GP Services: Christchurch

10:57:00

I will call Sir Christopher Chope to move the motion and I will then call the Minister to respond. I remind other Members that they may make a speech only with prior permission from the Member in charge of the debate and from the Minister. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

I beg to move, That this House has considered access to GP services in Christchurch. It is a pleasure to serve under your chairmanship, Mr Dowd. This short debate was triggered by the perverse decision, announced last week, of the Dorset integrated care board to refuse permission for Burton surgery to reopen. The surgery is a premises in Burton village in Christchurch constituency, which has had a GP surgery for more than 30 years. The surgery was converted from a guest house. It has good car parking nearby and a pharmacy adjoining it, and is a well-loved community facility. In 2007, the GP practice in Burton was amalgamated with Christchurch medical practice and became a branch of that practice. Then, in December 2023, patients were told that the Burton premises would be closed and all patients transferred to Christchurch medical practice in Purewell. I wrote to the integrated care board to express my concern at the impact that would have on the people of Burton. Although the ICB said that it was powerless to intervene because the surgery was only a branch, local residents were confident that another GP practice would acquire the premises and continue to provide GP services, because the building is in really good order: it has 11 consulting rooms and is a very attractive proposition for another GP practice. It was expected that it would be put on the open market for sale. Much to everybody’s frustration, that did not happen. The owners of the practice decided instead to do a closed deal with a veterinary hospital based in Christchurch, which agreed to acquire the site, thereby excluding the possibility of another GP practice taking it over. However, one thing they had not thought about was that they needed to get planning permission for a change of use. The planning application was strongly opposed by local residents, backed by me, and it became a major issue in the general election campaign. Eventually, Bournemouth, Christchurch and Poole council refused the application on a series of grounds, the principal one being that “insufficient evidence has been submitted to demonstrate that the loss of a community facility at this site would not result in a substantial decline in the range and quality of facilities and services available for local people.” In essence, the local planners said that it was necessary to keep the surgery in Burton because removing it would take away an important community facility. If nobody else was willing to open such a community facility, I would not have been able to put forward this argument, but another practice has now purchased the premises and is willing and ready to open a branch in them. However, in order so to do, it had to apply to the integrated care board for permission. It did just that last November. Extraordinarily, it took months before a decision was reached—so long that I raised the issue in an oral question. The Secretary of State himself took it on board and, as a result, the ICB was pushed into having to make a decision on 23 April. As I understand it, the decision was made on 23 April, but was not communicated until some time afterwards. In the meantime, and in anticipation that the application to reopen the branch was essentially a formality, South Coast Medical completed the purchase of the building and started the refurbishment. The plan was that it would reopen this summer. The ICB’s decision to refuse permission for the branch surgery to reopen is, in my view and that of my constituents and local residents, beyond belief. I appeal to the Minister to intervene on behalf of the 4,500 patients whom the ICB accepts would choose to re-register at Burton were the surgery to reopen. Ironically, it is said that the cost of re-registering those 4,500 patients would be a significant burden on the health service. That is because people who are in their first year with a GP are thought to be more burdensome, so the GP gets paid a slightly larger amount for each of them. To describe the exercise of patient choice in that way—as a burden on the NHS—seems to me to be pretty wide of the mark. After I heard the outcome of the application, I tabled a series of questions, one of which sought to establish how many people have been transferring from one practice to another in Christchurch each year, because I wanted to get a feel for that. The answer, from the Minister for Care, stated that the information is not available. Some of the arguments made in favour of not allowing the surgery to be reopened, in answer to another of my questions, were based on the number of appointments already taking place in Christchurch. That prompted me to table a named day question on that subject. At about 9.30 am this morning I received a holding response, saying that the information relating to the number of appointments at surgeries in Christchurch over the past couple of years is not available, yet the ICB says that it used that very information to help it reach its conclusion. I hope the Minister will explain why the ICB, which I think is basically the custodian of all this information, so far has not decided to share that information with Ministers. Either it has the information or it has not been wholly open in suggesting that the information helped in its decision.

Will the hon. Gentleman give way?

I will not just at the moment, but I may do later. This whole issue is a test case for the credibility of the new Labour Government’s promises about increasing access to GP services. In August 2024, after the general election, no one in government or in the NHS, including Dorset ICB, was suggesting that a GP surgery in Burton was not needed. Now that a serious plan to reopen the surgery is in place, without any capital cost to the NHS because South Coast Medical has acquired the premises using its own resources and does not need a grant, it is surely perverse that the ICB is arguing that such a branch surgery can no longer be afforded and that reopening it would adversely affect the financial viability of other practices in Christchurch. I tabled questions on that issue as well. There is no evidence that other practices in Christchurch would be adversely affected, and I challenge the Minister to share with me, the House and my constituents the evidence that has been used to reach this decision. Will she also explain what can be done to appeal against the decision? It has been handed down by an unelected and unaccountable quango, or arm’s length body, which, among other things, has said to me in a letter that there have been no complaints about the quality of service being provided by the other main practice in Christchurch, which was operating the Burton branch and chose to give it up. However, there have been many complaints; I have fistful of them here, some of which I may refer to. Either the ICB does not open its post, or it is closing its eyes and ears to representations about issues relating to the availability of doctors, the importance of patient choice and the inconvenience of having to travel so far in a community that is not well served by public transport and where taxis are very expensive. If somebody is dissatisfied with the quality of service being provided by their general practitioner, they may wish to exercise their choice, and it is good to have some healthy competition, but all that seems to be being squeezed out by the integrated care board. I will quote from a letter from Helen Yonwin, who writes: “Since the surgery closed last year in Burton and patients were transferred elsewhere, trying to get an appointment has been a nightmare. They seem to be unable to cope with the extra patients. The telephones are not always answered and it can take over 30 minutes to eventually get a response, only to discover that you are number 20-something in the queue. After a long wait to be told there are no available appointments, so ring again the next day, there are still no appointments, ‘But you can receive a telephone consultation from a GP’—but the next available slot is in four weeks’ time.” That is not improving access to GP services, which is what the Government pledged. It is a levelling down and reduction in service. I hope the Minister will say that it is intolerable and unacceptable, and that for it to be condoned, if not supported, by the ICB is appalling.

Will the hon. Gentleman give way?

I will just finish quoting from this letter: “If you are lucky enough to get an appointment, the next problem is getting there. Many people don’t drive or have a car, public transport is not easy for those with mobility issues, and taxis are expensive. If you do drive, another problem arises because parking is very limited.” It continues: “I cannot understand how it was stated that no complaints have been made. I and many others, in emails sent to the ICB, mentioned several issues, but I doubt any were noted.” That is a letter from one constituent; there are lots of others. A new housing development has been approved in the locality of Burton; with some 700 new houses, there will inevitably be increased demand for GP services. Indeed, the developer, or the owner of the land, has already approached a surgery to see whether it would open a branch on the new estate. That will not be necessary if the branch to which I have referred is reopened. I will quote from another letter. I will not give the person’s name because it refers to their condition, but she has multiple sclerosis. She says: “It’s so hard for me to get to the Purewell surgery even if you can get an appointment…I fell nearly two years ago, and I still haven’t had a proper appointment to see a doctor to see what’s causing my pain.” She says that she wants to have a choice. Another person wrote: “I previously lived in Stour surgery’s catchment”—that is another surgery within the Christchurch constituency—“and they were amazing. I couldn’t fault them one bit. I then moved to Burton and was forced into this alternative provision.” She says that it is a nightmare to get hold of and that we should have a right to choose who we want as our GP. She also says, “Every time I’ve had an appointment, it’s been running 30 to 45 minutes late.” Reopening the local branch surgery would resolve those problems. I hope that I have given a flavour of the strength of local feeling on this fraught issue. Somebody else wrote to me that not everybody wishes to complain publicly about the lack of service available from providers in the Christchurch medical practice, because they are worried about the consequences for them. I think that such concerns are irrational, but they are understandable.

I commend the hon. Gentleman for his campaign on this issue. It is what we expect from him, because he is very assiduous and very committed to his constituents. He has clearly laid out the issue. Does he feel that the main reason for the ICB’s not pursuing the case is finance? If it is, even with the proposed new housing, perhaps the Minister needs to look at the case personally to ensure that it is not being held back by anything that the Government are doing at this moment in time.

The hon. Gentleman mentions the issue of finances. I tabled a written question about how much the health service has been spending on general practice in the Christchurch constituency. Again, rather surprisingly, the information is available only for the year ending 2023, so we do not have any information for 2023–24. Although I would not expect the figures for 2024–25 to be available, I certainly would have expected the total costs for 2023–24 to be available by now. The answer says that in 2022–23, some £17.5 million was spent on providing GP services in Christchurch. The idea that the cost of transferring patients from one practice to another should be a decisive factor against the reopening of a branch seems extraordinary. It makes a nonsense of the argument that we must rein in our expenditure. While we are talking about the ICB’s expenditure, for the last several years I have been complaining that, at any given time in Dorset, under the ICB’s supervision, there are some 250 patients in Dorset hospitals who have no need to “reside”, as it is called. In other words, those people are in hospital but do not need to be there. Every day, that is 250 patients at a cost of between £500 and £1,000 each. The same body is presiding over that scandal. It said last year that it was going to halve the number, but it has failed to do so—indeed, the number is just the same as a year ago. Instead of taking it out on the people of Christchurch and saying, “You can’t have access to a reopened branch surgery,” it should be looking at its own poor performance. As I have said to the Minister informally, the idea that Dorset ICB will somehow be amalgamated with other ICBs—creating even more bureaucracy, and making it even more remote from the people—is, again, farcical. My final point—I want to give the Minister time to respond—is that, in answer to a written question, the Minister for Care said that as a result of what has happened in the last year, the number of patients in Highcliffe has increased by about 150. In Christchurch medical practice, the total number of patients has actually fallen; in the Stour surgery, it has increased; and in the Grove, it is about the same. To suggest, on those figures, that the financial viability of other practices in Christchurch will be threatened if this branch surgery is reopened seems to be without any justification. I hope that the Minister will be able to give a positive response, although I note that the Minister for Care is not responding to the debate.

Will the hon. Gentleman give way?

I will not, because I want to ensure that the Minister has time to respond to those points.

11:18:00

It is a pleasure to serve under your chairmanship this morning, Mr Dowd. I thank the hon. Member for Christchurch (Sir Christopher Chope) for raising GP surgeries, which is a vital matter to so many of our constituents. That is because GP surgeries are the front door to our NHS, and visiting a GP represents far better value for taxpayers’ money than accident and emergency departments. That is why, since coming into office, fixing general practice has rightly taken up a lot of our bandwidth, energy and focus. It is worth remembering that we inherited a system in total disarray, and a bizarre situation in which we simultaneously had a GP shortage and newly qualified GPs looking for work. I am proud of everything we have done to turn GP services around in the nine or 10 short months we have had. However, before I come on to that, let me address some of the hon. Gentleman’s points. Ahead of this debate, I asked my office to get in touch with the integrated care board locally so that we had a fuller picture of what is happening on the ground. My understanding is that Burton surgery was previously a branch of Christchurch medical practice, which is just under two miles away. The surgery closed in August last year because the owners wanted to sell. Although the ICB did not approve of the closure, it recognised that it had little influence over the sale as GPs are independent practitioners. I am informed that the local community were—as they often are—understandably unhappy with the news about changes to the services, and that the hon. Gentleman got in touch with Dorset ICB. When a veterinary business tried to buy the site, the application received over 100 objection letters and the sale did not go ahead. The ICB then received two further applications to renew the site, about which it considered a number of factors, as is normal practice: whether there is good access to surgeries in the area; what the impact would be on patients and on community needs; how it would affect the quality, equity and safety of provision; and how it might affect the stability and ability of other local GP services to run viable surgeries in their area. I have been assured that the decision that Dorset ICB took was not taken lightly but based on the needs of and the benefits to all prospective patients in the area. The surgery catchment area for Burton is covered by Christchurch medical practice and Farmhouse surgery. As the hon. Gentleman outlined, reopening would have required additional costs, which were not justifiable given the financial challenges facing the NHS—something that we all understand. Consequently, Dorset ICB felt that those costs would reduce provision in the area and lead to significant financial pressures on other local surgeries, which could lead to further closures. Dorset ICB has seen no degradation of services for patients since the surgery closed and the number of appointments has not decreased overall. I take the hon. Gentleman’s point about the numbers, and I do not know why that information is not available; I am happy to take that question back to the Department. Local MPs should have as much information as possible about services in their areas. These are taxpayer-funded services, so I will check as to why that information is not available. Dorset ICB has not received what it calls formal complaints from patients, but it has received communications from a local campaigning group, which is important. On balance, however, it decided that it could not reopen the practice. On the point about housing needs, which I talked about for many years when I was an Opposition Member of Parliament, the Government absolutely understand the issue of additional demand and the challenge it poses to primary care infrastructure.

Will the Minister give way?

I will not, because the hon. Member for Christchurch wants me to answer his questions. We are working closely with the Secretary of State for Housing, Communities and Local Government to address the issue of additional demand in national planning guidance and ensure that all new and existing developments have an adequate level of healthcare infrastructure for the community. The NHS has a statutory duty to ensure that there are sufficient medical services, including general practice, in each local area, with funding and commission reflecting population growth and demographic changes. The hon. Gentleman highlights an important point that we will continue to pursue. Those are the facts about the decision made by the ICB, which was its decision to make. I am not going to stand here and tell the hon. Gentleman that he is not right to do what he is doing; he is absolutely right to fight for the best possible service provision for the people of Christchurch, and I would do the same for my constituents—all hon. Members do that. These decisions are best made locally, however, and it is for Dorset ICB to use its autonomy to make them, not Ministers in Whitehall.

The ICB is not elected or accountable. We have an elected and accountable council—BCP council—which decided that the surgery in Burton, a community facility that had been there for more than 30 years, should remain and that permission should not be granted to change its use, because of its value as a community asset. Why should the ICB be able to second-guess the elected representatives of the community? Is that not intolerable?

I could talk for a long time about the accountability of health services, but we do not have time for that. The legislation, as set up by the previous Government and others, is clear that ICBs have responsibility for commissioning services on behalf of the local population within the resources that they have available. They need to do that under particular guidelines, which I have outlined, and it is important that they keep up communications with Ministers and local people. I am not au fait with the day-to-day running of Dorset ICB—that is not for Ministers—but at a strategic level, I recognise that Dorset currently has the fifth-highest ratio of GP clinicians to patients in the country. I know that everyone wants to be in first place, but I am sympathetic to the ICB’s arguments that other practices may suffer if the surgery were reopened. Closing the former site has made the services at Christchurch medical practice and other neighbouring practices slightly larger, which has given them greater resilience in the long term. The hon. Member for Christchurch mentioned the new Labour Government and what we are trying to address. I do not have the figures in front of me, but every hon. Member present will know there have been hundreds of GP service closures—not just branches but practices—over the past 14 years. The trend has been for primary care to receive a smaller share of the NHS budget, and as a result, secondary care has had much more activity. We all know about the 8 am scramble, and some GPs have been forced to work in appalling conditions with leaky roofs and buckets catching rainwater. That is why our priority is to stem the flow of resources away from primary care, shift the focus of the NHS from hospital to community, and begin building a much better neighbourhood health service. Our objectives are to hire more GPs, reach an agreement on a new contract, rebuild surgeries through increased capital spend, and bust the bloated bureaucracy that has built up. In the summer, we committed to bringing in an extra 1,000 GPs through the additional roles reimbursement scheme, which we backed with an extra £82 million of funding after changing a technicality that prevented primary care from hiring more new doctors. We have surpassed our initial target and 1,500 more GPs are now serving patients on the frontline. Since we took office, I am happy to confirm that 11 have been recruited by Dorset ICB, including, as I understand, three in the hon. Member’s constituency. In conclusion, we are committed to shifting the NHS from hospital to community and to building a neighbourhood health service. We are bringing back the family doctor.

One of the issues is that since the branch surgery was closed, Christchurch medical practice has reduced its number of full-time equivalent GP doctors. There used to be 10.7 and now there are only 10.2, which may be part of the problem. Surely it must be in the interests of the Government, the taxpayer and everybody else to allow a branch surgery to reopen, at minimal additional cost, to the benefit of 4,500 people in the Christchurch area.

As I said, decisions about how the additional costs are borne and the resilience of the rest of primary care in the area are for the ICB. It has been very clear that that is not the case, so the hon. Member may want to take it up with the ICB. Since we came into office, we have been doing the hard yards of restoring the role of general practice at the heart of our health service, including in the hon. Member’s constituency, by investing in people, places and programmes that cut bureaucracy. We are laying the foundations for an NHS that is fit for the future, particularly based around primary care and neighbourhood health centres. Question put and agreed to.

11:29:00