To ask His Majesty’s Government what assessment they have made of the effectiveness of the National Health Service (General Medical Services Contracts) Regulations 2015, as amended by the National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2025.
My Lords, implementation of the 2025-26 GP contract changes is still under way. GP practices have recently been issued contract variations, but the changes have not yet taken full effect. The changes, agreed with the British Medical Association for the first time in four years, will improve access for patients and enable local health systems to hire more staff. The Government will closely monitor the impact once the changes are fully implemented in the coming weeks.
My Lords, my concern is about the degree to which GP contracts are dictated by extremely prescriptive legislation. The recent change to keep GPs’ computers switched on overnight—rightly, to improve data sharing—is a striking example. It did not require just negotiation with GPs or advice from security and privacy experts, as it of course should: it also required Parliament to legislate to change the contract details. Does the Minister not agree that embedding this level of micromanagement in legislation not only is unhelpful but actively stifles innovation in the NHS?
That is an interesting assessment of where we are; it is not one that I was about to speak of, but I hear what the noble Lord says. Let me say that, in implementing contract changes, it is absolutely usual—and, in my opinion, correct—that regulations are important and are consulted on. There is a whole list of things here around transparency. There was consultation with the BMA’s General Practitioners Committee, as well as the laying of the regulations and bringing them into force. This is all quite the usual practice—and actually, I think, good practice. I appreciate that GPs are very much the front door to our NHS and it is absolutely important that we make these changes in order to assist them and their patients.
My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. What assessment have the Government, in particular the Minister, made of the way in which the GP contract will impact on rural doctors—not least the Dispensing Doctors’ Association, which cannot even access the EPS system at the moment, which is obviously disadvantaging its patients?
The expectation is that all GPs, including those in rural areas, will benefit greatly. The premise of the 10-year plan, which was announced recently, is to improve patient access. That is a particular issue in rural areas and is absolutely key, no matter where you are—whether you are appearing in person, are seeking to get online access to your GP or are on the phone. Remember, this is all about, for example, ending the 8 am scramble. Noble Lords have been very critical and I share in their criticism. I think that, particularly in rural areas, where people face various challenges in getting around, these changes will improve things massively for both GPs and patients.
My Lords, my noble friend has described these changes in terms of the benefits for patients. How will the Government know whether they are of benefit to patients, given the decision to wind up HealthWatch, which itself was less than adequate in terms of patient representation compared with Community Health Councils, an organisation I knew well many years ago? Surely, that is a negative step and there should be a mechanism for local consultation and local engagement with patients through an independent body.
I appreciate what my noble friend says about HealthWatch, which has done a sterling job over the years. However, in assessing where we are in ensuring that we have the right framework in place, including on patient safety—Dr Penny Dash recently published her report saying that the landscape was “cluttered” and it was difficult to hear the patient voice—it is right that we make the changes that we do to improve things. The reform to the GP contract very much assists general practice to be at the heart of a neighbourhood health service, and that is where we are going.
In terms of development, as my noble friend will know, the 10-year health plan speaks very clearly of a “neighbourhood health service”, which people will find it easier to access. It will be up to local areas how they do that. In a number of areas, as my noble friend refers to, that will mean clinics where all services are under one roof. We would certainly encourage that. I can also give an example of a pilot scheme taking place now with mental health crisis centres. They are 24/7, all year round, and are available without referral for people who need mental health support, as well as advice and guidance: they can access those.
My Lords, as the Minister will know, the 2025 amendments to the regulations made several key changes, one of which was to keep online consultation talks open during surgery hours. While these Benches welcome the shift from analogue to digital, we understand that the National Pensioners Convention estimates that between 500,000 and 700,000 older people would not be able to access either the online consultation tool or patient records, either because they are not online or because they struggle to navigate apps and websites. Can the Minister update the House about what her department is doing to work with GPs and, in fact, the whole system of health and care, to make sure that that small minority of people who are not digitally literate, including older people, are not locked out of receiving health and social care?
The noble Lord makes an important point. There is absolutely no intention that people will be disadvantaged in any way. This is about equalising access, which means keeping all forms of access open. That may be online, but it will also be possible to deal with things in person and on the phone. Obviously, if we can take pressure off phone access, or personal access, through the use of online, that will assist the group to which the noble Lord referred.