Primary Care: Patient Access

Mr Speaker, I associate myself with your remarks about the war in Ukraine. I know the whole House stands with Ukraine as it defends its freedom and democracy. This is precisely why the Prime Minister’s leadership at the G20, and in other international fora, is vital in standing up not just for our national interests but for our values across the world. Over the past decade, the Conservatives’ mismanagement has left the NHS with 1,400 fewer full-time equivalent GPs than in 2015, hundreds of practice closures, the loss of over 1,000 community pharmacies, and NHS dentistry a distant memory, which is why this Government took immediate action to employ 1,000 more GPs. Through the additional roles reimbursement scheme, through the Chancellor’s Budget measures and through our 10-year plan, we will shift the focus of healthcare out of hospitals and into the community.

In my Makerfield constituency, Wigan council and my local NHS trust are working closely together to pioneer a health system focused on prevention and delivered through neighbourhood health centres, but they need help. What is the Secretary of State doing to improve access to primary care, especially data-driven preventive care, through neighbourhood health centres?

I agree with my hon. Friend on the importance of prevention at a local level. We are trialling neighbourhood health centres across the country to bring together a range of services, ensuring that healthcare is closer to home and that patients receive the care they deserve. This is part of our broader ambition to move towards a neighbourhood health service, with care delivered close to home. I would be delighted to meet my hon. Friend to hear more about what is going well in his community and what further action we need to take.

Does the Secretary of State agree that access to primary care is hugely important to supporting accident and emergency departments at hospitals like the Princess Alexandra in Harlow? Does he also agree that access to primary care is about not just GPs but dentists? Finally, what are the Government’s plans to support dental surgeries such as the aptly named Harlow dental surgery, which I visited last week?

My hon. Friend is right that many of the pressures on our hospitals, such as the Princess Alexandra in Harlow, are a result of pressures in other parts of the health and social care system. It is outrageous that the biggest reason for five to nine-year-olds presenting to hospital is tooth decay, which is why we need to get NHS dentistry back on its feet, along with the rest of the NHS. My hon. Friend the Minister for Care and I have regularly met the British Dental Association since the general election to consider how the dental contract can be reformed to retain dentists and rebuild NHS dental services.

In my local area of Cambridgeshire and Peterborough, GPs are reporting feeling increasingly burnt out, with working conditions becoming more extreme. The number of patients per fully qualified GP in my area has increased by nearly 400 since December 2016, a higher increase than the national average. Can the Secretary of State tell me what his Department is doing to make the situation more sustainable while improving access to primary care?

General practice is a valued part of the NHS, and GPs are a vital part of our NHS family. In fact, they are delivering more appointments than ever before, and we recognise the significant pressures they face. At the same time, we know that patients are struggling to see their GP, which is why we have invested an additional £82 million into the ARRS to recruit 1,000 more newly qualified GPs this year. This will take pressure off general practice, and we will be announcing further budget allocations in the not-too-distant future to set out what further support we will provide for general practice.

I call the Chair of the Health and Social Care Committee.

Last week, I visited Summertown health centre. Staff there implored me to say to the Government that the issue is not just more money—we welcome the £100 million that has been allocated for capital investment in primary care—but the snarled-up process at integrated care board level and getting investment to the right places quickly. What will the Secretary of State’s Government do to ensure ICBs deliver that money to where it is needed, and fast?

The Chair of the Health and Social Care Committee is right that investment is vital, but so is reform. We tasked ICBs with leading the development of the new neighbourhood health service. We are removing their responsibility for performance management of trusts in order to free up their focus, so that primary and community services have the attention that is desperately needed. In the coming weeks, we will be talking to the British Medical Association and the Royal College of General Practitioners about how we ensure the investment announced by the Chancellor leads to improved patient care and a reformed neighbourhood health service.

Goff’s Oak, in my constituency of Broxbourne, has seen a lot of development. What steps is the Secretary of State taking to ensure that GP surgeries are delivered before hundreds of new homes are built?

Of course we need to deliver both new homes and GP surgeries, but the previous Conservative Government delivered neither. We have a housing crisis and an NHS crisis in this country; I would have thought Conservative Members might have shown some humility and responsibility for those facts before challenging a Government who have been in office for only four months.

In Cornwall, only 25% of delayed discharges from hospital are because of lack of social care packages, with the remainder involving the significant degree of support needed from primary and community NHS services. The Royal College of Nursing has pointed out that there has been a 45% reduction in district nurses in the last decade, so what can the Government do to replace those essential roles at a primary care level?

The hon. Gentleman is right. Last weekend, I was up in Middlesbrough with local Members, where we saw a great example of hospital at home delivered by the community nursing team and the community health trust. We have to do a lot more in that space to ensure we provide care closer to peoples’ homes—indeed, often in the home—keeping them out of hospital and close to home, which is better for them and better value for the taxpayer.

I call the shadow Minister.

The Royal College of General Practitioners has said the national insurance tax increase is expected to cost 2.2 million appointments. We know from answers to written questions that have been submitted that GPs, hospices and care homes are not exempt from the increases, and will not find out until April what, if any, mitigation will be put in place, so cutbacks are now being planned. Will the Secretary of State explain how his choice to tax GPs will increase GP access?

I can reassure health and care providers that we will be setting out allocations long before April next year. I recognise that people need to plan ahead of the new financial year. When deciding allocations, we take into account the range of pressures on different parts of the system. People have heard what I have said already about the need to shift out of hospital into primary and community services. The shadow Minister talks about choices; Conservative Members seem to welcome the £26 billion investment, but oppose the means of raising it. I am afraid they cannot do both. If they support the investment, they need to support the way in which we raise the money; if they do not support the way in which we raise the money, they need to spell out how they would raise it or be honest about the fact that if they were still in government, they would continue to preside over a mismanaged decline.

One GP described the situation as “Schrödinger’s primary care”: GPs are seen as private contractors, so not exempt from the NI increases, but they are exempt from the small business relief because they are deemed to be “public”. Did the Department of Health team knowingly go along with the Treasury team’s plan to tax primary care without mitigation, leading to cuts? Or did it not understand or spot the complexity of what is going on, so mitigations have to be put in place now? Which is it?

I was terribly impolite; I should have welcomed the shadow Minister to his place in response to his first question. Conservative Members seem to welcome the £26 billion investment and are happy to tell us how it should be spent, but they oppose the means of raising it. They cannot do all those things. They need to be honest with the country: either they support the investment in the NHS or they say they would cut it. Which is it?