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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Minister for Secondary Care (Karin Smyth)
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.
Karin Smyth
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.
Sir Christopher Chope
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?
Karin Smyth
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.
Sir Christopher Chope
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.
Karin Smyth
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.