The Secretary of State for Health and Social Care (Steve Barclay)
With permission, I would like to make a statement on the primary
care recovery plan. For most of us, general practice is our front
door to the NHS. In the last six months, over half the UK
population has used GP services, and GPs in England carry out
around 1 million appointments every single day. They are doing more
than ever. General practice is delivering 10% more appointments a
month than before the...Request free
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The Secretary of State for Health and Social Care ()
With permission, I would like to make a statement on the primary
care recovery plan. For most of us, general practice is our front
door to the NHS. In the last six months, over half the UK
population has used GP services, and GPs in England carry out
around 1 million appointments every single day. They are doing
more than ever. General practice is delivering 10% more
appointments a month than before the pandemic—the equivalent of
the average GP surgery seeing about 20 additional patients every
working day. There are more staff than ever, with numbers up by a
quarter since 2019, and we are on track to deliver our manifesto
target, with an additional 25,000 staff already recruited into
primary care. We are investing more than ever, too, with the most
recent figures showing that funding was around a fifth higher
than five years before, even once inflation is taken into
account.
But we know that there is a great deal still to do. Covid-19
presented many challenges across the health service, leaving us
with large numbers of people on NHS waiting lists, which need to
be tackled. In general practice, patient contacts with GPs have
increased between 20% and 40% since before the pandemic. As well
as recovering from the pandemic, we face longer-term challenges,
too. Since 2010, the number of people in England aged 70 and
above has increased by a third, and this group attends five times
more GP appointments than young people. Not only that, but
advances in technology and treatments mean that people
understandably expect more from primary care systems.
Today I can announce our primary care recovery plan, and I pay
tribute to the Under-Secretary of State for Health and Social
Care, my hon. Friend the Member for Harborough (Neil O’Brien),
for his work on this plan. I have deposited copies of the plan in
the Libraries of both Houses. Our plan will enable us to better
recover from the pandemic, to cut NHS waiting lists and to make
the most of the opportunities ahead by focusing on three key
areas: first, tackling the 8 am rush by giving GPs new digital
tools; secondly, freeing up GP appointments by funding
pharmacists to do more, with a “pharmacy first” approach; and
thirdly, providing more GPs’ staff and more appointments. NHS
England and my Department have committed to make over £1.2
billion of funding available to support the plan, in addition to
the significant real-terms increases in spending on general
practice in recent years. Taken together, our plan will make it
easier for people to get the help they need.
The plan builds on lots of other important work. Last year, we
launched the elective recovery plan, which is making big strides
to reduce the backlog brought by covid-19. We eliminated nearly
all waits over two years by last July, and 18-month waits have
now decreased by over 90% since their peak in September 2021. By
contrast, in the NHS in Labour-run Wales, people are twice as
likely to be waiting for treatment than in England. They still
have over 41,000 people waiting over two years and nearly 80,000
waiting over 18 months. In addition, this January, I came before
the House to launch our urgent and emergency care plan, which is
focused on how to better manage pressures in emergency
departments, with funding to support discharge to improve patient
flow in hospitals. Today’s plan is the next important piece of
work.
Turning to the detail of the plan, our first aim is to tackle the
8 am rush. We will do that by providing GPs with new and better
technology, moving us from an analogue approach to ways of
working in the digital age. An average-sized GP practice will get
around 100 calls in the first hour of a Monday morning. No team
of receptionists, no matter how hard-working, can handle such
demand. About half of GPs are still on old analogue phones,
meaning that when things get busy, people get engaged tones. We
are changing that by investing in modern phone systems for all
GPs, including features such as call-back options, and by
improving the digital front door for even more patients. In the
GP practices that have already adopted those systems, there has
been a 30% improvement in patient feedback on their ability to
access the appointments they need. That also reflects the fact
that online requests can help find the right person within the
practice, such as being directed to a pharmacist for a medicine
prescription review or to a physio for back pain.
In doing that, we will make the most of the 25,000 more staff we
now have in primary care. Today’s plans fund practices without
this technology to adopt it, while also providing them with staff
cover to help them manage a smooth transition to the technology.
Indeed, many small GP practices in particular find it hardest to
fund new technology, or to manage the disruption that comes with
transitioning to new ways of working, so we are funding locum
cover alongside the tech itself. Notwithstanding that, people
will always be able to walk in or ring if they prefer; if someone
wants to ring up and see someone face to face, these investments
will make that easier, too.
We also want to make sure that patients know on the same day that
they make contact how their request is going to be handled.
Clinically urgent issues will be assessed on the same day, or the
next day if raised in the afternoon. If the issue is not urgent,
an appointment will be scheduled within two weeks, but crucially,
people will not be asked to call back the following day. Instead,
they will get their appointment booked on the same day or be
signposted to other services.
The second area of the plan is Pharmacy First. As well as giving
GPs new technology, I know that we need to take pressure off GPs
where possible by making better use of the skills of all
clinicians working in primary care. We saw the incredible role
that pharmacists played during the pandemic—their capacity to
innovate and deliver for the communities that they served,
freeing up GP appointments in doing so—so the second part of our
plan is to introduce a new NHS service, Pharmacy First, on which
we are already consulting with the Pharmaceutical Services
Negotiating Committee.
Some 80% of people live within a 20-minute walk of a pharmacy, so
making it easier for pharmacists to take referrals can have a
huge impact. Referrals might be from GPs, NHS 111 or, from next
week, urgent and emergency care settings. Community pharmacies
already take referrals for a range of minor conditions, such as
diarrhoea, vomiting and conjunctivitis, but with our Pharmacy
First approach we can go further still. We will invest up to £645
million over the next two years so that pharmacists can supply
prescription-only medicines for common conditions, such as ear
pain, urinary tract infections and sore throats, without
requiring a prescription from a GP.
One of the most significant shifts we are making is on oral
contraception. Pharmacists can already manage the supply of
contraception prescribed elsewhere; from later this year, they
will also be able to start women on courses of oral
contraception. This is another way in which, in light of our
women’s health strategy, we aim to reduce the barriers to women
accessing contraception. Pharmacists will also be able to do more
blood pressure checks, which is one of the most important risk
factors for cardiovascular disease. Not only will those kinds of
steps make it easier for people to get the care they need, we
expect them to release up to 10 million appointments a year by
2024-25.
The third part of our plan is about providing more staff and more
appointments. We are making huge investments in our primary care
workforce, and are on track to meet the manifesto commitment of
26,000 more primary care staff by next March, meaning that we
have more pharmacists, physios and paramedics delivering
appointments in primary care than ever before. In 2021, we hit
our target of 4,000 people accepting GP training places, and our
upcoming NHS workforce plan will set out how we will further
expand GP training. We are also helping to retain senior GPs by
reforming pension rules, lifting 9,000 GPs out of annual tax
changes. These are the pension reforms that the British Medical
Association welcomed, describing them as “significant” and
“decisive” changes and citing them as “transformative for the
NHS”.
As well as freeing up more staff time, our plan cuts bureaucracy,
too, so that GPs spend less time on paperwork and more time
caring for patients. We will remove unnecessary targets, improve
communication between GPs and hospitals, and reduce the amount of
non-GP work that GPs are being asked to do. For example, patients
are often discharged from hospital without fit notes, meaning
that they then have to go to their GP to get one. By the end of
this year, NHS secondary care services, which understand those
patient conditions better, will be able to issue fit notes, and
we have streamlined the number of targets on primary care
networks from 36 down to just five. Taken together, this work
will free up around £37,000 a practice.
Today’s primary care recovery plan funds and empowers our GPs and
pharmacists to do more, so that we can prevent ill health, keep
cutting NHS waiting lists and improve that vital front door to
the NHS for many millions of people. I commend this statement to
the House.
Madam Deputy Speaker ( )
I call the shadow Secretary of State for Health and Social
Care.
4.36pm
(Ilford North) (Lab)
I thank the Secretary of State for advance sight of his
statement. This announcement was meant to be the Prime Minister’s
relaunch after he received a drubbing in the local elections.
Unfortunately for Conservative Members, it seems that the Prime
Minister is bouncing back in true Alan Partridge-style.
Having read that Downing Street had drawn up plans for a
health-focused mini relaunch, I eagerly tuned into the radio this
morning to hear the Health Minister, the hon. Member for
Harborough (Neil O’Brien). What was the Conservatives’ message to
the public this morning, following their worst defeat since 1997?
They are breaking their manifesto commitment to recruit 6,000 new
GPs. Once again, the Conservatives have over-promised and
under-delivered.
I think the Secretary of State just admitted to missing his
target to eliminate 18-month waits by April. Is that the second
broken promise of the day? It is hard to keep up. Millions of
patients are waiting a month to see a GP, if they can get an
appointment at all, in pain and discomfort, unable to go about
their normal lives. That is the price patients are paying every
day for 13 years of Conservative failure. The Prime Minister has
no idea what it is like to be most people in this country. He is
completely out of touch with what NHS patients are going through,
and that is why he cannot offer the change the country is
desperately crying out for.
The Health Secretary has called this announcement the GP access
recovery plan. What is this a plan to recover from, if not his
party’s appalling record of under-investment and failure to
reform? Does he now regret the 2,000 GPs cut since 2015, the 350
GP practices that have closed in the same time, and the 670
community pharmacies that have shut up shop on their watch? Is
expecting the Conservatives to fix the NHS after they broke it
not just like expecting an arsonist to put out the fire that they
started? It is just not going to happen.
It is not just the voters who are turning to the Labour party for
answers; the Government are, too. In January, we set out our
plans for the future of primary care, including allowing
pharmacies to prescribe for common conditions, opening up
self-referral routes into things such as physiotherapy, and
ending the 8 am scramble. Sound familiar? The problem is, that is
where the similarities end, because what the Conservatives offer
today is a pale imitation of Labour’s reform agenda. Where is the
plan to give patients real choice? There is nothing on enabling
patients to see the same doctor at each appointment, when doctors
themselves tell us that continuity of care is important. There is
nothing on allowing patients to choose whether they are seen
face-to-face or over the phone, merely the promise of better hold
music and the “invention” of things such as call-back, which has
existed for many years. In fact, where is the plan for better
mental health support, more care in the community and in people’s
homes and more health visitors to give children a healthy start
in life, or have all those issues been dumped into a box marked
“Too difficult”?
The Secretary of State says that patients will get an appointment
within two weeks as if it is some kind of triumph. When we were
in government, we delivered GP appointments within two days. When
will this pitiful promise be delivered? There is no date or
deadline. By when can patients expect the 8 am scramble to end?
There is no date or deadline. When will patients with urgent
needs be seen on the same day? There is no date or deadline. In
fact, I wrote to the Minister and asked him how many patients are
currently not seen on the same day. He said he did not know and
that the Department does not hold that information. What is the
point of these pledges if Ministers do not know whether they are
being met? The document says that the NHS and the Department have
“retargeted over £1 billion” to pay for the announcements, but
not where that money has come from. Where has the Secretary of
State cut NHS services to pay for these announcements?
The Secretary of State’s plans for patients to refer themselves
to physios for back pain, bypassing GPs, could lead to 5,000
cancer patients missing their diagnosis. That, as perhaps he
remembers, was according to—that is right—the Conservative party
back in February. Three months later it is the Government’s
policy, so perhaps the Secretary of State can clarify: was the
Conservative party telling porkies back in February, or does he
simply not know what on earth he is doing? Given that this is
meant to be a primary care recovery plan, where is dentistry? NHS
dentists are in even shorter supply than Conservative council
leaders.
Finally, let me turn to the super-massive black hole at the heart
of today’s announcement: where is the plan to train the doctors
and nurses the NHS is so desperately short of? Labour has set out
our plan to train 7,500 more doctors and 10,000 more nurses each
year, paid for by abolishing the non-dom tax status. When will
the Secretary of State finally admit he does not have any ideas
of his own, and adopt Labour’s plan? After 13 years, the
Conservatives have no plan to give the NHS the staff it needs,
they have broken their promise to recruit 6,000 new GPs and they
have missed a golden opportunity to give patients real choice.
Only Labour has a plan to rebuild and renew the NHS, and that is
why people across the country are coming home to Labour.
The hon. Member started with the message to the public, and the
message to the public can be seen by what key figures in the
sector say about this recovery plan. Let me just share that with
the House. The Pharmaceutical Services Negotiating Committee says
that the plan is
“the most significant investment in community pharmacy in well
over a decade”.
The Boots chief executive says that this is
“great news that they’ll be able use their clinical expertise
more widely”.
The Company Chemists Association says that it is a
“real vote of confidence for the future profession”.
The message to the public from the industries in this sector is
clear that this is a well thought through plan which will have a
beneficial impact for patients. I will give one final quote: the
chair of the Royal Pharmaceutical Society says that this plan
will be
“a real game-changer for patients”,
and that is what our focus has been.
The hon. Member raised the issue of our delivery against the 18
months target. It is very generous of him to give me the
opportunity to share once again with the House the contrast with
Wales, but perhaps he missed it first time around. We have
reduced the wait for 18 months by over 90%, yet Wales still has
vastly more—over 80,000 waiting there—and that is from a much
smaller population. Wales still has over 40,000 waiting more than
two years, a target that we virtually eliminated as long ago as
last summer. Those who want to see what a Labour Government would
mean for the NHS can see it with the performance against the
two-year waiting list and the 18-month waiting list in Wales, so
it is very generous of him to give me the opportunity to share
that once again with the House.
The hon. Member talks about what the recovery plan is for.
Clearly, the pandemic has placed huge pressure on primary care,
and we can see that just from the increased volumes of
appointments that primary care faces. Again, I touched in my
opening remarks on the fact that GPs and primary care are seeing
more than 10% more appointments than before the pandemic—1
million appointments a day. It is clear why we need to invest in
new forms of working, online booking technology and cutting
bureaucracy: it is so that GPs can focus on the aspects of their
role that apply purely to GPs and we can better use the 25,000
additional roles that are being recruited into primary care.
The hon. Gentleman talked about his direct referral policy. We
actually announced our policy guidance in December, a month
before his announcement, so it is something of a stretch to say
that we are following his approach. He again kindly raised the
issue of mental health, which gives me the opportunity to remind
the House of the increased funding that this Government are
making in mental health. That was a key priority when my right
hon. Friend the Member for Maidenhead (Mrs May) was Prime
Minister and a cornerstone of the long-term plan, with an extra
£2.3 billion going into mental health. But we did not stop there.
At the Budget, the Chancellor further prioritised mental
health—for example, mental health digital apps were a cornerstone
of the measures for economically inactive people. We are
recruiting an additional 25,000 roles into primary care in
recognition that specialists are needed, whether physios,
pharmacists, paramedics or specialists in mental health
support.
The hon. Gentleman spoke about other aspects of primary care such
as dentistry. We have said frequently that we have a recovery
plan for dentistry that we will announce shortly, so that should
not be news. On funding, it is slightly bizarre that, although
this plan announces more than £1 billion of new funding for
primary care, investment in tech, new ways of working, additional
staff and empowering our pharmacists, who bring great clinical
expertise that we can better harness, the hon. Gentleman, rather
than welcoming that, went back to the hackneyed non-dom funding.
We have heard that so much before and it has been spent so many
times. We have set out ways of best using the skills of our GPs
and of the additional roles, where we are delivering on our
manifesto with an extra 25,000 already recruited. Above all, we
have set out ways of best using our pharmacists, who are a huge
resource that we can better use. That is why we are targeting
more than £600 million additional funding into pharmacists, which
will allow people to better access the care they need in a timely
fashion.
Madam Deputy Speaker ( )
I call the Chair of the Health and Social Care Committee.
(Winchester) (Con)
I welcome the plan, which I note the Government have released at
the first possible moment after the local election purdah period.
Members of the Health and Social Care Committee and I will study
it carefully, and I know the primary care Minister has already
agreed to come before us so that we can give it a good going
over. My question is about timing. How quickly can investment in
the 8 am scramble part of the policy make a difference to those
practices that do not have it? The Secretary of State said that
they were already negotiating with the Pharmaceutical Services
Negotiating Committee, so how quickly can that very welcome new
investment get to the frontline of community pharmacy?
The short answer is this year, but the Chair of the Health and
Social Care Committee is right to focus, as with all recovery
plans, on deliverability. I hope he will take comfort from the
fact that around half of GP practices already have cloud
telephony, which is why we are so confident that it is the right
approach. It is one that is already working. We are seeing from
patients’ positive feedback that they hugely value online booking
and call-back systems, but they also allow primary care to better
triage calls to specialists and therefore to use the additional
roles we have recruited in an optimum way. That will be rolled
out this year, but it is already up and running and we can see
that it is working.
(Barking) (Lab)
I would like to take the Secretary of State out of the bubble of
Westminster and the green Benches and into the reality of what is
happening on the ground in my constituency. We have the second
highest number of A&E attendances for minor injuries—people
who should be going to their GP. We are the most under-doctored
and second most under-nursed area in north-east London and, last
year, just under 9% of patients could see their GP within 14 days
of requesting an appointment. So for me, the recovery plan
announced today is deeply underwhelming. I hope that the
Secretary of State can answer these three questions. When will
he, not plan, but deliver the 6,000 extra GPs promised? What work
is he doing to move GPs from working part time to putting in more
hours at the frontline with their patients? Where is the
commitment to deliver face-to-face appointments for those who
want them in my constituency? Only when I have answers to those
questions will I feel confident that there really is a plan for
GP services in Barking and Dagenham.
I know the right hon. Lady well, having served with her for four
years on the Public Accounts Committee, so I hope that she will
not mind me being slightly surprised about being told, as someone
who lives in the Fens and not in London, that I am in the bubble.
On her points, obviously, we have 37,000 more doctors than when
the Government came to power. Directly, the changes to pensions
lift about 9,000 GPs out of the tax changes. It is also about
training more—4,000, compared with 2,600 in 2014—so being on
track in terms of the number we are training. It is also about
the additional roles that we are funding, the 25,000 and the
manifesto commitment of 26,000. Also, the pharmacy announcement
is all about freeing up GP capacity for face-to-face appointments
for those who want come in. By enabling pharmacy capability for
those who want to get oral contraception, have a blood pressure
test or access services for the seven common conditions—including
urinary tract infections and ear infections, for which
prescriptions can then be given—we will free up GP time for
face-to-face appointments. If we look at last year’s patients
survey, we see that about two fifths of patients hugely valued
continuity of care and face-to-face, which means about three
fifths preferred to prioritise speed of access, rather than
seeing the same GP or seeing someone face to face. So it is about
tailoring the offer to what the patient wants, and patients do
not always want the same thing. Some want speed and pharmacies
can deliver that.
(Thurrock) (Con)
I congratulate my right hon. Friend on his announcement on
pharmacy, for which I have been calling for a number of years. We
ought to be making more use of this massively skilled body of
medical professionals, particularly to free up GPs. For many
people, they are the front door to the NHS more than the GP
surgery is. Could he confirm that, for the additional work that
they will be doing to support our NHS, they will get some
reward?
First, I commend my hon. Friend because this is an issue that she
has championed and she has been right to do so. These are
degree-qualified clinical roles, so it is sensible that we make
far better use of the skills that they offer. We saw during covid
just how much value they offer to their communities. I confirm
that they will be paid for these roles; that is what the
additional funding is all about. She has been right over the
years to highlight the importance of pharmacies and what they can
offer, and that is what this announcement is all about.
(Sheffield South East)
(Lab)
First, I thank the GPs in my constituency and their staff for the
job that they are doing for my constituents under the most
enormous pressure. I want to include in particular GPs’
receptionists in that for the up-front service they give; there
is particular pressure on them. GPs—often in their 50s—are saying
to me that they want to leave and give up not because of pensions
but because of the overbearing workload they have, and the
incredible centralisation and red tape coming from NHS England at
national level. They look for new GPs coming through and see so
many trainees and qualified doctors now going off to Canada, New
Zealand and Australia because the terms and conditions of work
are better there. When will we see from the Secretary of State
the workforce plan that has been promised over and over again—it
was supported by the Chancellor when he was Chair of the Health
and Social Care Committee—to deliver the amount of training we
need and the efforts to retain the GPs we already have?
I agree and thank the hon. Member, who is absolutely right to
recognise the huge amount of work done by GPs and their staff,
including receptionists. That is why the recovery plan is very
much targeted at recognising the workload. I flagged in my
statement the additional volume of patients that a typical GP
surgery is seeing and that reflects the huge amount of work that
is done. I think pensions were a factor, certainly in the
feedback from the profession. The issue was raised. The changes
the Chancellor announced take 9,000 GPs out of the tax changes,
but the hon. Gentleman is right—that was not the only factor; the
workload was another. The recovery plan looks to cut bureaucracy
and, as I say, reduces the targets to five. It also looks at
areas where there are appointments that we do not feel are
necessary—so it looks at how secondary care can do fit notes, for
example, rather than someone needing to go to the GP to get one.
There are areas where we can streamline GPs’ workload and that is
what the recovery plan does. On the workforce plan, we have said
on a number of occasions that, post purdah, we would set that out
very shortly. We will have more to say on that in due course.
(Harwich and North Essex)
(Con)
I join the hon. Member for Sheffield South East (Mr Betts) in
inviting the Secretary of State to thank all our GPs for their
incredible work. I very much welcome his statement. Will the
Pharmacy First plan enable places such as Harwich and Dovercourt
in my constituency to increase the out-of-hours cover that
pharmacies provide? Otherwise people will have to travel miles
just to get a prescription. Also, where are all these new GP
staff going to be put? Most GPs have very cramped premises. West
Mersea surgery in my constituency has been trying to develop new
premises for a long time, unsuccessfully because the GPs’
partners will not take the risk. At the Mayflower surgery in
Harwich, there is empty space in the building rented by the NHS
from a failed Labour private finance initiative project, but the
GPs cannot afford to pay the rent, so the space sits empty,
although it is still paid for by the taxpayer. What are we going
to do about that?
First, I join my hon. Friend in paying tribute to the work that
GPs do in his constituency, as they do elsewhere. On pharmacies,
part of the reason for the investment is to support pharmacy,
including in rural settings. The more funding going in, the more
they can prescribe. The more things they are able to do, the
better the business model. There are more pharmacists and more
pharmacy shops than there were in 2010, but it is important we
make the business model more viable and that is what the
announcement does. On estates planning, that is an issue for each
integrated care board to consider. He mentions a specific issue
locally with a former PFI and how it is being used. That is not a
new issue. I sat on the Public Accounts Committee when it was
chaired by the right hon. Member for Barking ( ) and I remember looking at
many a Labour PFI. The regional fire control centres were a case
in point; the estate could no longer be afforded and the space
was empty. If there is an issue like that, I will be happy to
look at it in due course.
(Coventry North West)
(Lab)
As chair of the all-party parliamentary pharmacy group and as a
pharmacist myself, this is a step in the right direction.
However, I have spoken to many pharmacists and many in the
sector, and we believe that, for the policy to unleash the full
potential of pharmacy, there needs to be proper investment in the
workforce plan. What we are seeing is pharmacists who can
prescribe leaving community pharmacies and going into other
sectors. It is great that they have the ability to prescribe, but
if the pharmacies are not there the full potential cannot be
unleashed. Secondly, we have a funding crisis, with many
pharmacies closing, so the plan needs to be accompanied by
further funding and steps to address the medicines supply
chain.
Will the Minister clarify a few points? Will pharmacists be paid
competitively for their prescribing skills? In previous
Government announcements, that has not been the case. Pharmacists
would like to feel valued from this announcement. Will the
announcement be followed by actual support for premises as well?
I am sure the Minister is aware of pharmacists who have
challenges, for example, in accessing a patient’s record, and who
do not have the workforce needed to take time out to go out to
speak to patients. Will he meet me and the APPG to discuss those
issues further?
First, I thank the hon. Member for recognising, constructively,
that this is a step in the right direction. As the quotes from
the sector show, many working within pharmacy welcome it. As I
said a moment ago, there are 20,000 more pharmacists than in
2010. The additional funding, including—directly to her
question—for prescribing, will make the business model more
viable and therefore support the workforce within the pharmacy
sector.
We are working on IT as part of the recovery plan. There is a big
read-across into the NHS app and how we better empower patients
both to access their own medical records and to find the right
services, including by being directed from the NHS app to
pharmacies.
(Erewash) (Con)
I welcome today’s announcement, which will undoubtedly widen
access to primary care services. However, will my right hon.
Friend consider investing in point-of-care diagnostic testing in
pharmacies and GP surgeries, to speed up the diagnostic pathway
and help to reduce NHS waiting times?
My hon. Friend raises a great point. I am extremely keen on how
we can improve diagnostic testing and make it more accessible. As
she knows from her time in the Department, early treatment is
more effective and more cost-effective. Looking at more home
testing, more testing at pharmacies and more work with employers
to accelerate early detection is a win for patient outcomes and
for delivering care in a more affordable way.
(St Albans) (LD)
Liberal Democrats and many others in this House have called for a
pharmacy first approach for a long time, but there appear to be
two major problems with today’s announcement. The first is that
the Government’s own plan says that the money will be
re-targeted; I would be grateful to know from the Secretary of
State which other service will miss out.
In my constituency two pharmacies have already closed, and across
England 16% of pharmacies have said that they do not think they
will survive another year. How does the Secretary of State expect
people to access a pharmacy first if their pharmacies continue to
close?
As I said, there are more pharmacists than in 2010 and more
people working in the pharmacy sector—the numbers have gone up by
24,000 since 2010—so to address the hon. Lady’s second question,
there are more. On funding, as I said in my statement, this is
new funding for primary care. That is the commitment that we
made, and it should be welcomed in the primary care sector.
(Isle of Wight) (Con)
I welcome the statement. I notice the difference in opinion on
the Opposition Benches between the people who know what they are
talking about and the people who do not.
Pharmacy First is a brilliant idea, and I thank the Secretary of
State. I very much hope it will be welcomed by pharmacies in my
patch. I want to reiterate some of the points that have been
made. First, some of my pharmacies have been under a lot of
financial pressure recently. Will the financial package be able
to support them and make them feel valued, considering what
extraordinarily good value for money they are? Related to that,
will any financial support or grants be made available to
pharmacies—especially the smaller ones in some of my rural areas
and small towns—so that they can have a room to see patients and
take advantage of this great Pharmacy First scheme?
I welcome my hon. Friend’s comments. There is £645 million of
funding over the next two years to support the expansion of this
work through Pharmacy First. As I said a moment ago, the estates
programme is more an issue for the integrated care boards. We
should not try to determine all the decisions on estates from
Westminster; it is right that we let the 42 ICBs have more
discretion over what is the right estate strategy in their area.
I am sure that his local ICB will hear his representations.
Sir (Rhondda) (Lab)
I completely support the idea of pharmacists being able to do
more. For instance, it makes more sense that someone with
shingles can go to a pharmacist today to get antivirals
prescribed. My fear is that what has been announced today does
not fully understand the crisis in primary healthcare. According
to the numbers given by the Government’s own Ministers, in
September 2015 we had 29,364 fully qualified GPs in England, but
last September we had 27,556. By the Government’s own numbers,
that is 2,000 fewer. Community pharmacies have gone from 11,949
in 2015 to 11,026—a nearly 10% fall. Do we need to do more to
enthuse people to work in our NHS across the whole of primary
healthcare? Would it be a good idea to change the model for GPs,
so that we have more salaried GPs?
I have touched on the numbers a few times, but let me give the
hon. Gentleman the precise figures. There are 335 more
pharmacists than there were in 2010, so it is simply not the case
that there are fewer. There are 2,000 more doctors in general
practice, and there are also the extra 25,000 in additional
roles. As I have said, someone who wants a prescription review
should see a pharmacist, and someone with back pain should see a
physiotherapist; not everything has to go through a GP, and it is
better for GPs’ time to be used more effectively. There are also
more doctors in training: 4,000 are receiving training in primary
care, as opposed to 2,600 in 2014. So we are seeing more staff,
more effort on recruitment, more effort on retention through the
pension changes, and better use of the additional roles.
(Sleaford and North
Hykeham) (Con)
I am pleased that the Government are looking at how they can best
support GPs and improve access to primary care, but how will
these plans protect and enhance the role of GPs who dispense in
their own practices? How will my right hon. Friend deal with
concerns about antibiotic resistance, and how will he solve the
root cause of the problem, which is the fact that there are not
enough GPs?
In respect of my hon. Friend’s first point, these plans will not
make any changes. As for the second, about prescribing, that will
be part of the consultation, and we will be learning lessons from
what is being done elsewhere: for instance, Pharmacy First is
already up and running in Scotland. We are looking into what
tests can be performed alongside those prescribing rights so that
antimicrobial resistance is targeted effectively.
(Feltham and Heston)
(Lab/Co-op)
The steps proposed in the statement reflect what Labour has been
calling for, and are well overdue. I am glad that at least some
steps are being taken, but they fall well short of the scale of
the challenge that we face. Pharmacists need to work in a strong
primary care environment. We need to see more GPs, an increase in
primary care services, and more tests, diagnoses and minor
procedures carried out in the community, speeding up primary care
and taking the pressure off secondary care.
Three years ago, I met Ministers and officials in the Department
to seek advice on and support for the rebuilding of the rundown
Heston health centre in my constituency. What is the Government’s
strategy on the rebuilding of rundown primary care facilities,
not only to assist the recruitment and retention of GPs but to
better facilitate the work taking place between GPs, pharmacies
and other community healthcare services?
There seems to be a slightly confused response from the
Opposition. They challenge this announcement on the grounds that
they are not happy with it, and in the same breath claim that it
is part of Labour’s plan or a step in the right direction. They
need to make up their mind.
As I said in response to two earlier questions, it is for the
integrated care boards to adopt estate strategies in their areas.
Not all decisions about estates should be made centrally.
However, one of the changes that we are setting centrally
involves embracing more modern methods of construction and a more
modular approach. The unit cost of that approach is much lower,
and when the level of confidence is higher, the contingency cost
is much lower as well. So we are changing the way in which we
build our estate, but the estate strategy is an issue for the
ICBs.
(Lichfield) (Con)
As the hon. Member for Coventry North West () will know, it takes five
years to obtain a master of pharmacy degree and to become fully
qualified. Training continues as pharmacists continue in their
work, so they are a valuable resource, and I welcome the
statement. As my right hon. Friend the Secretary of State will
know, in France, for instance, where it costs €26.50 to see a GP,
most people would choose to see a pharmacist first, but is he
sure that by taking pressure off general practices, he will not
overwhelm pharmacists such as mine in Lichfield and
Burntwood?
My hon. Friend is right to draw attention to the practice in
other countries, and the fact that patients are very happy to
visit pharmacists when that is more appropriate for the treatment
that they are using. That is what the Pharmacy First strategy and
the learning of lessons are all about, although we must also
think about how to mitigate some of the risks connected with
antimicrobial resistance. In the context of the impact on
pharmacy, I refer my hon. Friend to what has been said by those
in the sector. This is a move that they have called for and have
now welcomed, and it responds very much to our discussions with
pharmacists who have said that they can do more and are keen to
do more, but need the funding to enable them to do so—which is
what Pharmacy First delivers.
(York Central)
(Lab/Co-op)
The impact of today’s announcement will be miniscule compared
with the scale of the challenge facing primary care right now. In
York, our GPs are innovative and ambitious—far more ambitious
than the Secretary of State—and want to bring real change to the
way pathways operate. In light of that, will additional money be
available for innovation in primary care, so that GPs can meet
the challenge and lead the change that is needed?
There is funding in other parts of the Department’s budget, not
least for tech innovation and the work we are doing on artificial
intelligence. There is further scope to use AI in demand
management, for example to relieve pressure on GPs by looking at
changes in the behaviour of frail or elderly patients and picking
up changes early. The use of AI presents a significant
opportunity. There are questions about how we can use data
better; indeed, there are challenges for those across the House
in how we can use data better to manage pressure within primary
care. So there is funding elsewhere in the Department’s budget,
in addition to what I have announced here.
(Peterborough) (Con)
I am pleased to inform the House that my mother has moved in with
my wife and me, from the Secretary of State’s constituency. One
of the joys of living with my mother is helping her with Tesco
orders and Amazon deliveries and with surfing what she calls the
interweb, and I am looking forward to helping her with the new
NHS app. Does my right hon. Friend agree with me that enabling
many more people to use the NHS app, including Mrs Bristow, and
having many more services available on the NHS app is more
convenient for patients and will free up GP time, so that GPs can
do what they should be doing?
I am happy to recognise the scope for Mrs Bristow and many others
to make more use of the NHS app. That app is all about empowering
the patient and enabling them to get the right care, in the right
place, at the right time, whether from a pharmacist, one of the
additional primary care roles we are creating or a GP where
applicable. The NHS app can free primary care practices from many
of the tasks that are currently placed on them, such as people
phoning for their records or repeat prescriptions. It is a key
part of streamlining such tasks.
(Leyton and Wanstead) (Lab)
In my constituency, we have lost GPs and surgeries. There are
increasing numbers of people on fewer and fewer lists. Community
pharmacies are under pressure and some have closed, so people
then go to the local hospital, Whipps Cross University Hospital,
which is struggling, with 100% bed occupancy rates. The Secretary
of State has been ducking making an announcement about funding
for the new Whipps since he took on the job, but that hospital is
struggling every day. My question is twofold: when will the
Secretary of State announce the workforce plan for primary care,
and when will he finally get around to making an announcement for
Whipps Cross University Hospital?
Far from ducking Whipps Cross, I have actually been and visited
in person, so I am very familiar with the issue and I recognise
the importance of the new hospital programme. I hope to make an
announcement about that programme and about the workforce plan
shortly, just as I am doing today about the primary care recovery
plan.
In today’s plan, the hon. Gentleman may want see at the proposals
to look at the contribution to pressures on primary care from new
housing developments, and at what changes might be made to ensure
that where such developments take place, funding from them goes
not only to new schools, as it frequently does, but into primary
care, and particularly GPs.
(South West Bedfordshire)
(Con)
I warmly praise all those who work in primary care in my
constituency, including Dr and Dr Stephen Price, who
are the leaders of my two primary care networks.
It is great to see another 25,000 staff in primary care. They now
need somewhere to work, including somewhere in the middle of
Leighton Buzzard before we get the extra health facilities next
year. When we build tens of thousands of extra houses, my
experience, over decades, is that no Government, comprised of any
party, have made sure that extra primary care facilities come on
stream with as much certainty as a new primary school. If we
could crack that, we would do a huge service to the whole nation.
Please could the Secretary of State make it his personal mission
to do that?
We plan to change planning guidance this year to address that
specific issue. I have visited my hon. Friend’s constituency, and
we resolved one of the issues in relation to the estate, which
was extremely constructive. I know he has been discussing a
further issue with the Department, but I hope he can take some
comfort that his representations have been heard. The
Under-Secretary of State for Health and Social Care, my hon.
Friend the Member for Harborough (Neil O’Brien), is planning to
make changes to the guidance to better ensure that, where there
is new housing, a contribution is made to primary care.
(Kingston upon Hull West and
Hessle) (Lab)
The problem in primary care is that we do not have enough GPs to
meet the demand for appointments. The problem is not with the
telephone system. The area I represent has one of the lowest
ratios of GPs to population in the whole country. Will the
Secretary of State support our campaign to train more doctors at
Hull York Medical School, and for Hull York Medical School to set
up a training facility for pharmacists and dentists?
As I said in my statement, we have 4,000 doctors training in
primary care, compared with 2,600 in 2014. We are also looking at
how we can better retain the GPs we have. That is why we made the
pension changes, which will affect around 9,000 GPs. It is also
why we are looking at additional roles to take pressure off GPs,
and at how we can reduce some of the burden of bureaucracy, too.
We are training more doctors, and we are looking at retention and
bureaucracy. No one is suggesting that this is solely an issue of
telephony or online booking, as the hon. Lady suggests, but all
of this will help to relieve pressure on extremely busy primary
care.
(Bosworth) (Con)
I am pleased to be talking about primary care, for obvious
reasons. It is important that the Government made the pension
changes, which will make a difference to retention, but I am also
pleased with the next part of the plan. When I was a clinician,
15% of my workload was chasing letters and administration, which
is borne out by the evidence we have heard on the Health and
Social Care Committee. Will the Secretary of State comment
further on the bureaucracy he is cutting? Will he ensure that
this is the first step in pushing down on that bureaucracy, as
that will improve the welfare of both our workforce and our
patients?
My hon. Friend has a great deal of experience, and he is right to
focus on the amount of clinical time often spent on non-clinical
issues. Sending reminders through the NHS app will reduce
non-attendance. We are also looking at the key interface between
secondary care and primary care, as well as considering which
appointments can be done elsewhere, such as through pharmacies
and the additional roles. The online booking system can better
triage people to the right place, and there will be some
self-referral in order to take pressure off GPs—not for things
that carry a clinical risk, such as internal bleeding, as the
Opposition suggest; but for things like hearing aids. If a person
has taken a hearing test, they will not need to clear an
appointment for a hearing aid through their GP.
(Oldham East and
Saddleworth) (Lab)
I reinforce what colleagues have said. This is a step in the
right direction, but it fails to grapple with the grave situation
in which there has been a threefold increase in waiting lists
since 2010, including a twofold increase since 2019, before the
pandemic. In Oldham we have fewer GPs and more patients with
increased acuity, so when will we get our fair share of the
promised 6,000 GPs?
I have recognised throughout that demand has increased. Primary
care is treating 10% more patients than before the pandemic, with
around 1 million appointments a day. There is more demand, not
just because of the pandemic but, as I said in my opening
remarks, because we have a third more people over the age of 70,
and they are five times more likely than younger people to go to
their GP. That demographic change, the impact of the pandemic and
a change in public expectations of advances in medicine are all
creating additional pressure, which is why it is right that we
use the full range of additional roles and that we invest in
technology, in addition to the 2,000 more doctors in general
practice.
(Stroud) (Con)
GPs, pharmacists and primary care teams do an incredible job for
local people in the Stroud district, and I look forward to the
funding flowing to our pharmacists, as many of them have made a
constructive case for it. A local GP told me that he believes a
national education campaign is needed to advise patients of when
to access general practice and when to access other services,
such as pharmacies. I think this is a good idea, given today’s
announcement. Will the Government take it up?
My hon. Friend is absolutely right on this and we plan to have a
communications campaign. The front door to the NHS can often be
confusing for people—whether they should go to primary care, a
pharmacy, accident and emergency or elsewhere. We will have a
campaign, not just linked to the opportunity to access care
through Pharmacy First, but looking at the technology innovations
we are bringing on stream, particularly on the NHS app. We are
also making changes to 111. So there will be a communications
campaign, on exactly the lines she references.
(Liverpool, Riverside)
(Lab)
I wish to thank all the primary care workers in my constituency.
Despite the Minister’s assurances, 600 pharmacies have closed
since 2015, which is having a significant impact on our most
disadvantaged communities. Does he agree that more funding is
needed to prevent more pharmacies from closing and to fix the
broken NHS? Will he join me in condemning the Rowlands Pharmacy
on Lodge Lane, which is pulling out of the community and
preventing another pharmacy from taking its place?
I join the hon. Lady—as I did the other colleagues from across
the House who have done this—in paying tribute to the primary
care staff in her constituency for the work they do. We have
touched a number of times on the fact that there are both more
pharmacies and more pharmacists than there were in 2010, so there
is more capacity. However, we also recognise the scope to better
use the expertise within pharmacy, which is why an additional
£645 million of investment—new funding—is going into pharmacies
over the next two years.
(Boston and Skegness)
(Con)
I am married to a trainee GP, so I have read all 46 pages of this
excellent plan—reading it makes me different from those on the
Opposition Front Bench. Importantly, the plan is littered with
examples of brilliant practice up and down the country, with case
studies that should be adopted more widely. Almost all of them
come back to the use of technology. Will the Secretary of State
say that he will target the help needed to adopt that technology
at the practices that need it most, which are so often those in
coastal constituencies such as mine?
My hon. Friend is right about the opportunity that tech offers to
deliver changes at scale and the fact that this is proven
technology that is working and already up and running in many
primary care settings. So often within the NHS the challenge is
not the initial innovation—we get pockets of wonderful
innovation—but how we industrialise it across the wider NHS. This
recovery plan focuses on that, looking at how we scale the case
studies to which he refers. About half of primary care does have
digital telephony. The opportunity here is to target that funding
at the other half; that is often the smaller GP practices, as
well as those in coastal communities, because they find the
transition to tech more difficult. That is why a key part of this
recovery plan is about the investment in not just the tech, but
in locums, to provide cover so that staff can make the transition
to that new way of working.
(Kingston upon Hull North)
(Lab)
The NHS workforce plan has been promised for years. Meanwhile, as
my hon. Friend the Member for Kingston upon Hull West and Hessle
() says, we are short of GPs,
pharmacists and dentists in Hull. Will the Secretary of State
answer the question she put to him: can we please build on the
excellent work of the Hull York Medical School to set up a dental
training school there, and a school of pharmacy and one for
ophthalmologists? That would help in the longer term, but we need
a proper workforce plan and the Government need to get on with
it.
As I have said several times, we will publish a workforce plan
shortly. We are committed to that and the Chancellor set that out
in the autumn statement. Of course, when he was doing this job
and when I was previously in the Department, we expanded medical
undergraduate places by a fifth, so there was an increase then. I
have said that we will also set out a dental recovery plan in due
course.
(Stoke-on-Trent South)
(Con)
I very much welcome these plans to improve access to primary
care, particularly around the 8 am scrum, which is beneficial
neither for patients nor for NHS staff. In North Staffordshire we
have some very good GP practices, but also some very poor ones,
which we need to see improve. Will my right hon. Friend confirm
that, with these new measures, the archaic practices that we see
in some of those GP surgeries will be outlawed, and that we will
put in place the new services as soon as possible?
My hon. Friend touches on an extremely important point. The
measures will provide, for all Members of the House, much greater
transparency on the variation between primary care settings. I am
keen that we should publish much more information showing, within
constituencies, the differences in the services offered by
different primary care settings. We already see that between
those that have digital telephony and online booking and those
that do not, but we also see that in other indicators, and I am
keen that he and other Members of the House get visibility of
that.
(Strangford) (DUP)
I thank the Secretary of State for his statement. The primary
care recovery plan is very welcome, and it will be wonderful for
NHS England when the goals are achieved. However, I have a very
specific question about Northern Ireland. My constituents are
struggling to get hold of their medical records over the phone
for personal independence payment assessments and appeals. He
referred in his statement to improvements in the app system. What
discussions will he have with the Department of Health in
Northern Ireland about introducing a similar system to enable
patients in Northern Ireland to access their medical records via
an NHS app?
The hon. Member is right to recognise the importance of access to
medical records. It is a key part of the functionality that we
are delivering through the NHS app. He is correct that that is
focused on England and not on Northern Ireland, but I am very
happy for us to have discussions with him and his colleagues in
Northern Ireland on any shared practice.
(East Devon) (Con)
Today’s welcome announcement will help patients get prescriptions
directly from hard-working, resilient but sometimes overstretched
pharmacies, freeing up GP appointments. Will my right hon. Friend
outline how pharmacies in my constituency of East Devon will be
able to access funding and support to deliver this?
The funding will include for prescriptions for the seven common
conditions, which form part of Pharmacy First. That will be part
of a new NHS service that will be offered, as set out in this
plan. That is what the £645 million over the two years is
targeted at, and obviously we will have further discussions with
the sector on the roll-out.
(Buckingham) (Con)
I very much welcome this recovery plan. It is the right thing to
do and will make a big difference. Does my right hon. Friend
agree that it is also critical for rural communities to have
local and convenient access to GPs? With that in mind, will he
redouble his Department’s efforts, alongside the Buckinghamshire,
Oxfordshire and Berkshire West ICB, to find a way to fund the
construction of Long Crendon’s innovative model to replace the
old village surgery, which sadly had to close under covid. This
will not only deliver first-rate primary care to the village of
Long Crendon and surrounding villages, but relieve the pressure
on Brill surgery, where patients find themselves displaced
to.
My hon. Friend has raised this issue previously, and he is quite
right to champion it—I know that it is hugely important to his
constituents. I hope the ICB will take heed of the issue he
raises, particularly in relation to the level of visibility on
the estate plan. Based on our conversations, I think that more
can be done to share that with him. I urge the ICB to engage
closely with him to make sure that the estate plan addresses the
very real needs that his constituents have identified.
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