GP Contract

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

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

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

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

I call the shadow Minister.

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

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

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

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

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

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

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

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

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

I call the Liberal Democrat spokesperson.

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

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

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

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

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

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

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

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

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

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

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

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

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