GP Funding: South-west England

I beg to move,

That this House has considered GP funding in the South West.

It is a pleasure to serve under your chairship, Dame Siobhain. GPs are the front door of the NHS. They diagnose and treat illness, prevent disease and provide vital mental health support. As Lord Darzi once observed, general practice displays “the best financial discipline” in the NHS family while constantly innovating to keep patients out of hospital. However, GP funding is complex, obscure and insufficient. The bottom line is that the amount of money GPs receive is insufficient to deliver the obligations they carry. That is a view held by every single one of the 28 practice managers I met in and around my district, who tell me the situation is unfunded, unsustainable and unsafe.

GP funding is broadly based on two elements: a so-called global sum for core service costs, and additional quality and outcomes framework payments. The global sum starts with a payment per patient per year of £121.79—that is less than we might pay for our dog to go to the vet for an annual check-up, or about a third of the cost of servicing a Renault Megane. It is no wonder that practice managers spend their evenings juggling spreadsheets simply to keep the lights on.

It gets worse. That paltry sum is then modified by something known as the Carr-Hill formula. Carr-Hill was designed for a different era. It weighs patient numbers and postcodes but underrates deprivation, multimorbidity and today’s population health priorities. The consequences are stark and deliver what is known as the inverse care law. In my constituency, the Buckland surgery looks after some 4,000 patients on its list but is effectively funded for 3,200.

The hon. Member talks about the number of patients that GP practices have on their books. We have an ambitious plan for building more houses. Does he agree that we need to consider not just existing GP practices but funding the infrastructure for future practices, so that we have adequate services for people? There are places in Swindon that will be expected to take on thousands more patients, and the infrastructure is simply not there right now.

The hon. Member is absolutely right: we have to consider these things. I have spent many hours persuading my local hospital trusts and the integrated care board to talk to the local authorities and work in the cycles of the local plan, so that they get their requirements into that plan. All too often they say, “A new housing development has just been built. We need a new GP practice with it,” and that is too late. The cycles do not add up. The system is broken, and we need to change that.

The Buckland surgery is underfunded by some 800 patients every year. It is part of the Templer primary care network, in which 2,500 patients are effectively treated for nothing. This means that the Buckland practice faces an annual shortfall of approximately £84,000—money that would cover another GP. If we then look at the changing number of patients per GP, in 2019 each GP was supporting 1,800 patients, compared with around 2,400 today.

My constituents tell me of their difficulty in getting an appointment with their GP. Does the hon. Member share my view that GP practices should get a bigger share of NHS funding, which would enable them to improve the health of our constituents? And does he share my concern that much of the extra money allocated by the Government risks being swallowed by increased national insurance contributions, inflation and pay awards?

Practice managers tell me that that has already happened and they are less funded now than they were last year.

On the changing numbers, each GP was supporting 1,800 patients in 2019 and is supporting 2,400 today, but safe care is often estimated to be closer to 1,400 per GP. So we are overloading GPs with patients. Practices make heroic use of pharmacists, physios and nurse practitioners, but the arithmetic does not add up. Meanwhile, the other part of their funding, the quality and outcomes framework scheme, has faced changes that have negatively impacted primary care. This meant that, nationally, £298 million was redistributed from the QOF into the global sum—we can see how bizarre this funding set-up gets; the names are just weird—and into cardiovascular disease prevention funding. Another £100 million of funding was repurposed but does not put extra capacity into the system. Rather than providing new money to support GPs, this felt to practice managers that the Government had been rearranging the deckchairs.

I congratulate the hon. Gentleman on securing this debate. He is right to address this issue—I spoke to him just before his introduction. We have great difficulty across all this United Kingdom of Great Britain and Northern Ireland when it comes to securing GPs for practices. In recent years, I have been trying to ensure, with the health service, that action can be taken regarding the student loans of young medical students, if they give a commitment to remain in a GP practice for a set period of, say, five years. That would enable more GPs to stay in the system. Does he feel that that is something the Minister and the Government should take on board?

All those things help, along with things like bringing back nurses’ bursaries. On rearranging the deckchairs, it is no wonder that practice managers described this year’s settlement as unfunded, unsustainable and unsafe.

Does the hon. Member agree that the increase of over 7% in GP contract funding for 2025-26, which the Government put in place, represents the biggest investment in GPs for more than 10 years? We always want to get more money for GPs and the Government are committed to that, but does he think that the largest increase in 10 years should make at least some difference for his constituents in Newton Abbot as well as mine in Mansfield?

I thank the hon. Gentleman for that intervention, but sadly, I must disagree. That is not what practice managers are telling me. Their costs have gone up so much that all of the increase has been swallowed up, and they are not sure they can keep the lights on. They are really struggling. I have partners in GP practices who are paying themselves less than the minimum wage, which is not sustainable.

Patient demand has also increased post pandemic, and continued cuts have seen the removal of many services and social care that have supported what GPs do. On top of the cuts to Sure Start and a 40% drop in health visitors since 2015, carers already stretched thin face the prospect of losing personal independence payment support, which will inevitably rebound on general practice—the first line of defence. That is not to mention long covid and pandemic backlogs. All of those drive more people to want to see their GP. The cost of living crisis is compounding multimorbidity, where the most vulnerable in society with chronic illnesses are further pressured.

And then, we get the new requirement to run the appointment schedule from 8 am to 6 pm, filling every single slot. From October, practices must hold digital front doors, open all day, for non-urgent requests. With 100% booked appointments, there is no spare capacity for the person who falls in the care home or for the child who needs attention after school. Partners in the Albany surgery in Newton Abbot warn me that an unlimited invitation will flood a service that simply cannot be limitless. This is unsafe—unfunded, unsustainable and unsafe.

Talented doctors are leaving. The partnership model, still the cheapest and most community-rooted option, is no longer attractive when partners shoulder unlimited liability for premises, pensions and payroll, yet cannot guarantee safe staffing levels. The Royal College of GPs reports a 25% fall in GP partners over the past decade. The chair, Professor Kamila Hawthorne, put it bluntly:

I thank my hon. Friend for securing the debate. Patients in Lynton, one of the remotest communities in North Devon, will soon have access to a GP, but that only happened because of a spirited campaign by local patients. Does he agree that if we are relying on an active community to highlight gaps in provision, it will always be the marginalised communities who find it hard to see a GP?

My hon. Friend is absolutely right. I commend him on obtaining a ministerial visit to his hospital in North Devon. North Devon district hospital is fantastic and we need to ensure that it gets the investment it needs—just so long as we can get some south Devon patients there as well.

In Teignmouth, the previous four practices have merged into one, mostly due to not being able to find new partners. In Newton Abbot, one practice was on the verge of handing back its patient list due to not being able to replace retiring partners. We have not even talked about specific issues facing some of these surgeries, such as the unbreakable lease on a building that is not fit for use as a GP surgery, where the only possible course of action they could see was to declare themselves bankrupt. As doctors, that ends their careers.

And yet, these practices are doing amazing things. The Kingsteignton medical practice, partnering with the charity Kingscare, has created a model that is delivering for patients. Just think what could be done with a better funding model. Buckland surgery would like to link with the local school to tackle adverse childhood experiences before they turn into permanent ill health, providing better family support—much as it has already done with its links to a number of local support services through the Buckland hub.

Prior to the election, the now Health Secretary often quoted that a GP visit cost £40, whereas an A&E visit cost £400. I am not sure I agree with the absolute numbers, but the principle is fine: it is 10 times more expensive to put somebody through A&E than it is to put them through a GP. If we talk to Devon integrated care board on GP resilience and prevention, the evidence is crystal clear: prevention saves money. And yet, as Torbay and South Devon NHS foundation trust remains in NHS operational framework 4—we might perhaps equate it to “unsatisfactory” if it was a school—because of historical deficits, it is tasked with huge efficiency savings and is understandably risk-averse. Community services that once propped up primary and secondary care—the stroke recovery group, Devon Carers hospital service, the Torbay and Devon dementia adviser service—have vanished as funding evaporates. Closing gaps in prevention only widens cracks elsewhere. It is not getting better.

Order. I remind Members to bob if they wish to be called. I ask for some self-restraint, with speeches restricted to six or seven minutes, so that we can get everybody in.

It is a pleasure to serve under your chairmanship, Dame Siobhain. I thank the hon. Member for Newton Abbot (Martin Wrigley) for securing this important debate and for his contribution on this matter of long-overdue concern.

Cornwall faces some of the most severe health inequalities in the country. In January, more patients waited more than 30 minutes in ambulances outside hospital in Cornwall than anywhere else. That is not just a statistic; it is a clear sign that our health system is under serious pressure locally.

We know the reasons: our higher levels of deprivation, an older population, poor transport links that make it harder to recruit and retain the NHS and social care staff we urgently need, and the enormous impact of our visitor economy, which is finally going to be taken into account in local government funding, thanks to the fair funding review. Those deep-rooted structural challenges mean that many people across Cornwall struggle to access timely care.

For that reason, I welcome the forthcoming announcement by the Secretary of State for Health and Social Care that the Labour Government will top up the system with £2.2 billion to improve general practice in the poorest areas with the highest health need. That is the right decision and the right priority for communities like mine in St Austell, Newquay and the clay country. The impact is already being felt. In mid-Cornwall, Newquay health centre and Brannel surgery are already set to receive vital upgrades. That is part of the biggest investment in GP facilities for five years, even before today’s announcement.

Last month, the Government announced the primary care utilisation and modernisation fund, which will deliver more than £100 million for upgrades to more than 1,000 GP surgeries. A number of GP surgeries in my constituency will benefit, including the Sherwood Medical Partnership surgery in Forest Town, Mansfield. Does my hon. Friend agree that that funding will make a huge difference? It will enable practices to boost productivity by seeing more patients and will improve patient care overall.

Yes, I agree. I am greatly relieved for my hon. Friend and his constituents that vital funding is already coming through and that the urgency has been recognised. In Newquay, for example, people have not even been able to sign up with a new GP. That is shocking, given that it is now Cornwall’s biggest town and one of the fastest growing. The assertion should not be levelled that we are not doing enough to invest in infrastructure and services alongside house building, because we are coming forward with the needed investment.

Nationally, we are looking at 8.3 million more GP appointments a year, but it is not just about the numbers. It is about restoring trust in the NHS—trust that the infrastructure and services that we need will come together with growth, which will make care local, accessible and timely. We are fixing the front door of the NHS in our GP surgeries and, thanks to our Health Secretary’s leadership, we are fixing the corridors, the consultation rooms and the care that happens before patients reach A&E, as the hon. Member for Newton Abbot mentioned. That should be the goal.

Cornwall must not be overlooked. We must be prioritised in the 10-year plan for health. How will the Government ensure that rural and coastal communities such as those in Cornwall are prioritised for once and receive their fair share of new investment, particularly considering our peninsula penalty—just as we are now starting to see happening through local government? Will the Minister commit to delivering not just more appointments, but a long-term workforce plan that reflects the needs of our ageing population and the barriers to staff recruitment in rural areas? Cornwall’s health inequalities have been ignored for too long, but with this new Labour Government we finally have a partner in Westminster that is listening and acting.

I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing this important debate on GP funding in the south-west, and for his passionate speech.

I want to shine a spotlight on a village in my constituency called Sherston, where the future of the local GP surgery hangs in the balance. I realise that Sherston may not be the centre of everybody’s universe, as it is of mine, but in many ways it is a microcosm of the wider issues facing NHS-funded GPs in the rural parts of the south-west. For years, residents of Sherston and the surrounding villages have lived with growing uncertainty as to whether they will continue to have access to primary care close to home.

Here is the situation: the lease on the current building for Tolsey surgery expires in 2027 and, for a range of reasons, it cannot be renewed. A local housing developer stepped in and offered to build a brand new surgery at no cost to the NHS, in exchange for a modest increase in the number of homes in a proposed development. Understandably, the community overwhelmingly backed the plan. The only missing piece is a commitment from the integrated care board to fund the running of the surgery.

The issue has been running and running. It is not just the local residents who have been calling for action; the parish council, our county councillor and I have all repeatedly urged the ICB to commit to supporting this facility—not just the bricks and mortar, but the long-term operation of a much-needed service. After months of dialogue, however, no clear answer has been given.

The ICB relies on a toolkit to decide how to allocate resources. Early in our discussions, it acknowledged that the toolkit was designed with urban settings in mind and is not well suited to rural areas, yet the ICB has continued to defer to the toolkit, as if it is unable or unwilling to apply common sense to a rural context. It argues that there is spare capacity at the Malmesbury primary care centre, but anybody familiar with these places knows that that is simply not the case. Staff are stretched, appointment slots are limited, car parking slots are even more limited and patients are already struggling to get seen. Understandably, the people of Sherston are at their wits’ end. This is not just about one surgery; it is about a broader failure to meet the healthcare needs of rural communities.