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Edward Argar (Melton and Syston) (Con)
Thank you for calling me, Madam Deputy Speaker, and through you I thank Mr Speaker for granting this important Adjournment debate. I congratulate the Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), on his well-deserved promotion to ministerial office—it was in very short order, but it is very well deserved. I thank him for being present to respond to this debate tonight, because he has, as I have just indicated, a rather longer journey home to his constituency than I do back to Leicestershire. At the outset of this debate, I should put on the record that I am, of course, registered as a patient at one of the NHS GP practices in my constituency, which I may refer to in the course of this debate.
As every Member of this House will recognise, general practice is in many ways the gateway to the NHS for our constituents. It has the potential to do a huge amount more. Sadly, on some occasions the gateway to NHS services for our constituents is simply to go to A&E, rather than seeking to go to their general practitioner, or indeed rather than using—to the extent that it has the potential to be used—pharmacy as a first port of call, as people can see a pharmacist for some advice in the first instance. For the vast majority of people, though, it is the GP practice that is the route into the NHS and where people go when they are concerned about their health.
I am sure that all Members of the House would recognise the challenges and pressures faced by general practice irrespective of Government in recent years. There are a number of factors behind that. We should not forget the impact of the pandemic, with the changing patterns of attendance that followed it and the increased demand that came immediately after it. We are also seeing the consequences of an ageing population in our country, with people living longer with more chronic conditions.
We also see the increased pressure in many of our communities, irrespective of where they are in the country, that arises from increases in housing development that are not met with increases in the provision of key local infrastructure. This has been especially true in recent years in my constituency, where we have seen huge increased local development without that infrastructure. There is also the prospect of significantly more development.
I am going to talk primarily today about the particular issues in Melton Mowbray and the surrounding villages, as I have indicated to the Minister, as I am keen that he is able to give a pragmatic and helpful response for my constituents. I will also touch on some broader themes and on the provision of general practice in the village of Sileby in my constituency, which also faces pressure and challenges.
Jim Shannon (Strangford) (DUP)
I find in my constituency, and I think the right hon. Gentleman will find the same, that the extra responsibility of filling in forms, such as for personal independence payments, universal credit, employment and support allowance and disability living allowance, falls on the GP. Has he found that providing the evidence for those benefits adds even more to the already large workloads of GPs?
Edward Argar
The hon. Gentleman is right. Although I spent two and a half years as a Minister in the Department of Health and Social Care, I was never the Minister for Primary Care, but I am very much aware, as I suspect Members across the House are, that that is an additional pressure on time for general practitioners. We in government sought to do what we could to reduce that, and to be fair to the new Government, I know the Secretary of State is actively looking at what can be done to further streamline administrative processes to allow general practitioners and their teams to spend more time with patients.
Although my focus is on GP services in Melton Mowbray and Sileby, it is true that all GP surgeries in my area—whether that is the County practice and Jubilee medical practice in Syston, or practices in Thurmaston, Bottesford, Long Clawson and other nearby villages—continue to face huge pressures. It is important to say that these practices really do their best. Their staff—not just the GPs, but the whole teams—work incredibly hard, and I know they care deeply about the service they provide to their patients. In Melton Mowbray especially, they see acute pressure, particularly on appointments: we have just one GP practice for a growing town. Latham House medical practice has over 36,000 patients on its books, making it one of the largest in the country. Timely access to GP appointments is one of the largest regular issues to appear in my constituency inbox, with waits—according to the correspondence I receive—of at least six weeks, and it can be eight or 10 weeks before an appointment is available. Clearly, that is not right.
It is important to say, to be fair to Latham House medical practice, that when my constituents get to see either a nurse, an allied health professional or a GP, they regularly cite in their emails the quality of the care and the kindness shown by the staff. Indeed, we recently saw a Cavell star award given to Debra Gilbert, one of the nurses at the practice, so the team there work hard and are passionate about what they do. In 2024, they saw an average of 6,900 appointments per 1,000 of the population on their list. That is higher than the national average, but I would urge a little caution because that is a crude statistic that does not necessarily comparatively reflect the different demographics of different areas, such as whether an older population or deprivation in an area lead to a higher need. It is important to put on the record that they are doing what they can to try to improve access, but clearly, an increase in provision is needed locally.
Back in 2021, the then clinical commissioning group agreed that it recognised the need for increased provision of GP services in Melton Mowbray. In 2023, the integrated care board continued with that and agreed to explore a second GP practice, recognising the need for it. I believe that was a sensible decision by the ICB, but regrettably, just a few weeks ago in early October, it announced that it was pausing its work to develop such a plan until 2027. I have been around the Department of Health and Social Care and worked with the NHS long enough to know what a pause, sadly, all too often means. In Melton Mowbray, we have seen a pause of six months at the St Mary’s birth centre—a midwifery-led unit—to allow for staffing shortages to be addressed. Four months into that pause, we have yet to see any suggestion of how it might be brought to an end. When I hear the word “pause”, I fear that will run on into something more permanent.
This issue, which is hugely important to my constituents, has been covered extensively and powerfully in the local media—in particular by the excellent local paper, the Melton Times. It is important to say that I am conscious that neither I, as a Member of Parliament, nor Melton borough council—which is equally keen for increased provision and with which I have spoken—or indeed the Minister himself have the power to simply overrule a decision taken by an integrated care board in a local matter such as this. I took through the 2022 Act, so I have a vague recollection of how that works.
That remains a deeply disappointing decision, and, I believe, the wrong one. The value of access to general practice, and the impact that a lack of access has, is writ large. Earlier today, I had one of my regular catch-ups with Councillor Ronan Browne, the leader of the opposition on Melton borough council, who did a lot to get us to the point where we were hopeful of seeing a second GP practice. He set out his deep disappointment about this decision. There is a clear remaining need.
The ICB, in its announcement on reaching its decision, stated that the section 106 payments on which it was aiming to base the provision of capital for the new building were now insufficient. It also stated that slow growth in new registrations, and slower population growth than had been anticipated, were relevant to its decision making. However, that does not help my constituents. I am conscious of the challenges of funding buildings. As the Minister and I have discussed, in a sense—ironic though it may sound—finding money for a building is sometimes easier than the second part of the equation, which is securing the staff, and managing the oncosts to fund that.
I should say that I am grateful to the ICB for its engagement and to Toby Sanders, its chief executive, for his open engagement with me. As I say, he has emphasised that he believes that section 106 payments are not enough, and the ICB has said that it has no funds to backfill that or pay for anything from its own funds. It is important to remember that, as the Minister will be aware, general practitioners and general practices are, in many ways, private businesses contracted to provide services to the NHS, but they are not direct employees of the NHS, so they cannot be directly instructed by the Minister, by ICBs or by NHS England—it is important to put that context on the record.
In respect of the argument by the ICB that there were insufficient increases in new registrations and new patients to justify a second GP practice at this time—noting the pause—I am afraid that that fails to reflect the importance of choice for patients in switching to a different service in their locality if they so wish, and, in so doing, potentially easing pressure on the existing practice’s list. Pausing without a clear alternative long-term plan is simply not good enough.
Latham House surgery has recently announced that it has taken steps to help to address this in the short term. On 15 October, it announced that it was recruiting an extra five GPs and additional nursing staff, that its Asfordby satellite surgery would be opening full-time in the future, and that it was looking to create new provision in a small premises on Sherrard Street in the town. Those are welcome steps for which I am grateful, and I look forward to hearing more about those proposals from the practice, but they do not alter my view on the long-term needs of Melton Mowbray and the surrounding villages. The ICB needs to act and be supported in doing so by the Department of Health and Social Care. It is true to say as well that ICBs face real challenges, including the Government requiring them to force cuts in staff and to restructure, but without seemingly providing them with additional ringfenced funding for the costs of that restructuring, be they redundancies or otherwise. That means that regardless of whether the end is a good one—that is, a leaner ICB—ICBs will potentially have to cut from the frontline in the short to medium term to fund that restructuring.
As I have alluded to, there are also the challenges of oncosts and funding GPs to staff a surgery. GPs have a choice as to where they choose to work, and I suspect the old Carr-Hill formula, which the Minister and I have spoken about in the past, does not aid that. It is a challenge that Governments of all complexions have faced and I hope that he, if he is willing, will take on the challenge of looking at the Carr-Hill formula. He will have my constructive support in doing so. Latham House practice has cited the challenges in securing and retaining staff so I recognise that, but again, those are challenges for the Government and the ICB to assist and support with and not ones that should be borne, as a consequence, by my constituents.
I will briefly mention Sileby, another village in my constituency. It has two good GP practices, but it is a rapidly growing village, and larger premises are needed. Again, the ICB has indicated that it will not have funds to fund or support that and once again, section 106 moneys are likely to be insufficient. It is a real challenge faced by GP practices up and down the country as to how they take that step, often having to accept more patients as houses are built. Even when there is a section 106 payment, it is only triggered later in the process once they have already had to absorb an increase in patients. I hope that the Minister might look at that.
Although I recognise and welcome Latham House’s actions and hard work and I hope that delivers results, I fear it simply is not enough to tackle the long-term needs. The Secretary of State’s new neighbourhood health centre programme may well help us in the longer term. For example, one of those could be allocated to Melton Mowbray, which already has Melton Mowbray hospital—in my view an underused and therefore perfect site, and the Minister can take that as a potential early bid for such a centre. That may help in the long term, but we still need action now for my constituents to improve access and to build for the long term.
I am sure the Minister will know that Melton Mowbray and the surrounding villages and towns are fantastic places with a real sense of community, a proud history, a great present and huge future potential, just like the other parts of my constituency. Melton Mowbray’s residents are good, decent people who need, and frankly deserve, improved access to GP appointments and an increased focus on tackling this for their communities.
Will the Minister set out what steps the Government are taking in partnership with ICBs to help address increased need for access to GP appointments, both nationally and locally? Is he willing to take on the challenge of looking at the Carr-Hill formula and how GPs are funded per patient for their activity? Will he reassure ICBs that all restructuring costs, over and above their current budgets, will be centrally funded to avoid them cutting frontline services? Will he work for better links between section 106 moneys and the needs of healthcare provision locally? Will he meet me, ideally in Melton Mowbray—he is very welcome—to discuss what can be done locally to improve GP provision?
I genuinely hope that he shares my view that Melton Mowbray and the nearby villages not only need further enhancement to existing services, which Latham House is trying to put in place, but genuinely need that second GP practice to meet their future needs. I will continue to campaign on behalf of my constituents for that, but I will also, as I hope he has seen in the brief time we have known each other, be willing to work with the NHS and with any political party that helps facilitate that locally and nationally. Finally, will he agree to work with me and my constituents to deliver the improved premises and services needed to meet the current and future primary care needs of my fantastic constituents in Melton Mowbray and the surrounding villages?
The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)
I thank the right hon. Member for Melton and Syston (Edward Argar) for raising the crucial issue of GP provision. As a relatively junior Member of this place, I have always looked around at the Benches on both sides of the House for elder statesmen and women who are exemplars of how to conduct oneself in this Chamber. He is certainly one of those Members. We miss him on the Front Bench, and we are grateful for all his contributions.
Edward Argar
I am grateful to the Minister for that. The only point I would make is that when, at the age of 47, one is described as an elder statesman, one can see retirement looming. I want to reassure him that I have no intention of retiring or stepping back from my duties in this House.
Dr Ahmed
As a medical practitioner, I can assure the right hon. Member that he is ageing well, and I am sure he has many more years of service to give.
I will now take on some of the challenges that the right hon. Member said faced GP services in Melton Mowbray and Syston. He is knowledgeable—possibly more knowledgeable than me—about the Carr-Hill formula. I can assure him that my hon. Friend the Minister for Care, whose portfolio this comes under, is very engaged in reforming the Carr-Hill formula. I am sure he would be pleased to give an update on how he is getting on with that. The right hon. Member wishes for a meeting with the Minister of State, and I would be delighted to arrange that for him—I am afraid I cannot confirm the location, but I can certainly arrange the meeting.
When asked about their top priority for the NHS, the public overwhelmingly call for us to fix general practice and access to it. That is at the heart of what people care about in this country, and it is what they need first and foremost from their health service. General practice remains the front door to our NHS, delivering vital care to millions across this country, yet we all know the challenges faced by both patients and GPs—the right hon. Member alluded to many of them in his excellent speech: access to appointments, capacity and workforce pressures, to name but a few. The Government are absolutely committed to tackling these issues, to ensure that everyone receives the care they deserve.
Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)
On the subject of capacity, one of the biggest concerns that is raised with me when new houses are proposed for a particular area of Doncaster East and the Isle of Axholme is access to appointments in the future. Can the Minister reassure me and my residents that discussions take place between his Department and the Ministry of Housing, Communities and Local Government on forecasting future appointments, to ensure that everyone gets the support that they require?
Dr Ahmed
That relates to the point made by the right hon. Member for Melton and Syston about section 106 funding. It would definitely be in the spirit of mission-driven government to work collaboratively across Departments—in this case, the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government—to ensure that, as we build the millions of homes that we wish to in the lifetime of this Parliament, we do not neglect the services required to make those homes happy and fulfilling for the communities who live in them.
Timely access to GP appointments is at the heart of a strong and responsive healthcare system. To deliver more appointments, we must have more GPs. That is why, in October 2024, we took decisive action, investing £160 million in the additional roles reimbursement scheme, or ARRS. This targeted funding has enabled the recruitment of over 2,500 new GPs across England, directly increasing appointment availability and improving care for thousands of patients. Our new £102 million primary care utilisation and modernisation fund will create additional clinical space in over 1,000 GP practices. That will enable them to deliver over 8.3 million more appointments, further expanding appointment capacity and enhancing patient care. In our newly published medium-term planning framework, we have also set an ambitious new target for practices to deliver all urgent appointments on the same day, helping to ensure that patients who need urgent care will be prioritised.
This Government have invested an additional £1.1 billion in general practice—the largest such investment in over a decade. This 8.9% boost to GP contract funding for 2025-26 surpasses the overall NHS budget growth, marking a generational uplift in funding, and it means that we are beginning to reverse a decade of a dwindling share of NHS resources going to general practice.
We are not just investing but reforming contracts, giving GPs streamlined targets, incentivising improved continuity of care for those who would most benefit—usually people with chronic illness—and, crucially, requiring practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. That will also free up time for patients who might require an in-person visit or a phone call.
I turn to the GP-patient ratio in Melton and Syston. As a result of our investment, primary care networks in Melton and Syston have recruited an additional 64 GPs through the additional roles reimbursement scheme, bringing patients in the right hon. Member’s constituency the care they need. Today, the median number of doctors in general practice per 10,000 registered patients in Melton and Syston is 6.2 full-time equivalents, which is above the England median of 5.6 full-time equivalents.
I reassure the House that we are listening to patients in the right hon. Member’s constituency and trying our best to respond to their needs. For the first time, more patients are contacting their GP online than by phone. That is why, from 1 October, we extended access to GP online services throughout core hours—8 am to 6.30 pm—making it easier for patients to reach their practice in their preferred way. That is a huge step in delivering our manifesto commitment to ending the 8 am scramble, which has long been a barrier to care up and down the country.
Most importantly, practices already using online systems have gone on to see bigger improvements. If I may talk about London for a moment, one London GP surgery reduced its waits from 14 days to just three, with 95% of patients seen within a week. I turn to digital health, which is transforming access in healthcare in Melton and Syston. Patients can now access their GP through the NHS app. They can use it to book appointments, order prescriptions and even receive rapid online consultations, with AI-supported triage ensuring that urgent cases are prioritised within hours.
The GP patient survey shows that in the right hon. Member’s integrated care board area of Leicester, Leicestershire, and Rutland, the percentage of patients using online GP services has increased from 65% to 73% over the past year. The ICB operates virtual wards as part of its “home first” strategy. It uses secure remote monitoring, which saved 11,000 bed days across Leicestershire in 2024 and enables patients in Melton and Syston to recover safely at home.
The Government have approved a spending review settlement that will bring care closer to the community, shift the NHS from sickness to prevention and from analogue to digital, and ensure that the NHS is more people-centred. We will provide additional funding by 2028-29 to bring back the family doctor by training thousands more GPs, delivering millions of appointments more over the spending review period, and building further on the 2,500 GPs already recruited.
Patient satisfaction needs to be our guiding star. As a result of all our efforts, 8 million more appointments have been delivered this year compared to last, and it is making a difference to patients’ lives. According to the latest health insights survey, 73.1% of patients reported a good overall experience. That is up from 67.4% in July 2024, and reverses years of patient dissatisfaction.
I understand that the development of a new primary care facility in the right hon. Member’s constituency has been a matter of local concern for some time. I am grateful to him for bringing it to the Government’s attention. I have been informed that Leicester, Leicestershire and Rutland ICB is working with Melton borough council to explore options to improve access and extend service capacity for Melton residents. I very much take on his suggestion that it could be a location for a health centre under the Secretary of State’s new programme of neighbourhood health centres; I will certainly pass that on to the Secretary of State.
The ICB is working with Latham House to increase the ways in which the practice can support local residents. Proposals include a new digital suite at the main site, and an approved redevelopment of a property owned by the practice on Sherrard Street to extend clinical services. The ICB and Melton borough council will continue to meet to discuss progress. The ICB will revisit the scheme’s progression in the fourth quarter of 2026-27 to allow more certainty about developer contribution, the impact of new registrations and staffing availability.
Let me talk briefly about industrial action. The Government are firmly committed to supporting general practice, and we want to continue engaging constructively with colleagues in the profession as we shape the future of general practice together. Since coming into office just over a year ago, this Government have made significant strides in supporting general practice, and we are asking our colleagues in general practice not to close the door on patients, but to work with the Government to rebuild the NHS for the benefit of patients in the right hon. Member’s constituency, and indeed the country.
In conclusion, everything that this Government have done since the election has been geared towards saving the NHS and giving it back to the people, primarily through the lens of community and largely through general practice. We are placing power back into the hands of patients—where it rightly belongs—because this is their health service and it must work for them. Ensuring that every patient has access to the care they need is not just a priority; it is a guiding star for this Government. The Government are committed to delivering on that promise. I end by associating myself with the remarks of the right hon. Member about the hard-working staff in GP practices up and down our constituencies, and the quality of care that they provide. I know how hard it is to work in difficult circumstances, and it is this Government’s job to make the working lives of those staff easier, more valuable and more fulfilling. I look forward to working constructively with the right hon. Member, to the benefit of patients and citizens up and down Melton and Syston.
Question put and agreed to.