Access to GP Services and NHS Dentistry

I call the shadow Secretary of State for Health.

I beg to move,

That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.

Mr Speaker, thank you for the opportunity to open this debate on the future of primary care, access to GPs and access to dentists. It is a particular delight to see the Secretary of State here. I so enjoyed our exchange of letters last week that I cannot wait to repeat the exchange in real life.

Primary care is the front door to our NHS—for most of us, the general practitioner is the first port of call when we are worried about our health—but after 12 years of Conservative mismanagement and underfunding of our health service, the front door is jammed. Patients are finding it impossible to book GP appointments, serious conditions are going undiagnosed, patients are waiting longer than is safe for treatment, with backlogs building up and greater pressure placed on the rest of the health service, and millions of people are waiting more than a month to be seen, often in pain and discomfort.

My hon. Friend has made an excellent beginning to his speech. What is his view of my local hospital, where, instead of 350 people daily, we have 710 people coming into accident and emergency at the North Middlesex Hospital? What response does he have to that kind of demand? Where is it going to lead if people cannot see a GP? They are going to end up in A&E.

My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.

At the GP practice in Norton in my constituency, it is almost impossible to get an appointment on the phone. I have dozens of cases of individuals unable to access vital care. One tried 196 times. The Care Quality Commission has not inspected this practice since 2015. Does my hon. Friend agree that it ought to be doing so now?

Even in the context of the pressures that we see right across primary care—I think every GP practice would acknowledge they face challenges—the case my hon. Friend has just described sounds extreme. We cannot allow the decade or more of mismanagement we have seen from this Government to excuse that kind of care, or indeed absence of care, for patients, and that brings me on to the next point I want to make.

We know why patients are forced to wait: Conservative Governments have cut 4,500 GPs over the last decade, they have closed 300 practices since the last election and they have failed to provide any meaningful reform of the system. The public are sick and tired of waiting. Public satisfaction with GP services stands at the lowest level on record as patients become ever more frustrated with not getting an appointment when they need one, or in a manner to suit them.

It says so much about the NHS at the moment that, while we have the lowest level of patient satisfaction since 1997, when we ask the public whom they trust, nurses and doctors are right up at the top of the list. The public understand that the staff who work in the NHS are trying to grapple with the biggest crisis in its history. Of course, the Government will want to pin that simply on the pandemic, but that does not explain why we went into the pandemic with NHS waiting lists already at record levels, with 100,000 staff vacancies in the NHS and with a decade or more of under-investment, leaving us ill-prepared for the pandemic—or, in the words of the Culture Secretary, “found wanting and inadequate”—but also now struggling to get the recovery from the pandemic that we need to build the health and care service we need for the future.

The shadow Secretary of State says that we need GP reform. What kind of reform does he have in mind? What does he think should be the right balance between in-person, online and telephone consultations?

I am grateful to the right hon. Gentleman for that intervention. I will conclude my speech by talking about what a Labour Government will do, but let me answer his direct point about the range of options through which people should be able to access their GP. I value patient choice. Thinking back to my experience of accessing NHS services last year—as many people know, I did quite a lot of mystery shopping on the NHS—I had a range of interactions with GPs. Some were face-to-face. Some interactions at my GP surgery were not with my GP but with a nurse, which was entirely appropriate and much appreciated. Some of my engagements with my GP were over the telephone. I also had a video consultation with a dermatologist. I really valued that flexibility and range of approaches.

I think that the future for primary care has to be different courses for different horses. Of course, people should have a right to see their GP when they want to see their GP—I am clear about that—but there is also a range of ways in which we can offer more flexible access to GPs, particularly for working people who do not necessarily want to traipse down to the GP surgery in the middle of the afternoon if it is something that could be dealt with over the phone or on a video call.

The shadow Secretary of State is making a powerful speech. I commend in particular the point he made that people still trust their doctors. They are desperate to see them, even if it is online. A 74-year-old constituent of mine contacted me and said that he asked for an online appointment but it would take him 30 days to get there. He appreciates that the issue is not with GPs but with the Government’s lack of planning for the number of GPs who can provide that service in Oxfordshire.

The hon. Lady makes a powerful point. How is it that the NHS can be one of the largest employers in the world—it employs 1.2 million people—but does not have a workforce plan and strategy that says, “This is the workforce need that we have today, this is what the workforce need will be in the foreseeable future and, in the longer term, this is how we need to change the shape of the workforce to take into account advances in medicine and modern technology, and the changing demographics of our society”?

We gave the Government the opportunity to commission such a report when we debated the Health and Care Bill. It was supported on a cross-party basis, including by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—sadly, he is not able to be with us at the moment—yet the Government voted against it. What is it about the ostrich mentality of the Secretary of State and his ministerial team—or, I suspect even more, that of the Treasury—that they would rather bury their heads in the sand, pretend there is no problem with workforce and not even count the numbers of doctors and nurses needed because they worry that the Treasury might face up to the reality of what they need to provide?

Is it not the case that, in the pandemic, the Government fundamentally misunderstood the connection between the health of the nation and its economic success? All the argument the shadow Secretary of State makes about the NHS workforce and what they can achieve for our country shows that the Government are still making the very same mistake.

I wholeheartedly agree with my hon. Friend, who understands well the link between the health of the nation and the health of the economy. Given the labour market challenges in this country, it is simply not acceptable that we are losing so many people who could be in the labour market to ill health. We are also losing so many people from the labour market who are caring for relatives, because there is a disproportionate burden on families. Who disproportionately bears the burden of that care? It tends to be women, so we are losing a whole tranche of women from the labour market who could be contributing to the growth of the nation and the economy.

I will give way one more time and then I need to make some progress.

It is not just about GPs and surgeries; it is about dental access as well. In my constituency and across the whole of the United Kingdom of Great Britain and Northern Ireland, dentists are prepared to take private care and monthly care, but they will not take NHS patients. As poverty levels and prices rise, dentistry is at the end of the queue. Does the hon. Gentleman agree that dentistry is at crisis point and that Government intervention is absolutely critical?

The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.

[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.

The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:

“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]

Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.

Perhaps the hon. Lady could tell us why they want to run away from their record of 12 years.

I thank the hon. Gentleman for giving way. He makes grand statements in support of the NHS, but I am afraid his actions do not support the NHS. He has backed these train and tube strikes today, which have meant that in my constituency patients cannot get to hospital, and nurses and doctors cannot get to their places of work. Can we have better action, rather than words?

I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]

Order. I want to help a little bit. We do not want to open up a debate that is not down for today. We have got a little bit carried away. The hon. Member for Kensington (Felicity Buchan) got in, and I was quite right to allow a response, but I think we have heard enough now.

Thank you, Mr Speaker.

I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are

“all as ants before the might of the all powerful shadow health secretary”.

When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?

I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.

I commend my hon. Friend for the tone of the speech that he is making, because it is vital that we stand up for our NHS, which the Government are failing to do. They seem happy to let everybody be angry with their GPs and about their inability to seek the medical help they need, but very unwilling to do something about it. Is this argument not really one to be had with the Government entirely? They should be making sure that we have sufficient GPs to treat the people in this country.

I wholeheartedly agree with my hon. Friend; it is the trend with this Government to seek division, sow division, pass the buck, devolve the blame and not take responsibility for anything. What Opposition Members would not give for just one day of being able to govern in the interests of the people in this country! This Government want to give the appearance of being in office but not governing at all. That is what is happening on their watch. If that is not bad enough, against a difficult economic backdrop, with scarce resources, not only is the way in which they manage and govern bad for patients, but it is squandering taxpayers’ money.

I will give way in just a moment. The problems in general practice are storing up problems for the rest of the NHS; as we have heard, people are presenting in accident and emergency because they cannot see a GP. That failure is costing the taxpayer dearly. A GP appointment costs the NHS £39, but a visit to an urgent care centre costs it £77 and a visit to the emergency department costs it £359. The Government’s failure to invest in new GPs may be penny-wise but it is pound-foolish. It is wasting money and inconveniencing patients, and it is not the way to manage the NHS. One of my constituents wrote to me yesterday to say that if she wants a same-day appointment for her baby, her GP sends her to A&E. She wrote:

“I was sent to A&E to check a newborn baby’s suspected ingrown toenail that had no sign of infection. How is going to A&E for a non-urgent matter a good thing for anyone.”

Yet that is what our constituents are forced to do, because they cannot get a GP appointment. I hope the hon. Member for Sleaford and North Hykeham can give us some insight as to why.

As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—

Order. Interventions are meant to be questions. I know that the hon. Member is down to speak. I would not want you to use up your speech now; I want you to save something for later.

Let me first say in response to the final point the hon. Lady made that there is absolutely no excuse for abusing NHS staff whatsoever. Most people in this country do not blame NHS staff for the state of the NHS; they place the blame squarely where it belongs, with the Government who have been in power for the past 12 years. Her first point would be more powerful if we did not have 1,500 fewer full-time equivalent GPs now than we did when her party came to power. Her point would have been more powerful if her party had not whipped its MPs to vote against having a workforce plan for the NHS, but I am afraid that that is what it did. Conservative Members cannot run way from their choices and decisions, and from the fact that they have now been in government for 12 years and there is no one else to blame but themselves. In communities right across the country, we now see the consequences of their mismanagement.

I regret to inform the hon. Gentleman that the situation in Wales is not much better, but I do not want to make a party political point. Will he commend the potential role that pharmacists can play in alleviating pressure on GPs? I have an excellent pharmacist in my home village of Pen-y-Groes, which provides an invaluable service for the communities in my area.

I wholeheartedly agree with the hon. Gentleman’s point about the importance of looking at primary care as a whole and the really powerful and valuable contribution that community pharmacies can make, alleviating pressures on other parts of the primary care system, particularly general practice.

Communities across the country are experiencing those problems; let me take one place at random to illustrate the scale of the challenge. Today, after a decade of Conservative mismanagement, the city of Wakefield has 16 fewer GPs than in 2013. In fact, Wakefield has not seen a single additional GP since the Prime Minister promised 6,000 more at the last election, and since Wakefield has been served by a Conservative MP—albeit, thankfully, no longer—it has seen three GP practices close, with some surgeries so short-staffed that 2,600 patients are left to fight over one family doctor. Last month, patients in Wakefield were able to book 25,000 fewer GP appointments than in November 2019, the last month in which they were served by a Labour MP. The only good news for general practice in Wakefield in recent years has been that Simon Lightwood, an NHS worker and brilliant candidate in Thursday’s by-election, has successfully campaigned to save the King Street walk-in centre. [Interruption.] They don’t like it. Conservative Members shout in protest and point the finger at us, but they have been in government for 12 years.

The hon. Gentleman is talking about problems, but his motion does not include one solution. He has now been speaking for 20 minutes, and he has not outlined one solution. If he wishes to be taken seriously as a politician, will he now turn to some solutions to the problems he has outlined?

It is certainly true that I am saving the best until last in my speech, but the hon. Gentleman may have missed the point I have made repeatedly, which is that the NHS—an organisation that employs more than 1.2 million people—needs a workforce strategy. It needs a proper analysis of what its workforce needs are today, the workforce needs of tomorrow, and the future shape of the workforce. We gave Government Members the opportunity to vote for that; the hon. Gentleman voted against it, and he wants to lecture me about being taken seriously as a politician. Who is he trying to kid? I do not know how the hon. Gentleman voted, because it was a secret ballot, but the fact that a majority of Government Members voted to keep the current Prime Minister in office means that they are not in any position at all to lecture anyone else on who is and is not a serious politician.

I am very grateful to the shadow Secretary of State for giving way. I have in front of me figures from the House of Commons Library on the increase in GPs per 100,000 population between September 2015 and April 2022, which show an 8% increase for Wakefield.

I notice that the hon. Gentleman has played the old trick of selecting figures from a specific set of years, but nothing he has said contradicts the facts that I have outlined. In any case, the people of Wakefield will draw their own conclusions on Thursday when they go to vote. The fact is that the Government have had more than enough time to reform general practice in this country, and they have no one other than themselves to blame for the crisis we are in.

Since the Conservative party has been in government for the past 12 years, I thought I would take a trip down memory lane to remind us, the House and the British people exactly what they have been promising since they were first elected in 2010. The 2010 Conservative party manifesto promised that GP surgeries would be open 12 hours a day, seven days a week. The Government failed to deliver that—maybe they blame their coalition partners, although I do not think the Liberal Democrats would have disagreed with GP surgeries being open for that long—so they promised the same again in 2015. That time, they set themselves a deadline of 2020, and guess what? They missed that, too.

In 2015, they promised that everyone over the age of 75 would get a same-day appointment—another promise broken. They said they would hire 5,000 more GPs by 2020—another promise broken. In 2019, they promised 6,000 more GPs, but the Health Secretary has already admitted that he is on course to break that promise, too. They promised 50 million more GP appointments a year, but as the British people know from their experience, appointments are down. That is today’s Conservative party: over-promise and under-deliver, never take responsibility, and leave patients paying the price.

This morning, one of my constituents contacted me to say she was standing outside her GP practice at 7.15 am in order to secure an appointment. She said that she was successful in securing an appointment, but a number of people who were also standing outside did not. Does my hon. Friend remember the Health Secretary promising that people would have to do that in order to secure a GP appointment?

I wholeheartedly agree with my hon. Friend. This is the problem: they overpromise and underdeliver. If they will not hear it from me, Mr Speaker, let us remind ourselves of what some of the Secretary of State’s colleagues have said. The hon. Member for South West Bedfordshire (Andrew Selous), who is in the Chamber, said in Prime Minister’s questions only last week:

“At one of my surgeries, which has double the recommended number of patients per GP, the bowel cancer diagnosis of a 51-year-old father of four was missed and is now terminal.”—[Official Report, 15 June 2022; Vol. 716, c. 283-4.]

Earlier this month, the hon. Member for Telford (Lucy Allan) read a letter from a constituent to the Health Secretary. It said:

“Trying to get basic healthcare is a joke in Telford. Maybe I would be better off in…a third-world country”.

If the Secretary of State is not going to listen to us, he should at least listen to his own side. Before Conservative Members leap to the defence of their Government’s record, they should probably go back and check the record to make sure that they had not agreed with us in the first place.

As for dentistry, 2,000 dentists quit the NHS last year, around 10% of all dentists employed in England. It is an exodus under the Government’s watch. Four million people cannot access NHS dental care and cannot afford to go private either.

My hon. Friend is making an excellent speech. My constituent, Ellie Cokeley, wrote to me. She works as a receptionist in a local dental practice and gets hundreds of calls a week from upset members of the public who are unable to find an NHS dentist. She said that it feels greatly unjust that the poorest in our society are being forced to pay huge amounts for vital dental care or, worse still, having to continue without any at all. Are the Government not failing people in this country when it comes to the care of their teeth? It is vital that we get more dentists in the system.

My hon. Friend is absolutely right. Some places, such as Somerset, are dentistry deserts because the remaining NHS dentists are not taking on new patients.

I will give way first to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), then to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier) and then to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone).

My hon. Friend mentioned Somerset, but can I also mention Sunderland, to keep up the alliteration? In Sunderland, we cannot find an NHS dentist and the few good ones we have are now turning to private practice to make it work. It is an existential crisis in dentistry—it really is at breaking point. Does my hon. Friend agree that the blame lies squarely with the Conservative Government, with backlog Britain, and that this is the effect on our constituents?

My hon. Friend is absolutely right about the state of dentistry. It is not alliterative, but I suspect that my hon. Friend the Member for Hackney South and Shoreditch has similar points to make.

A constituent of mine told me that she had a terrible toothache, rang 111 and was assigned to an emergency dentist. The system worked, but does my hon. Friend agree that that that costs the taxpayer so much more money? My hon. Friend talks about overpromising and underdelivering, but with dentistry the Government have not even promised anything and they are underdelivering.

My hon. Friend knows exactly what she is talking about. Of course, there is no one better in this House to make the point about the waste of public money. That is the outrageous thing about all of this. People are paying more and getting less. Their taxes have been put up, justified in the name of the NHS, but the money is not being directed in the right way to deliver better care. In fact, the Government admit that even with the investment they are putting in, people will be waiting longer for care and that is a disgrace.

I thank the shadow Secretary of State for giving way. He is very civil. Can I also go down memory lane? We have had a Government of a rather different colour in Scotland since 2007, and today I have constituents coming to me and saying, “I cannot get on an NHS dentist’s list”. That echoes the point made by the hon. Member for Strangford (Jim Shannon). Does the shadow Secretary of State agree that in the event of the present Government sorting this situation out, they would do well to share what they did with the Scottish Government? And in the event of a change of Government after the next general election, will the shadow Secretary of State commit to giving advice to the Scottish Government?

This is the thing that the First Minister of Scotland does not want to acknowledge, but for all her noise, bluff and bluster she knows full well that a Labour Government here in Westminster would be good for the people of Scotland. The investment and reform that we would put into the NHS to deliver the same kind of results as the previous Labour Government did would be good for the people of Scotland. I look forward to the day when I can phone the Scottish Government to give them some advice and I look forward to the day when the Governments in Westminster and Edinburgh are Labour Governments delivering for people across the United Kingdom.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) mentioned the trip down memory lane. The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes, regularly blames Labour for what is happening in dentistry. That is because of something that happened 16 years ago: it was a contract that was put in place by the last Labour Government, which we committed to reform in our 2010 manifesto. Unfortunately, that manifesto was never implemented. The tragedy is that the Conservative manifesto that promised reform of the dentistry contract was not implemented either.

In 2010, the Conservatives promised to introduce a new dentistry contract. In 2017, they also promised to introduce a new dentistry contract. What is the Minister’s policy today? She promises to introduce a new dentistry contract. She must make up her mind: either, the current contract is so good that every time she tries to change it, she cannot find a way of improving it, or, the Minister’s Department, her Secretary of State and her Government are so incompetent, so distracted, or so indifferent, that they simply cannot get the job done. It is no good their blaming the Labour party for the problems in NHS dentistry. They have been asleep at the wheel for 12 years. They have failed to do anything to improve the service, and now 4 million people cannot access a dentist. The consequences are severe.

Let me tell the Health Secretary about a constituent of my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper). She tells me that this constituent cannot get a dentist appointment anywhere for an unbearable toothache, and that they are in too much pain to sleep through the night. When they contacted a dentist, they were told that they would have to wait two years for an appointment. They wrote in an email:

That is rubbish!

It is rubbish, but it is his record.

Why is it that so many people are accessing NHS services because of a failure to invest in social care, where staff can be recruited and deployed a lot faster? On the dentistry contract, the last Labour Government acknowledged that the 2006 contract was not good enough, which is why we put the reform of that contract in our 2010 manifesto. The difference is that we will not wait 12 years to deliver the promise after the election of the next Labour Government. Those are just some of the practical steps that we would take immediately and that the Government could take immediately.

Let me tell the House about some of the fundamental issues we would fix. First, mental health services in this country are in such a state that GPs are seeing more and more of their own cases present with mental ill-health. A Labour Government would recognise that there has been a surge in mental ill-health following the pandemic and we would not leave it to overwhelmed GPs to see them. That is why we have committed to recruiting 8,500 new mental health professionals, including specialist support in every school and mental health hubs in every community. We would pay for that by ending the charitable status of private schools and closing the tax loopholes enjoyed by private equity fund managers—and do not tell me the Health Secretary does not know where they are; he was using them before he became a Member of Parliament.

That policy—[Interruption.] Conservative Members are funny. They ask for our policies but they do not like it when we provide the answers, because we have them and they do not. That policy, which would put mental health hubs in every community and support in every school and speed up access to treatment for everyone in our country, would help to reduce pressure on GPs and to deliver better mental health treatment in every community and faster access to a GP for everyone else who needs to see them. It also tells you something about the choices we would make and the priorities we would have as a Labour Government: better public services enjoyed by the many, paid for by closing tax perks for the few.

I welcome this chance to come to the House to discuss primary care and dentistry, but I have to say that the audition by the hon. Member for Ilford North (Wes Streeting) did not go very well. I hope that he can see the irony—some might even say the hypocrisy—of his sudden interest in access to public services, today of all days. It is thanks to the strikes that he has been so vocal in supporting the fact that people right across the country cannot make their appointments, that GPs and dentists cannot get to work and that patients do not have access to the treatments they desperately need.

I will take some interventions in a moment.

The hon. Gentleman has had every opportunity to do the right thing, to put patients first and to condemn these unjustified and reckless transport strikes, yet at every turn he has chosen to back his union paymasters.

I hope the hon. Lady will condemn the strikes.

The Secretary of State speaks about opportunities. In this House, we had a number of opportunities to get workforce reform, workforce numbers and a plan for our health service into the Health and Care Act 2022. Why did he miss those opportunities?

We are seeing record investment in the workforce, and we are seeing record increases. For the first time ever, the NHS is also coming up with a 15-year long-term workforce strategy, which I hope the hon. Lady welcomes.

The Government have always been on the side of patients and the people who care for them. I pay tribute to everyone working in primary care and dentistry for the difference they make day in, day out to their patients’ lives. I know that the pandemic has brought some unimaginable pressures, and equally I know that many of those pressures have not gone away now we are living with covid.

The hon. Member for Ilford North talks as though he does not know where the pressures have come from—as though he has had his head under a rock for two years. The NHS has said it believes that between 11 million and 13 million people stayed away from the NHS, including their GPs and dentists. Rightly, many of those people are now coming forward for the treatment they need—and I want them to come forward.

When the Secretary of State does the much-needed manpower review, will he ensure that a fast-growing area such as Wokingham with lots of new houses gets proper provision for that growth? Will the manpower plan also address how we recruit the doctors we have authority to get?

I absolutely agree with my right hon. Friend’s important point. In fact, I met my hon. Friend the Member for South West Bedfordshire (Andrew Selous) about that last week, and I agree with them both.

Last month, a constituent contacted me who had developed severe dental pain. He phoned 40 dentists and not one of them could take him on as an NHS patient. It got so bad that he phoned 111 but was told that he was not eligible to see an emergency dentist. What advice would the Secretary of State give to someone in those circumstances? Many other hon. Members on both sides of the House will be able to tell similar stories. In the end, my constituent had to pay to go private, but that should not have happened. Why are our constituents being placed in that position?

I am sorry to hear about the right hon. Gentleman’s constituent. If he will allow me, in a moment, I will come on to the pressures that dentistry is facing and, most importantly, what we are doing about them.

Those pressures have come about for two reasons. First, there was a fear of infection, which was understandable in a context where 10 minutes in a dentist’s chair during the pandemic could have meant 10 days in self-isolation or, perhaps, worse. Dental practices were almost uniquely at risk of spreading covid, so their activity was rightly severely constrained across the world—not just here in England and across the UK—by the infection prevention rules that were necessary at the time. Despite all the innovations in dentistry over the last few years, dental surgeries do not have a Zoom option.

Secondly, the British people stayed away because of their innate sense of responsibility during the pandemic. As all hon. Members saw in their constituencies, people understood our critical national mission. Our GPs were doing their duty vaccinating people in care homes and in thousands of vaccination centres up and down the country, protecting the most vulnerable and working hard to keep us all healthy and safe.

When omicron struck—we all remember that period, which was not that long ago—I stood before this House and asked GPs to stop all non-emergency work once again. I did not take that decision lightly, but we were faced with a stark choice of having more lockdowns or accelerating our vaccine programme. We chose to accelerate, with help from all corners of the NHS and with the backing, at that time, of the hon. Member for Ilford North. I remember him standing at the Dispatch Box pledging his full support for that effort and rightly stating that the Government were acting

“in the best interests of our NHS, our public health, and our nation.”—[Official Report, 13 December 2021; Vol. 705, c. 795.]

He recognised that it was the right thing to do then; he has now conveniently changed his mind. I wonder why.

But people like Mark in my constituency cannot find an NHS dentist. This is not about covid; it was happening before covid. The investment just is not there. He is in pain; he is in agony. The Secretary of State needs to step up, step in and get things right.

We are putting record amounts of investment into the NHS, including more funding into dentistry—I am about to come on to that right now—which will help with those pressures.

Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.

I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.

The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.

Does my right hon. Friend agree that a lot of the issues with primary care services are about leadership? In my constituency, we have the brilliant Thistlemoor surgery with Dr Neil Modha and Dr Azhar Chaudhry, who serve 29,500 patients, 80% of whom do not have English as a first language. Same-day, face-to-face GP appointments are the norm in that practice. In contrast, a Thorney surgery has just temporarily closed a surgery in my constituency due to a lack of admin staff, which is not the fault of the admin staff themselves. Will he back my campaign to make sure that that GP surgery is open again serving local people as soon as possible?

My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.

Does my right hon. Friend recognise that the crisis in NHS dentistry, which affects my constituency as it does his, well predates the pandemic, and indeed goes back to at least 2006 when the then Labour Government changed the way in which dentists are paid? Will he undertake to look at the units of dental activity system, which disincentivises dentists from providing dental work particularly in the most disadvantaged communities?

My right hon. Friend is absolutely right in his analysis, and I can give that undertaking. I will say a bit more about that in a moment.

If the hon. Member for Ilford North wants to talk about funding for the NHS, I am happy to oblige. Under the last NHS long-term plan, before the pandemic, we made a historic commitment of an extra £34 billion a year. Because of the pandemic, we then necessarily put in £92 billion of extra funding. At the last spending review, we increased funding still further so that the NHS budget will reach £162.6 billion by 2024-25, supported in part by the new health and social care levy.

We have made sure the NHS has the right level of resourcing to face the future with confidence, but we must also be alive to the consequences. The British people expect every pound spent to be spent well, and they expect us to be honest with them that every extra pound the hon. Gentleman calls for will be a pound less spent on education, infrastructure, housing and perhaps defence. I believe in a fair deal for the British people, and especially for our young people. We will be making plenty of changes alongside this funding.

One of the major problems we face in Wales and across the UK is the need to replace retiring GPs and dentists. There has been a welcome increase in the number of international medical graduates training in Wales, but the British Medical Association informs me that very few GP practices and dental practices in Wales are registered as skilled worker visa sponsors. Will the Secretary of State raise this with the Home Office to see what can be done to help GPs and primary care practitioners retain those international graduates to work in Wales and across the UK, if they so decide?

We are working with our colleagues in the Home Office on this and other skills and healthcare issues, so I can give the hon. Gentleman that assurance. He talks about the major problem he is facing in Wales, and that major problem is a Labour Government. I hope he agrees—[Interruption.] He is nodding.

Look at the performance of Labour in Wales, whether on health or education: the median waiting time for outpatients in Wales is almost double the median waiting time in England. People in Wales are waiting more than three years, whereas the longest wait in England is more than two years. Thanks to the covid recovery plan we set out in this House a few months ago, the number waiting more than two years has been slashed by more than two thirds in just four months, and it will be almost zero next month.

Thousands of people in Wales are waiting two or three years. In fact, one in four patients in Labour-run Wales are waiting longer than a year. In England it is one in 20, which is far too high and will be lowered, but in Wales it is one in four. It is not surprising the hon. Member for Ilford North had nothing to say about his colleagues in power in Wales.

I would like to hear what the hon. Lady thinks of the Labour Government in Wales and their abysmal performance when it comes to healthcare.

There is much better performance from the Welsh Government than from the UK Government. The Prime Minister promised 6,000 more GPs, which has not happened.

I wrote to the Secretary of State about Blackburn having only 33 GPs per 100,000 people, whereas the south-west has 73. I wrote to him about a young man whose cancer was misdiagnosed, but I have not had a response. I would say Wales is doing much better than the Secretary of State.

That is a very strange comment about the hon. Lady’s colleagues in Wales. Either she does not know or she is deliberately saying something she does not quite believe. Perhaps I can make her aware of the facts in Wales, where the number of people waiting more than two years for treatment currently stands at more than 70,000. That is more than three times the figure in England. That is more than three times the figure in England. It is at 70,000, and the hon. Lady seems to be very comfortable with that. I am surprised—it tells us all we need to know about Labour’s ambitions for government if she thinks that is acceptable.

Maybe the hon. Member for Rotherham (Sarah Champion) can tell us whether she agrees with her hon. Friend the hon. Member for Blackburn (Kate Hollern) on Wales.

The Secretary of State knows we are having a debate about the whole UK, but I am asking him specifically about England and his responsibility. Can he answer the original question from my hon. Friend the Member for Blackburn (Kate Hollern), which was about the Prime Minister’s 2019 commitment to 6,000 extra GPs? We know there are 1,000 newly qualified foreign GPs who are about to be deported by his Government, plus students who are unable to complete their studies because this Government are not providing them with the money for the final years. Under the management of the Secretary of State’s Government in the last decade, we have lost 4,500 GPs. Can he talk about what he plans to do to replace them?

I am happy to talk about that. Because of the record funding this Government have put in, both pre and post pandemic, we are seeing record increases in the workforce across the NHS. When it comes to GPs, since March 2019 we have seen an increase of some 2,389. On top of that, we have seen a further increase of more than 18,000 full-time equivalent staff working in other important primary care roles. That is in England—I am talking about England numbers.

Of course, we are working hard towards the targets we have set. We are also seeing more GPs in training in our medical schools than ever before, with more medical schools operating than ever before. I hope the hon. Lady will welcome that result and that investment.

We are talking about GP and dentistry services today, but the wider primary care family includes community pharmacy and ophthalmology, the vast majority of which are not NHS providers but operate under contract providing NHS services. In my excellent right hon. Friend’s second year in the Health Secretary job, will there be a ruthless focus on the wider primary care landscape? When it comes to prevention, surely those people must be the front door of the NHS to ensure that the system is sustainable in the long term.

Yes, absolutely. I know my hon. Friend speaks with great experience in this area. I am just about to come on to some of the changes we will be making to primary care, which I am sure he will welcome.

When the Secretary of State goes back to the Department, will he have a quick look at how it is that, in Leeds, north-east Lincolnshire, Fylde and Wyre and Stockport in the past six-and-a-half years, we have increased the number of GPs by between 18% and 22%? I am curious to know whether there are any lessons we can draw from those areas for the rest of the country. Will he ask his officials to look into that to see whether there are useful points for us?

I will, and I will get back to my hon. Friend on that issue with more detail. I hope he welcomes the investment we are seeing and the record numbers of doctors and GPs in training.

I know my right hon. Friend is coming on with some more ideas, but from talking to GPs across my constituency, one of the issues I have found is that, as we have diversified primary care staff beyond GPs to paramedics and others, the role of what might be called receptionists and telephonists has moved far more into triage. It is now a more complicated role. Is he attracted to the idea in the Policy Exchange document of creating an NHS gateway to provide more medically qualified staff at that first point of entry to GPs, but on a nationalised basis, available via internet, telephony and the cloud?

Yes, I am. I have seen the report my hon. Friend refers to and have discussed aspects of it with its authors, so the short answer is yes.

Will the Secretary of State give way?

I will later.

In terms of the changes we are making, let me first turn to primary care. The hon. Member for Ilford North, in his motion today, is calling on me to

“urgently bring forward a plan to fix the crisis in primary care”,

as he puts it. That is his motion. He is probably too busy supporting the strikers to have read my speech to the NHS Confederation last week. Had he bothered to listen to or read what I said in that speech, or the similar words from Amanda Pritchard, the chief executive officer of NHS England, he would have heard me acknowledge that our current model of primary care simply is not working. I have made no secret of that, or of my desire for change.

We are now working on a plan for change and, based on today’s motion, I will be glad to count on the hon. Gentleman’s support when we bring those plans forward, because what he has asked for, we are already doing. Our plans, for example, include a much bigger expansion in what our fantastic pharmacists can do. In fact, on the very day that I made that speech in Liverpool, we also announced a new pilot scheme to allow people with signs of cancer to be assessed and referred by pharmacists. That is yet another example of how we are working hard to enhance the role of our brilliant pharmacists and thereby freeing GPs to spend more time with their patients.

Thus far, if I have got this right, the Secretary of State has told us that there have been record levels of investment across our NHS services, including GPs and hospitals, and that any minor concerns that have arisen are because of the covid years. Does he think that the British public have been asleep for the last 12 years? Does he think that the British public will buy this? The stark reality on our streets—the Secretary of State may want to go and have a look—is as dire as it has ever been.

As I said—I am glad that the hon. Gentleman was listening—there have been record levels of funding in the NHS, and, as we set out in our spending plans, that will continue. But that is no thanks to the hon. Member for Ilford North and his colleagues, who all voted against that record funding. They wanted to deny those resources to their constituents. He should reflect on the impact of that had their wish gone through the House.

On the changes that we are making, we are going further, from improving telephone services to letting others such as nurses and pharmacists complete fit notes. Appointment numbers are already exceeding pre-pandemic levels—for example, in April, GPs and their teams were delivering 1.26 million appointments per working day. That is a phenomenal achievement, which the hon. Gentleman should be commending, not castigating.

The hon. Gentleman raised Wakefield and primary care. He was using dodgy numbers, so he was corrected by my hon. Friend the Member for South West Bedfordshire. He also gave out further dodgy information by somehow claiming that the King Street walk-in centre was under threat. I do not know if you have seen this in the by-elections, Mr Deputy Speaker, but the Labour party has a history of just making things up and creating fake news to scare local people. That is the respect that they show for local people. The walk-in centre has never been under threat. The local clinical commissioning group has confirmed that it has never been under threat. If he had any decency, he would stand up and withdraw his remarks. I give him that chance.

I would have thought that the Secretary of State would have learned by now that it is silly to give way to me when he makes these facile points. It is absolutely the case that the walk-in centre’s future was in jeopardy. It is absolutely the case that Simon Lightwood campaigned to save it. If that is what Simon Lightwood can achieve as a candidate, imagine what he will do as Wakefield’s next Labour MP.

The hon. Gentleman is now using the past tense. A moment ago, he claimed that it was under threat. He clearly has no issues with giving false information in this House. The truth is that, if Wakefield wants a better future, as everyone in Wakefield deserves, only one by-election candidate can provide that, and that is Nadeem Ahmed.

We intend to go much further to build a truly 21st-century offer in primary care. That includes Dr Claire Fuller’s independent review, which I found to be extremely valuable, and the changes that will stem from that as well as the many others that we will bring forward shortly. We will work with the population and the profession alike. The hon. Gentleman was right to focus on the importance of the profession, but he did forget to mention, as I referred to earlier, that since March 2019 we have more than 2,380 additional GPs in primary care, record numbers of doctors in training and more than 18,000 additional primary care professionals.

Let me turn briefly to the important steps we are taking in dentistry. Urgent care has been back at pre-pandemic levels since December 2020, and the 700 centres for urgent care that we set up to provide treatment for patients during this difficult period have helped thousands of patients across the country. At the start of this year we put an additional £50 million into NHS dental services, which boosted dental capacity by creating 350,000 extra appointments. Dentists are currently required to deliver 95% of pre-covid activity, and we are planning to return to 100% shortly. I commend all the dentists who are already achieving that.

The Secretary of State referred to an additional £50 million. As he knows, the way in which that was framed made it difficult for dentists to draw down the money. Will he tell the House how much of it has been drawn down and used?

I do not have the exact figures to hand, but I know that millions of pounds were drawn down and used to deliver tens of thousands of appointments across the country. That made a huge difference to a great many people.

The urgent care centres are an important innovation, but it is also important for them to be accessible throughout the country. There are seven in Kent, but the one nearest to my constituents is 33 miles away. Could my right hon. Friend intervene with the NHS in the south-east to bring about a more even distribution?

My right hon. Friend’s point is important and well made, and I will look at the issue closely and get back to him, if I may.

As we have already heard today—but it is such an important point—the challenge for NHS dentistry predated the pandemic. It is not just about the number of dentists in England, but about the completely outdated contracts under which they are working, which were signed under a Labour Government. [Interruption.] Labour Members do not like it, but it is true. These contracts mean that we are operating almost with one hand tied behind our backs. They do not incentivise prevention, they hold back innovation, and they mean that hard-working families cannot get the dental services that they deserve. However, we will now be changing that; our work with the sector, along with the work of Health Education England on recruitment and retention, will be vital for the future.

Will the Secretary of State give way?

I will in a moment.

If there is one thing that unites all our work on primary care and dentistry, it is this. We are shifting to a new mode of operating—one that is about helping the whole population to stay healthy, not just about treating those who ask for help. We need to get to a place where we are healthier for longer, because freedom is hollow without our health.

Our new Health and Social Care Act 2022 is an important step in that ambition. Statutory integrated care systems will be responsible for the funding to support the health of their respective areas—not just treating people, but helping people to stay healthy in the first place. The Act also allows us to make safe and effective public health interventions such as water fluoridation, and we will set out further plans for that shortly.

Prevention, personalisation, people and performance: those will be our watchwords for modernising NHS services. They will sit at the heart of everything to come, from the health disparities White Paper to the update of the NHS long-term plan. While the Opposition continue to go off the rails, we remain firmly on track, laying down our plans to deliver a truly 21st-century offer for the profession and, most of all, for patients.

Order. As Members can see, there is a great deal of interest in this debate. I am not imposing a time limit now, although I—or whoever occupies the Chair after me—will obviously be free to do so later, but some discipline in this regard would be very useful. We will start with Paul Blomfield.

A range of important issues has been raised by those on both Front Benches and in the interventions on them, but I want to focus specifically on NHS dentistry issues.

We have all had so many constituents contact us, and I would like to share a small selection of mine. One new resident to the city said:

“I moved to Sheffield earlier in the year. I am unable to register for an NHS dentist. I am being quoted waiting lists of eighteen months just for a check-up.”

Another wrote:

“My partner has been trying to get into a dentist for a check-up for around 18 months. We have rung every dentist within a 6-mile radius to be told they are not taking on NHS patients…and he will need to go private.”

One woman wrote to me:

“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.

A young mother told me:

“We’re told dental care is important and that we should get our children seen early and regularly. We moved to Sheffield in December 2020. I started to look for a dentist. I’ve been on a waiting list for a year with no progress.”

Another parent told me:

“Our son was referred for NHS orthodontic treatment by his dental practice in February 2019 at the age of 12. He has now been on the waiting list for 35 months and will turn 15 next month. He still has not had an initial assessment appointment.”

I thank my hon. Friend for giving way; the Secretary of State seemed to forget to do so. Does my hon. Friend share my concern that, even before the pandemic, the No. 1 reason for hospital admission among children aged five to nine was tooth decay? Is that not a shocking indictment of the failure to address health prevention and care for children and their teeth, and is it not a bit galling for the Secretary of State to suggest that this is the fault of the last Labour Government, when before the pandemic his Government had already been in power for 10 years?

I thank my hon. Friend for that intervention, and she is absolutely right about how that highlights the crisis we are facing in NHS dentistry. That exists right across England, and it was interesting to hear comments from other nations, because significantly less is spent on dentistry in England than in Wales, Scotland or Northern Ireland. The Secretary of State blames everything on the contract, but the cuts to dentistry have been deeper than in the rest of the NHS, with spending a quarter less than it was in 2010, and I am not surprised that he made no mention of that.

Last Wednesday, I met our local dental committee to discuss the problem—dentists who are committed to their profession and to NHS provision, and who want a solution—and following our discussion, they commissioned a survey of waiting lists across the city. Some 37 practices responded, which is about half of the city’s providers, but only one practice could offer a waiting time shorter than a year. For 29% it was up to two years and for 32% more than two years. The most significant number was that 35% of practices were unable to add any patients to their waiting lists.

Across England, the number of dentists providing NHS services fell from 24,700 in 2019-20 to 21,500 now, which is a fall of 15% in just two years—

I see the Minister shaking her head.

However, there is provision for those who can pay. Healthwatch reported last year:

“Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”

That is adding to health inequalities, and it is not because dentists are reluctant to take on NHS patients, but because the system discourages them from doing so. We have patients wanting NHS dentistry and dentists wanting to provide it.

It is true that there are flaws in the 2006 contract. It is based on units of dental activity using figures from the two years prior to its imposition, which are now massively outdated. It contains huge discrepancies in remuneration rates between practices doing the same work. There are penalties through clawback for underperformance for reasons beyond the control of practices, but no reward for overperformance. I see the Minister smirking, but she has been delivering this contract, and the Government have been operating within it for 12 years. There are limits on how much NHS treatment a practice can provide. That is because of quotas and the way that providers are contractually obliged to spread their NHS work. Dentists have a disincentive to take on new patients, who are more likely to have greater treatment needs, because the fee-per-item system was replaced with a system in which the same is paid for one filling as for 20.

As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.

Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.

We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.

NHS services are devolved, but many concerns about them are shared across the UK. Some of my constituents have concerns about the price of NHS dentistry offered through private dental practices, and about transparency in how final costs are calculated. Does the hon. Gentleman agree that, particularly given the economic climate, practices must give cost breakdowns before treatment begins, so that patients can budget and understand what they are paying for?

We need transparency, and that starts with a new structure for remunerating dentists—a structure that no longer disincentivises them from taking on NHS patients, and that does not push them towards private care. If we do not make those changes, the system will get worse. Some 50% of NHS practices have already reduced their NHS commitment, and 75% are planning to reduce further their contracts. Patients will face frustration and all the pain involved in not accessing help when they need it. As others have commented, children’s oral health will be severely damaged. It is a disgrace—it shames the country—that last year, hospitals in England carried out almost 180 operations a day on children to remove rotting teeth, and it cost the NHS more than £40 million. Those problems will impact those children throughout their life. Poor dental health is linked to endocarditis, cardiovascular disease, pneumonia, premature births and low birth weights, all of which add strain and cost to the NHS.

The good news is that there is an answer, but it is in the hands of the Government. We need to restore adequate funding to dentistry in England, and we need a commitment that the long-promised contract reform will take place. It must be real reform, and not tweaks at the edges. Otherwise, we face the slow death of NHS dentistry.

With regard to access to GP services, there is a significant challenge that must be met head-on. The solution must address patients’ ongoing concerns, involve long-term strategic workforce planning, and respect, not abuse, the GPs themselves.

The issue that I wish to focus on is access to NHS dentistry, which after 18 months retains the unenviable and scandalous position of being No. 1 in my postbag. It is quite clear that the situation is replicated for colleagues across the House. Access to NHS dentistry is a problem that has been brewing for a long time. It can be likened to a house built on shallow and poor foundations, which—with the earthquake of covid—have led to the house falling down.

The impact on people is profound: millions unable to find a dentist; thousands in agony, resorting to DIY tooth extraction; as yet untold numbers of undiagnosed mouth cancers; children suffering and having whole mouth replacements; and the poorest hit hardest. The solutions are fivefold: a secure, long-term funding stream; a strategic approach to recruitment and retention; replacement of the dysfunctional NHS dental contract; a prevention policy promoting personal oral healthcare from the cradle to the grave; and transparent and full accountability through the new emerging integrated care systems.

To be fair to the Government, measures have been put in place to address the crisis. Locally in Lowestoft, funding has been provided for an established dentist to attend to emergencies. The practice has responded heroically and prevented the system from collapsing. A new long-term NHS contract has been awarded to Lowestoft-based Dental Design Studio. That is welcome, although given that it was not possible to commission similar contracts elsewhere in Suffolk and Norfolk, there is concern that demand for NHS dentistry across the region will continue to outstrip supply, and that the new service could have a large and unserviceable catchment area.

The Government’s announcement in February of a £50 million dental “treatment blitz” was welcome, but there is concern that the take-up of that funding has been limited because dentists have been too overstretched to take on the extra work. In the long term, the fact that the feasibility of establishing a dental school in Norwich is being considered is also very much welcomed.

I put on record that my husband is a senior manager in the NHS.

Dr Claire Fuller was commissioned by the Government to lead a national review of primary care. In her introduction to that review, she says that

“there are real signs of…discontent with”

general practice,

“both from the public who use it and the professionals who work within it.”

Every day, more than 1 million people benefit from primary care professionals and, by Dr Fuller’s own admission, primary care teams are over-stretched “beyond capacity”. Sadly, we have not heard anything today from the Secretary of State to address that issue.

GPs have been working in local communities for over 100 years. The concept has not changed: GPs are still based in their local community, with the only difference being that the buildings they work in are much more modern. GPs have now moved to a triage system, creating the perception that it is difficult to get a face-to-face appointment, and for some of my constituents that perception is reality. Bookable appointments have now moved to a longer lead-in time, from three to four weeks in advance to seven to nine weeks in advance. Nationally, there were half a million more appointments in January this year than in January 2020, but the number of GPs is roughly the same, despite the Government’s promise in February 2020 that they would recruit 6,000 more GPs by 2024. More than two years down the line, we are simply no further on.

People are frustrated and angry that they are being contacted by GP surgeries to book in for a health check, yet cannot get to see their GP when they feel unwell. While it is undoubtedly important for GPs to carry out health checks, which can enable interventions, that cannot be at the expense of routine appointments. Those health checks are on an enhanced service contract, meaning that the GP is paid for every patient who takes them up. That is in addition to their normal contractual obligations, so it is no wonder that patients are frustrated. At the NHS Confederation last week—the gathering of more than 5,000 senior NHS managers and staff—which the Secretary of State said he attended, the single biggest area of concern was workforce.

It is a pleasure to follow the hon. Member for Liverpool, Wavertree (Paula Barker). My observations are based on having, in the past six months, spoken and spent mornings with the people at about 11 of the 13 GP networks in my constituency and on some of their observations, which I have shared with the Minister previously.

Part of the issue in my area is that the population has grown so significantly. Since 2000, the number of patients per GP has gone up by about 40% in the constituency, which puts on significant pressure, which GPs are responding to, primarily by recruiting other direct care professionals, such as paramedics and various qualified nurses. That has a role in providing support to deal with the problems, but it has not overcome them. Significant efforts are being made to enable my constituents to contact their GP. One interesting issue in those observations was that the practice’s choice of phone system had a significant effect. Practices that chose system A—I will call it that, as I do not want to say a bad word about a particular practice or phone system—would find that the response for the customers, the patients, was terrible. In effect, when 10 people were waiting, the 11th caller got a signal that the number was no longer obtainable. So they would then go to the practice. This was just after covid, so they would go to the practice, try to get in and there would be a big sign on the door saying, “No entry”. These very easy-to-understand problems cannot be solved by the Government but they have a direct impact on people’s experience of primary care.

However, there are aspects that can be affected by the Government. One of the biggest concerns in my area has been the level and pace of housing development and the absence of an infrastructure-first policy. Can the Minister update the House on her conversations with the Department for Levelling Up, Housing and Communities about implementing infrastructure-first? It means that, before a large housing development can take place, the GP services and the school places need to be there. We should not have people moving into their new houses on some of these estates and then finding that there are no GP places, school places and dentists. This was a manifesto commitment of my party and we should be putting it into law.

It is a pleasure to follow the hon. Member for North East Bedfordshire (Richard Fuller). His points on planning resonated with me as a Lancashire MP. Where we see large expansions of housing that do not go hand in glove with expansions in GP practices, school places and public transport networks, it is hard to get buy-in from the current population in those areas for that expansion, with patients already struggling to get GP appointments.

When I was collecting my thoughts for this debate, I was worried that I might fall into the trap of talking about the huge number of constituents who get in touch with me daily about their frustrations with GPs and dentists, so I will begin by paying tribute to the GPs and dentists who work in my Lancaster and Fleetwood constituency. Having worked very closely with them for seven years, it is clear they are working to the best of their ability in a system that is, frankly, broken.

I will single out one GP in particular. It is always risky to start naming GPs because there will be someone I miss, but I pay tribute to Dr Mark Spencer. When he recognised the health inequalities, the differences in life expectancy and the increased number of cancers and other conditions among his patients in Fleetwood compared with patients in the rest of the borough of Wyre, he started an initiative called Healthier Fleetwood, which has the buy-in of our town, to promote healthier living and exercise. It is for that work that Healthier Fleetwood was awarded the Queen’s Award for Voluntary Service last month. I congratulate all the volunteers at Healthier Fleetwood and Dr Mark Spencer on having the initiative and foresight to do that. He established it because of those health inequalities, which are exacerbated when access to primary care is made difficult. The reality is that record numbers of people are waiting for care and waiting longer than ever before. When we say that people are waiting longer for care, it is important to remember that people are waiting in pain and in discomfort, and with conditions that become more severe and more difficult to treat.

All the GP surgeries in my constituency have worked incredibly hard throughout this period. I saw some of that up close when I was volunteering with the vaccination effort in the weeks that I could. The entire period has been a complete whirlwind for them, and they went straight back into there being a huge demand for appointments. I commend them for what they did during covid and what they are doing now.

The job of an MP is to not just champion but challenge. As every other Member of the House has, I have heard complaints about the difficulty of getting GP appointments, which I need to raise with surgeries. Those complaints are about getting an appointment at all, getting a face-to-face appointment, getting through on the phone, or—more for dentists than GPs—being able to register.

We know that the covid pandemic is a huge part of that problem, because we asked the public to stay at home and protect the NHS, which they did almost to a fault. I remember Ministers at the Dispatch Box, as the pandemic went on, pleading with people to come forward if they thought they had something. Understandably, however, people did not want to burden their GP or hospital. They are now rightly coming forward, and they may have had hospital treatments delayed again because of the backlog, so they are going to their doctor instead.

Sometimes, my constituents are unhappy about not getting face-to-face appointments; they dislike eConsult and telephone appointments. I have used eConsult successfully, and I think it and telephone consultations have a place, but as a GP at one of my surgeries said, the risk with both of those is that GPs do not see the thing that the patient has not come in about. A patient may come in about their leg, and while they are there, the GP says, “Can I just have a look at the thing on your neck?”.

I completely agree with the hon. Gentleman’s point about GPs not being able to identify the issues that people have not come in for. Another thing that doctors can notice at face-to-face appointments is that someone is a victim of domestic abuse or violence.

I completely agree; the hon. Lady has made an important point. Sometimes, what people present with is not the biggest issue in their lives, and a skilled practitioner can uncover that.

As has been touched on, the issue is partly about telephone systems, bizarrely, as I will come on to, but it is also undoubtedly about a shortage of GPs. The Government have a grip on that: we have 1,500 more GPs now than in March 2019; 4,000 more trainees have taken up training places this year compared with 2014; and we have a health and social care levy which, as has been touched on, the Labour party opposes but which provides £12 billion a year to the health and care system, so there is more money to improve telephone systems and face-to-face appointments. Looking at the data this morning, we had 2 million more face-to-face appointments in April this year than in April last year, but we are still below pre-pandemic levels.

The complaints I get about dentistry are more about not being able to register anywhere. There is a particular issue with the promise that we make to pregnant women about being able to see a dentist, because even they cannot get registered. I met the Minister about that recently. The issue there is less about a shortage, as it is with GPs, and partly about the contract; there seems to be cross-party agreement that the 2006 Labour contract needs to be changed. I am also pleased that the Government will allow more internationally qualified dentists to support the dental system here.

There are two things that we need to get better at. One of them was touched on by my hon. Friend the Member for North East Bedfordshire (Richard Fuller). My constituency has also seen a huge growth in housing—we have two housing developments in Didcot alone, which will house 18,000 people—and the promised GP surgeries for these increased populations never arrive. As my hon. Friend said, we must get better at putting in the infrastructure first and at planning for the increased populations.

I shall finish on the second thing. Some Members may know that I worked in social mobility before I became an MP, running charities for disadvantaged young people. Unfortunately, the medical profession is the most socially exclusive profession in the country. Only 6% of doctors are from a working class background. A person is 24 times more likely to become a doctor if they have a parent who is a doctor. That is worse than politics, worse than the media, worse than the law, and worse than any other profession that we can think of. There are many reasons for that. It is about the allocation of work experience, how the recruitment process works, and the fact that 80% of applications to medical school come from 20% of schools. There is a whole range of things.

I am grateful for the opportunity to raise the issues affecting my constituents in this important debate. Sadly, those issues are now becoming frustratingly commonplace for far too many people in Portsmouth, as record numbers of people are waiting for care, and waiting longer than ever before.

According to research by the Nuffield Trust, published in The Times last month, the figures are stark. Portsmouth is the worst affected area in the country, with just 40 GPs per 100,000 people. Meanwhile, one of the key GP practices in my city, the Guildhall Walk Healthcare Centre, closed in September last year, impacting more than 8,000 patients, many of whom are my constituents. Another GP service at the John Pounds Centre in Portsea also remains closed. I have raised concerns with local decision-makers about this, but it is clear that Government intervention is urgently needed to deliver the GP services that my constituents need and deserve.

It is a similar story with dentistry. A recent report from the Association of Dental Groups found that Portsmouth, at 42, has the seventh lowest number of NHS dentists per 100,000 in the country. Local Tory Ministers have claimed that the additional £6.8 million of piecemeal funding for dentistry in the region will help, but during the local dentistry forum that I convened with practitioners and representatives of the British Dental Association, they made it clear that it does not even begin to meet the scale of the challenge. They also underlined that there should be changes to rules and regulations on recruitment and retention to tackle this problem, as we have seen with NHS GPs.

I would welcome confirmation in the Minister’s response to the concerns raised by my constituents during my various lobbying efforts that reforming the NHS dental contract is under way, and that the BDA will be involved in its development. However, this cannot just be tinkering around the edges. My constituents need real action, and they need it, now.

In a survey that I conducted to hear the views of Portsmouth people, one respondent told me:

NHS and care services have been under significant pressure over the last few years, due to the pandemic and now in restoring services as we open up. That includes dentist and GP services. I thank all of our NHS and care workers for all that they do and, especially, for all that they did during the pandemic.

Many of my constituents have contacted me because they are struggling to get GP appointments or to register for a place at an NHS dentist locally. I have been supporting many of my constituents to get access to GP services and to get into NHS dentists locally. That is something that we must address. The Government are prioritising £36 billion of additional investment to help to improve our health and social care services, which is very welcome. Primary care must be a key part of that investment and the improvements we need to see. I hope that, particularly with the reforms we are making in the NHS and the development of integrated care systems, we will see far more joined-up local healthcare that focuses on providing the seamless services patients need.

We also need to improve some of the quality issues. In some surgeries in Stoke-on-Trent we see very good quality of care, but the picture is far from uniform. We must also see the CQC taking a greater interest in issues of quality, such as whether someone can actually get an appointment, and not just the issues of safety that it focuses on at the moment.

Bringing decision making to a more local level for primary care will also ensure we can provide more joined-up and coherent health care services in our communities. For far too long, patients have struggled to access the healthcare they need, and both GP and dentist services have buckled under the strain of ever growing demand. Many GPs in Stoke-on-Trent have often raised with me the increasing challenges they face with greater demand for services and the increasing complexity of physical, mental health and wider social issues patients are presenting with. We need to fix the pressures we see in the system to create a healthcare system that shifts the balance far more towards prevention and earlier intervention. Whether it is physical or mental health, the more we can take action sooner, the better the outcome for the patient and the less likely more intensive and costly healthcare will be needed in the future. To achieve that, we must see the NHS collaborating far more with wider healthcare partners, including pharmacies, local charities and others who have much to give in terms of preventive healthcare, especially for mental health. We very much need that support so that those GP and dentist services can improve.

It goes without saying that GP surgeries play an essential role in our communities and in our NHS. They are often the first port of call for anyone in need of medical help, and it is the hard work of GPs that ensures we can all obtain advice, medicine and referral to other services. However, like much of the NHS, GP surgeries are overstretched, under-resourced and understaffed, due to more than a decade of Tory mismanagement.

Frustratingly, my constituents in Coventry North West are suffering the consequences of that. Constituents contact me every week, telling me about the difficulties they face in trying to access their GP. Like so many of the GP surgeries discussed today, surgeries in my constituency are made up of dedicated health and administrative staff who have been stretched often to breaking point and simply do not have the capacity, resources or staff they need to serve their patients.

I will focus on one example—a constituent who reached out to me about their 2-year-old daughter. Their daughter is non-verbal, has recently been having nosebleeds and is exhibiting symptoms of head trauma. Each day, my constituent wakes up and joins a queue to try to access a GP appointment. Even though they are often on the phone for hours, they are still not able to book an appointment. In fact, they have not been able to speak to anybody at all at the surgery. My constituent is understandably concerned for their child’s health and, like many others, is desperate to see their GP.

The difficulties facing our GP services are having a knock-on impact on the rest of the NHS. Patients unable to see their GP are more likely to request an ambulance or visit A&E. In the west midlands, we have seen ambulance waiting times skyrocket to more than 8 hours for some people. Another constituent raised a case where the patient had to wait more than two hours for an ambulance to arrive, even though they were experiencing a heart attack. If the Government do not get to grips with the scale of this problem, the entire NHS will have to pay the price.

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests. The debate is about GPs and dentists, and I will deal first with GPs. I pay tribute to the GPs who work in my constituency, and in particular those at the New Springwells practice and at Caythorpe and Ancaster medical practice, which have outstanding CQC ratings. I also pay tribute to the GPs who delivered the vaccine service. Not only did they work during covid with its challenges, but they delivered a vaccine service as well. They are a very hard-working, admirable group of people.

I agree with the Opposition that much of the overall problem with the NHS is a workforce problem. That is true. There are too many staff overall, and not enough of them are directly delivering or improving clinical care. We have expensive, very highly trained clinical decision makers being asked to do admin tasks that take them away from the clinical tasks that we are paying them for and which we need them to do. That contributes to our longer waiting times. So we need to increase the number of doctors.

The Opposition are making a big point about 12 years, but it takes 10 years to train a GP, and it takes longer than that to train a consultant. So, actually, the shortage was created during Labour’s time in government and we are trying to fix it. That is indeed why the number of medical schools has been increased by five. I am pleased that one of them is in Lincoln, just outside my constituency. It is training a new generation of doctors who will provide services locally—people predominantly stay where they train—which will help the people of Lincolnshire to have more access to doctors. However, the Government should go further. In the year when we had challenges with A-levels caused by covid and more people than expected got the grades required to get into medical school, places were exceptionally increased. There are challenges with that—only so many people can get around a bedside and a patient will be happy to have only so many people listen to their heart or feel a lump or bump or suchlike—but, nevertheless, it has been managed for one year, and I think that it could be managed for more. The best thing that the Government could do for the health service in that regard would be to massively increase the number of doctor places. At the moment, we are turning away keen, enthusiastic potential young doctors doing their A-levels because places are so oversubscribed, but then we find that we have a shortage. That surely cannot be right.

The Conservatives have been running our health and social care system into the ground for years. Covid has made an already bad situation worse, but it was already bad, and my constituents—patients and healthcare professionals—can really feel it. A constituent who is a professional chauffeur needs to provide regular medical assessment certificates to keep his job, but his GP is not doing them right now, so my team have had to work hard to make sure that his employer will not sack him.

Some of my constituents have managed to see their GPs. One has had a referral for chronic back pain, another for a diagnosis of breast cancer that needs treatment, but having had those appointments they then discovered weeks later that the referral letters were never sent. Another constituent who had a contraceptive implant has had some very severe side effects and wants to have it removed, but she cannot get an appointment. A constituent who contacted her GP to say that she was having suicidal thoughts was asked to fill out a form.

I was so concerned about these reports that I have been to visit our GP surgeries in St Albans. From the other end of the spectrum, it is incredibly shocking. The very second the phone lines open in a GP surgery, there are flashing lights on its big screen. At one minute past the time that its phone lines open, there are hundreds and hundreds of calls on the electronic board. Many of those phone calls are from very distressed callers who are in pain and very concerned. Many of the people at the counter—the receptionists at the other end of the phone—are receiving verbal abuse, and we know that GPs are receiving abuse in their surgery rooms behind closed doors as well. The BMJ suggests that violent incidents in GP surgeries have doubled in the last five years.

One of the GP surgeries in my constituency has now employed somebody on a full- time basis to do one job: to chase the local hospitals to send the letters so that the GPs can get the results that their patients need. We have heard Members across the House talk this afternoon about how fantastic it would be if we could use big data and if our constituents could become expert patients and use all the information collected on their phone, but frankly, at the moment, we are starting from a basis where we cannot even get a letter from a hospital to a GP surgery. It feels as though the entire system is creaking at the seams, and that is even before we get to the postcode lottery of the number of patients each GP has, or the length of appointments.

The hon. Lady will know, because she raised this in oral questions, that dentists return that data in quarters. We will have that data from the dental community by the end of June, and we will then be able to answer her questions. She knows that; she is making a political point here.

I am genuinely incredibly grateful for that answer, because when I challenged the Minister on this last week I did not receive that answer. I am grateful to receive that response. I submitted a letter to the Minister—I think it was in April—and attempted to come to some drop-in events that were cancelled, so I am pleased to hear that that data will be provided by the end of June. However, my constituents in St Albans have seen absolutely zero appointments created from that money. Every dental practice has said that because of the way the funds have been set up, it has been impossible for them to apply for them. A number of other Members have raised that point.

The truth is that the Government have failed to recruit the GPs that we need. We have a retirement time bomb among our general practitioners, and we know that dentists are leaving NHS work as well. We need to see a serious plan from the Government so that everybody who needs to see a GP or a dentist can actually see one.

Before I turn to the main substance of my speech, I want to take advantage of the presence of the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is sitting there waiting to sum up the debate, by raising a few points further to my earlier intervention on the Secretary of State. They concern the Medicines and Healthcare products Regulatory Agency and the mandatory logging of mesh complications, which was a recommendation in the Cumberlege review. It has been more than a year since the most recent review, so I think that the Secretary of State may have been a little confused when, in his response, he referred to what was happening a year later. We have just learnt that the MHRA will continue the yellow card system, and will not be introducing mandatory reporting. I am keen to hear the Minister’s response to that point.

As joint chair of the all-party parliamentary group on endometriosis, I am also keen to hear from the Minister when we will see the women’s health strategy. Although that is not specific to the debate, it does relate to GP services. I should also like to hear her response to the anecdotal news I have been hearing that more appointments for gynaecological procedures are being cancelled than appointments for any other operations, and that gynaecological elective procedures are the least likely to take place. Again, it seems that there is a real issue surrounding women’s health.

I hope that the Minister will be able to address those issues of the women’s health strategy, endometriosis and mandatory reporting, but I will now turn to the main substance of my speech on access to GP services. Hull has only 40 GPs per 100,000 patients, which is one of the lowest proportions in the area. I want to draw attention to what two of my constituents have said. One, a gentleman called Rob Grimmer, told me about the birth of his granddaughter Nova. That was wonderful news, but unfortunately the family were unable to contact a GP surgery or get through to 111 when they needed to, and eventually they had to take the baby to A&E for treatment. The good news is that the baby is fine, but I am sure that Members can imagine the trauma involved. I have been a new mum myself, and I know that going to A&E with a new baby must be terrifying and very upsetting. I should like to hear from the Minister why we are seeing so many mums and babies having to go to A&E to obtain support.

According to the Association of Dental Groups, only a third of adults and half of children in England have access to an NHS dentist. As we have heard, the top reason for children being admitted to hospital is tooth extraction. It is 2022, not 1922. Back in 1947, when the NHS and NHS dental services were brought about by the then Labour Government, many of us naively thought that they would be around for ever, that we would always be able to access those services when we needed them. Unfortunately, we now see the return to the poverty-linked ill health that we saw in the 1940s.

As MPs, we hear heartbreaking stories. There was the Salford man with a badly infected tooth who could barely afford to live, let alone pay for private dental treatment. He could not find an NHS dentist who would take him on. He said to me that, had it not been for the fact that he was on anticoagulants, he would have pulled his own teeth out with a pair of pliers. There was the Salford woman with countless abscesses all over her jaw, and no money to go private. She was in acute pain and putting her life at risk from a spreading infection. She had been trying to get on an NHS waiting list for a dentist for over five years. There was also the Salford mother living on the breadline, yet forced to borrow and scrape together the money to go private. She told me that she had to pay £100 just to get on a dentist’s list. There are thousands of stories like this.

Recently, I asked the Government what data they held on the number of people trying to access an NHS dentist in Salford, such as the stories I had heard from my constituents. The Government confirmed that they held no data for my constituency or even across Greater Manchester. Frankly, that is staggering.

So what is at the heart of the decline of NHS dentistry? The British Dental Association details that chronic underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services.

For many people living in Bradford, being unable to get an appointment with their GP for days or weeks, or being unable to see an NHS dentist at all, is one of the most depressing issues they face—if not the most depressing. Although such a scandal in our healthcare system is of course unacceptable anywhere, the harm that it is causing in Bradford, where we face especially stark health inequalities and where people are dying a decade earlier and facing a higher rate of preventable diseases, is particularly damaging.

It seems that the Government either do not understand or just do not care. Earlier, the Secretary of State opened for the Government. According to him, we have had record levels of investment, the Government are now planning many initiatives, and any concerns were entirely a result of the two years of covid. Of course, everybody in this Chamber would accept that the NHS, GPs, dentists and all the health services faced pressures during covid. I do not think anyone is denying that. The Secretary of State said to the shadow Minister, “You supported us during that period”. Of course we did. We were a responsible Opposition and of course we ensured that any pressures during a very difficult period could be alleviated. But to say that the issues have suddenly resulted from that period is simply untrue, and Ministers know that it is untrue.

The second assertion—those who were in the Chamber will recall that I pressed the Secretary of State about his record investment in the NHS—was that of course there was record investment, but let us look at that investment. Let me go to my district, to Bradford, and see the record investment that Ministers and the Secretary of State want to boast about. Frankly, they live in some parallel universe, because we do not see the effect that they come here and tell us about. In Bradford, one of the most deprived districts—more than 50% of the deprivation in my constituency is in all the top 10 deprivation indices—child poverty is now at a record high because of those on the Government Benches. Nearly 50% of children in my constituency today live in poverty because of the draconian, ideological cuts made by this Government over the past decade. I have said this in the Chamber many times: people who live in the inner cities are likely to live 10 years less than if they live in the leafy suburbs, which are far more affluent and, frankly, get more investment.

When the Minister comes to her feet, I am sure she will say that X number of people have been able to access a GP, but have they been able to access their own GP? We have heard time and time again from health professionals how important continuity of care is. Does my hon. Friend agree that this is not just about seeing any old GP—it is about someone seeing their own GP?

I absolutely agree with my hon. Friend, who makes the point that I was coming on to raise. Her Luton constituency is not dissimilar to mine. With a single GP having 2,800 patients, it is obvious why those patients are not getting to see their GP. I could spend a long time in this Chamber going through constituency cases that I have recently dealt with. Indeed, I have done that in the past and those cases are on the record. Let me cite just one case today. An elderly lady in her 90s had to go to hospital and was then told to go to see her GP. Her son tried day after day to make a simple GP appointment for her. She had multiple health needs. My office had to intervene and even we were unable to secure a GP appointment for her. People are having to go through this ping-pong of not getting a GP appointment and then going to A&E as they have nowhere else to turn.

I am grateful because I did ask the Health Secretary about Bradford and urgent treatment centres, and he did favourably say that he would arrange a meeting with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who joins us now, at precisely the right time. I look forward to that meeting because that is a way through and I am grateful for that offer. But the reality remains that the Government’s promise—or the points the Secretary of State made earlier today—is not apparent on the streets. People continue to suffer, they cannot get GP appointments and they have nowhere else to turn. That point has been made eloquently by a number of Members.

At least, after days and weeks of trying, people are able to get an appointment with a GP. Many Members have talking about issues with joining an NHS dentist. There is more chance of finding gold bricks on the street, or of finding the parallel universe that Government Ministers live in, than there is of getting on to the list of an NHS dentist. People simply cannot get NHS dentists, and we have heard accounts today of how they are being forced to carry out DIY operations at home, without anaesthetic or any medical care—I have come across such cases in my own constituency—because they have no other option. Frankly, as the fifth largest and richest economy in the world, it is shameful that people are having to resort to DIY treatment at home. Again, that is happening on this Government’s watch.

I would be interested to hear the hon. Gentleman’s opinion on the position in Wales, which was set out in the Secretary of State’s opening remarks. Wales faces exactly the same pressures, and its waiting times are actually worse than England’s. What is the hon. Gentleman’s reason for why the Welsh Labour Government are in exactly the same position as this Government?

Again, the first defence is “Labour 12 years ago”; the second defence is “Labour in Wales”. The point about Labour in Wales has already been appropriately addressed, but the Minister’s job is to address those issues in England. Rather than address those issues, she thinks that saying “What about Labour in Wales?” somehow provides a cover, an umbrella, and a defence against the incompetence that exist across our health sector. That does not wash with the British public, because they have not been asleep for the past 12 years. They have noted the devastation that the Tory Government have caused in our communities, and the back-door privatisation and ideological agenda they have brought to our health service. I have said it before, and I will say it again: people will repay them with interest at the ballot box.

It is a great honour to follow my hon. Friend the Member for Bradford East (Imran Hussain). I have received a steady stream of complaints from my constituents in Bedford and Kempston about excessive GP and dental waiting times. They are angry, frustrated and bewildered that the system is failing them, but there is also a sense of fear that the NHS they knew and loved is no longer there for them.

For over a decade, Opposition MPs have warned about the impact of underfunding the NHS and of the harmful top-down reforms; and about what would happen if the Government failed to take seriously the recruitment, retention and training problems for GPs and dentists. We expect an announcement on dental contract reform before the summer recess, but we need more than short-term quick wins to reform that fundamentally flawed contract. For patients across the country to see any real difference in the level of access to NHS dentistry, we need genuine, meaningful contract reform, yet formal negotiations on such reform have yet to begin.

Over recent months, I have met GPs across Bedfordshire, who have all made it clear to me that there is a crisis in general practice. In Bedford, there is only one GP per 2,500 people, which makes it one of the places worst hit by GP shortages in the whole country. Those shortages are leading to staff burnout and poor retention, and unfortunately are hitting patients in need of care hardest. Surgeries are being assimilated into trusts to try to rectify those issues, but as GPs take on more acute care from hospitals that face their own backlogs, surgeries are seeing increased demands from patients.

Worryingly, we are also seeing escalating levels of verbal and physical abuse directed at GPs, dentists and surgery staff. Much of the current narrative, which is actively encouraged by those on the Tory Front Bench, is that GPs are hiding behind remote appointments and are working part time. That is not true; the truth is very different. GPs who are considered part time often find themselves in their surgeries covering full-time hours due to the growth in administrative work.

People are struggling to get GP and dentist appointments, and this is a crisis of the Government’s own making. In their 2019 manifesto, the Conservatives promised 6,000 more GPs in England by 2025 but, in his evidence to the Health and Social Care Committee last November, the Secretary of State said when asked about this target:

“I am not going to pretend that we are on track when clearly we are not.”

Dr Richard Vautrey, chair of the BMA’s GP committee, said at the time:

“The bottom line is we are haemorrhaging doctors in general practice. While more younger doctors may be choosing to enter general practice, even more experienced GPs are leaving the profession or reducing their hours to manage unsustainable workloads.”

Recent statistics show there are now fewer than 6,500 GP practices in England, compared with more than 8,000 in April 2013. As of April 2022, there were the equivalent of 1,622 fewer fully qualified, full-time GPs in England than in 2015. All this has happened on the Conservatives’ watch.

The lack of access to GPs has implications for patient safety. We know early diagnosis is important, but it cannot happen if people cannot see a doctor. People who cannot get an appointment, or who face long waits to get one, are at risk of not getting the referral they need, which can lead to health problems down the line. Those who are able to get an appointment but are seen by a GP who is suffering stress and burnout due to the pressures of the job are also put at increased risk.

A poll of nearly 1,400 GPs by Rebuild General Practice in March found that 86% of those surveyed say they do not have enough time with patients, and it found that GPs are seeing, on average, 46 patients a day. This is a matter of great concern, as the safe maximum number of daily appointments, as recommended by the BMA, is 25. Doctors are seeing nearly twice the safe maximum number, which is bad for patients and unfair on very hard-working GPs.

People in Wirral West tell me they have ended up going to A&E because they cannot get an appointment with their GP, which puts more pressure on an already stretched A&E. A recent study by the Royal College of Emergency Medicine showed that, in 2021, an average of 1,047 people a day were waiting more than 12 hours in A&E from their time of arrival, which is wholly unacceptable. People need to be able to access GP services when they need them, both for their own health and to keep the pressure off A&E.

In the time that I have this afternoon, I will focus on the incredible difficulties my constituents have had in accessing NHS dentistry. As others have said, the pandemic has intensified problems in our dental healthcare system, but the architecture for those problems was in place long before the pandemic. We have heard from the British Dental Association that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.

Helen Hunter, chief executive of Healthwatch Calderdale, which serves my constituency, has argued that the pandemic has made

“a significant problem even worse”.

At a national level, dentistry is now the No. 1 issue raised with Healthwatch. Almost 80% of people who get in contact with the organisation say that they find it difficult to access dental care, with the General Dental Council saying that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months.

Healthwatch Calderdale has been relentless in its campaigning on this issue. In August last year, it contacted every dental practice across Calderdale to establish whether it was willing to accept new NHS patients, whether it would register a child and whether it was offering routine appointments. Every dental practice told Healthwatch that it could not currently register a new NHS patient of any age. When neighbouring Healthwatch Kirklees did the same, it had the same outcome.

As others have said, having people get in touch with us, as MPs, because they cannot find a dentist is one of the most difficult issues that we are asked to contend with from a local casework perspective. As things stand, there is simply nothing we can do to help people. We speak to the CCG, we call the dentists, we speak to NHS England and we write to Ministers, but the capacity is not there because the system is so broken, and no amount of pleading from local MPs can fix it for someone in need.

There are many issues that my constituents are experiencing when trying to access GP services, but I will focus my remarks on the crisis affecting dentistry across England and the impact that is having on people in Durham. I want to start by paying tribute to the dentists, dental nurses and other key workers in practices in County Durham and across the country.

Sadly, despite the brilliant work of dental workers, NHS dentistry is on the brink of collapse. Whether in Bowburn, Brandon or Pity Me, my constituents are struggling to access the dental services they need and deserve. Four in five people who contact Healthwatch say they have found it tough to access timely dental care, while tooth decay, as we have already heard, is currently the most common reason for hospital admissions among young children. In County Durham, 245 children under the age of 10 were admitted to hospital for tooth extraction between 2020 and 2021. Thousands of children are currently in pain, distracted as they learn, in pain as they eat and struggling to sleep because they cannot access vital treatment. Let that sink in.

Why is it so difficult to access NHS dental appointments? Because dentists are being driven away from NHS dental services en masse. A recent poll of dentists in England found that 45% had reduced their NHS commitment since the start of the pandemic, while 75% were likely to reduce their NHS commitment in the next 12 months. Alongside that, an alarming 87% of dentists say they have experienced symptoms of stress, burnout or other mental health problems in the past year. In total, 3,000 dentists have moved away from NHS work completely since the start of the pandemic.

As the British Dental Association has said,

“This is how NHS dentistry will die”.

The warning is not sensationalist; it is the reality that dentists and their patients in Durham are facing. This crisis is entirely avoidable. It is certainly not the fault of our rail workers striking today, as the Secretary of State would like us to believe—utterly disgraceful. What planet is he on when he talks about record funding? That is certainly not the case for NHS dentistry, which has faced cuts unparalleled to the rest of NHS services. In real terms, the Government’s net spend on general dental practice in England was slashed by over a quarter between 2010 and 2020, while the Government’s £50 million injection into dentistry will fund less than 1% of the appointments we have lost since March. In fact, the British Dental Association estimates that it would take £880 million a year to restore dental budgets back to the level when Labour left office.

I thank Members from across the House for their contributions this afternoon. I want to praise some of the powerful contributions we have heard during the debate.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) raised the absolutely ridiculously long waiting lists for NHS dentists in his constituency. It is worrying to hear that pregnant constituents cannot even register with a GP, let alone see one. Shockingly, he mentioned the children in his constituency, one of whom has had to wait 35 months to see an orthodontist. He rightly pointed out the issues with the dentist contract, which is disincentivising dentists to take on NHS patients, and reminded us of the last Labour Government’s commitment to reforming it.

We heard from the hon. Member for Waveney (Peter Aldous), who set out the NHS dentistry crisis in his constituency. He rightly set out that many dentists are simply not drawing down on the £50 million Government funding that the Minister says is being used. He set out, in comments I really welcome, the issue of our crumbling primary care assets. I thank him for raising the issue of the NHS app and I could not agree with him more. When are the Government going to move the app into the 21st century? Finally, he mentioned that patient choice is really important. I welcome those comments.

We then heard from my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), who mentioned the huge number of constituents who are frustrated with their current lack of access to primary care. She mentioned her constituent Dr Mark Spencer, who set up Healthier Fleetwood to tackle health inequalities. I, too, send my thanks to him. She also mentioned that demand is not being met in primary care, and she rightly mentioned the Government’s financial illiteracy, with patients being forced to go to A&E instead of having their demand met in primary care.

On dentistry, my hon. Friend set out how children in her constituency cannot access NHS dentists and the shocking experience of constituents who are resorting to DIY dentistry, as was raised by many hon. Members. She rightly set out that the Government are getting it very wrong. She also set out the Government’s shocking record on GP recruitment and the exodus of NHS dentists. Most shockingly, she mentioned the number of children aged zero to 10 years old who are admitted to hospital for tooth extractions in her constituency in just one year: 30 in Lancaster and 40 in Wyre, of whom 30 were aged five or younger. If that is not a wake-up call for the Minister, I do not know what is.

It is a pleasure to close this debate after a wide range of speeches. First, I will put my hands up and acknowledge that there are challenges and difficulties in primary care and dentistry. We heard that from Members from Scotland, Northern Ireland and Wales, which shows that all the devolved areas of healthcare are facing exactly the same challenges.

I start by thanking all those in primary care and dentistry for going above and beyond, and not just during the covid pandemic but as we are coming out of it, whether that was dentists providing urgent treatment under difficult infection control measures, or GPs delivering millions of vaccinations while continuing to see patients. We are now seeing not only the routine number of patients we would usually see, but the two years’ worth of patients who stayed at home and protected the NHS, as we asked them to do.

Despite the Opposition’s protests, we are making progress and record numbers of patients are being seen—higher than ever before. We are seeing 1.3 million patients per working day in primary care. That is a 44% increase since last year, and 63% of those are seen face to face. As my hon. Friend the Member for Wantage (David Johnston) said, that is 2 million more face-to-face appointments than this time last year.

There are record numbers of GPs, despite what Opposition Members have said—nearly 36,000 full-time equivalents, which is 1,400 more than in March 2019. We are going further, with 4,000 more trainees taking up GP training this year, providing more GPs for the future. We have delivered 30 million extra GP appointments, as part of our manifesto commitment to deliver 50 million more GP appointments. As an indication of the scale of the record numbers of patients coming through the system, we are seeing 11,000 cancer referrals a day, which is a record high.

How are we supporting GPs? We had the £250 million winter access fund, which helped deliver a cloud-based telephony system that some practices took up, which is transforming how patients can get through to their practices. If practices did not take up that offer, NHS England is rolling out the system across the country, so I urge them to look into it because it delivers better capacity, allowing patients to get through to make their appointments. It bought extra hours to pay for staff to do more shifts and see more patients, and it paid for more physical space in practices.

Will the Minister give way?

No, I will not.

We are also delivering zero tolerance to abuse through the Police, Crime, Sentencing and Courts Act 2022. Labour talk the talk, but it was those of us on the Government Benches who voted to double the maximum sentence for those who abuse our emergency care workers. Labour actually voted against giving the Bill a Third Reading. That tells us all we need to know.

With the time I have left—

Will the Minister give way?

I will not give way. Members did not—

Give way!

Order. If the Minister is not giving way, she is not giving way.

Frit!

I am not frit, but I am conscious that another debate follows this one. I did not want to play politics, but if Opposition Members want to, I will give them politics.

The Labour party is against everything and for nothing. We have not had one suggestion from Labour or the Lib Dems. They are full of complaints without a single solution. We know that the shadow Secretary of State was busy over the weekend deleting his past misdemeanours, but he cannot delete Labour’s misdemeanours with the NHS. As Davina McCall would say, let’s have a look at their best bits. There are the PFI contracts that they mysteriously introduced—£1.4 billion a year is still going to private investors because of the deals made under a Labour Government. Full Fact confirmed that £57 billion will be spent in total on those PFI deals.

Moving on to the 2004 GP contract negotiations, evening and weekend cover was taken away, handed to primary care trusts and given to private companies. Changes to the law in 2007, voted for by Labour Members, allowed bigger businesses to buy up GP practices, resulting in the evidence we saw on “Panorama” last week. The top hit is the 2006 Labour dental contract—

Oh, here we go.

The hon. Gentleman may say, “Here we go,” but Opposition Members acknowledged this afternoon that the Labour contract was causing the problems. We are getting on with dealing with that.

My hon. Friend the Member for Waveney (Peter Aldous) asked what progress is being made. We put the negotiations to the BDA on 24 March and made a final offer—[Interruption.] They don’t want to listen, Madam Deputy Speaker; they don’t care. We put the final offer to the BDA on 20 May, and we are waiting to hear back. We are reforming the dental contract, which perversely disincentivises dentists to take on NHS work.

To correct the hon. Member for Portsmouth South (Stephen Morgan), he did not host that dental summit; it was my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who invited me. The summit came up with a solution, and I am meeting her team so that we can work on that and take it forward.

In addition to the dental contract, we are reforming how we take on dentists from overseas. We consulted the GDC, which recently ran a consultation, and we will be laying legislation to give it powers to allow dentists to come here more easily—[Interruption.]

Order. I can hear what Members are saying, and it is just not right. It is simply rude when we are supposed to be listening to the Minister.

And I think she could do better.

Order. You are not saying anything while you are sitting down—nothing! I call the Minister.

Thank you, Madam Deputy Speaker. Labour Members do not want to hear about the work that the Government have been doing. They are just too busy criticising.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) also mentioned the work that we are doing on centres for dental development. We are already working in places such as Cornwall to start training more dentists in those areas. In Norfolk and Norwich, we have met representatives from the university. The meeting was led by local MPs who brought people together to set up centres. We have also been working in Lincolnshire as well.

We are empowering the dental workforce by changing and upskilling dental technicians, dental nurses, and dental assistants to be able to take on more work. We are also tackling the issue of clawback.

You would think, Madam Deputy Speaker, that this is just an issue in England. If we look at Labour-run Wales, we find that the Community Health Councils have acknowledged that Wales is also facing a crisis of access to GPs, and that patients are waiting more than an hour to get through on the phone only to find that there are no appointments left.

The number of dental practices in Wales has fallen—from 1,500 in 2019 to 1,389 last year. In the past year alone in Wales, there was a 71% drop in courses of dental treatment. Why is that happening under a Labour Government? [Interruption.] I have given the answer. Opposition Members are too busy talking, Madam Deputy Speaker. They do not want to hear the answers.

Opposition parties need to be honest with the public. Whether we are talking about Scotland, Wales or Northern Ireland, we are all facing the same challenges. [Interruption.] No! There is a Labour-run Government in Wales and an SNP Government in Scotland. [Interruption.] The Opposition continue to play politics, but we are getting on with the business of reforming and making those changes. They have no solutions, no answers and no ideas. It is this Government who are delivering the changes. We are being honest with the British public that we will face challenges, but we are making the changes to improve access to both dental and primary care services.