice closing down so that a commensurate service is provided; that is a really important part of the ICB’s responsibilities. If he has specific examples where he feels that his ICB has not been delivering on that basis, he is welcome to share those with me.

I pay tribute to the GPs in Dewsbury and Batley and the surrounding villages. The Minister mentioned preventive health. What steps are the Government taking to support GPs in their treatment of patients with preventable or avoidable diseases through the prescription of exercise and healthy foods? Secondly, we talk about online access, which is welcome—my constituents welcome surgeries that offer appointments throughout the day—but how will the Minister support the digitally excluded who cannot get through at 8 am and do not have access to online applications?

On prevention, there are some really important measures in the contract: in essence, we are recalibrating the quality outcomes framework, which is the basis for payments to incentivise the actions that GPs take. By changing the QOF, as it is called, we can shift that in one direction or the other, and we have changed it to incentivise boosting childhood vaccination rates, particularly in those areas of the country where vaccination rates are worryingly low, and better care for patients living with obesity. That is about exactly the things the hon. Member just mentioned: prescribing, if you like, exercise regimes and advising on better nutrition. We are also changing the QOF to require GPs to share data with the lung cancer screening programme. Those are just three examples of what we are doing within the contract.

On online access, it is clear that there must always be three channels of access to a GP—walk-in, telephone and online—and that for an urgent matter it would be a walk-in or a telephone call. What has really worked is that online access has taken pressure off the telephone lines as people who do not have urgent requirements have been migrating online and using the NHS app—take-up of the app is also excellent—so we are moving in the right direction.

My father was a family doctor in my Camborne, Redruth and Hayle constituency for more than 40 years; now that he is in his 91st year, I am thankful he is no longer practising. I have the highest number of deep-end group GP practices in my constituency, including the one where my father practised. While I welcome the consideration for deprived areas, will the Minister elaborate on what targeted funding there will be for areas with the highest levels of deprivation?

I thank my hon. Friend for that question and ask him to please pass on my best wishes to his father and thank him for the outstanding service he provided over many years. The Carr-Hill formula review is an important piece of work. It will have a complex range of drivers in it, based on remoteness and coastal areas, but socioeconomic indicators will be very much at its heart. Those are the clear terms of reference that we gave to the National Institute for Health and Care Research, and that is the basis of the review. I expect those documents from officials very soon, and we will update the House accordingly. Some of the process was set out in a “Dear Colleague” letter a little while back, but we are also keen to have feedback from MPs in that process.

Many of the surgeries in my constituency have faced enormous pressure when having to deal with patients who cannot get an appointment, so I welcome the additional support that will come to our communities, especially inner-city communities. The Laurie Pike and al-Shafa medical centres in my constituency do so much work on prevention; I hope the Minister will join me in commending them on the work they do. Will there be ringfenced funding for preventive work in areas such as cardiovascular disease detection, respiratory illnesses and diabetes?

Please do pass on my thanks to the Laurie Pike and al-Shafa practices for the outstanding work they do. We are not really doing ringfencing; we are embedding prevention in the contract through the quality outcomes framework. Those incentives are the best way to give practices the flexibility they need while ensuring that they are clear about what we expect in terms of outcomes.

Issues such as cardiovascular disease and diabetes are part of the quality outcomes framework. It is also worth mentioning the Pharmacy First scheme, which is looking to move some of this work out of GPs and enabling pharmacists to operate at the top of their practice. That is another example of the shift from hospital to community, which is so important in enabling people to get the best possible care in the right place at the right time, as close as possible to their homes.

I thank the Minister for his answers so far. One of the No. 1 issues that came up on the doorstep when I was canvassing across my constituency before the general election was same-day access to GPs. Although I recognise that there is still work to be done, I welcome the work the Labour Government and the Minister have done to improve GP access for constituents across Harlow. Does the Minister recognise that there is still more to be done? Will he touch a little on the importance that the shift from hospital to community will have for hospitals like mine, the Princess Alexandra hospital, and specifically the accident and emergency department?

My hon. Friend is right: avoiding preventable admissions is right at the heart of what we are trying to achieve. Of course, we have challenges with delayed discharge—something like 14% of patients in hospital beds are medically fit for discharge—and if we look at the flow of patients through hospital, we see that we can address a lot of the problems at that end of the process by preventing avoidable admissions in the first place. The advice and guidance element of the contract is therefore very important, because it is by improving co-ordination and teamwork between primary care and secondary care that we will ensure that the 1.3 million people who would have ended up on the electives waiting list or going into outpatient clinics no longer need to be there—they will be dealt with by the teamwork between consultant specialists and GPs. They will be helped, supported and cared for close to home, without having to go into hospital, which will have a positive knock-on effect right through the system.

I thank the Minister very much for his positive answers, and I thank the Minister and the Government for the giant steps they are taking to improve the NHS; we are encouraged by that. While the Government have rolled out major changes to the GP contract in England to improve access to same-day appointments, the situation in Northern Ireland, as he will know, is critical. Patients back home are struggling to get GP appointments, waiting times are long and workforce shortages are acute.

I know from past questions that the Minister has a good working relationship with Mike Nesbitt, the Health Minister in the Northern Ireland Assembly. What discussions has he had with the Department of Health in Northern Ireland to ensure that local GP services in Northern Ireland work in parallel with the new guidance in England so that patients are not left behind?

I thank the hon. Member for his kind words about the Government’s work. I do have an excellent relationship with the Minister in Northern Ireland. Devolution is vital to the Government, and we are certainly not in the business of trying to micromanage what is happening both across the regions of England and in the devolved nations of our United Kingdom, but it is clear that there should be learning in both directions. When I speak to the Northern Ireland Minister, we are clear that we want to see the best possible performance and outcomes right across our United Kingdom. I look forward to continuing to work with him on that basis.

The beautiful and vibrant yet very isolated community of Coniston has had a GP practice for the last 200 years or so, but it runs the risk of losing it this year. Its GPs, who were wonderful, retired last summer and a caretaker service is being provided. Bids have been invited and there has been much interest, but no bid has been made. The reason is that the finances are really marginal at such a small surgery where people cannot go anywhere else. There is an answer, and I want to ask the Minister whether he might intervene and talk to the ICB to help us to get there. If the dispensing contract were to be let jointly with the GP contract, that would make it viable, and I know of GPs who would be interested if that were to happen. Will he talk to the ICB to ensure that that flexibility is applied so that we can save the surgery in Coniston for the next 200 years?

I thank the hon. Gentleman for that question. It would be deeply troubling if such an important service to the community were to be removed, so I would certainly be happy to speak to him. Perhaps he would like to write to me to provide more details. Looking to the medium to longer term, the review of the Carr-Hill formula could well end up benefiting communities such as the one he has mentioned, because remoteness and rurality will be an important factor in the Carr-Hill review, but I accept that that might be a bit too far off for what sounds like a more urgent issue. If he would like to write to me, I am sure we can look into that.