Healthcare Services: Acute, Primary and Community

Baroness Walmsley Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, community and primary care services are at the heart of the Government’s objective in the 10-year plan to shift from sickness to prevention and from hospital to community. But the funding does not always support that.

Over the past nine years, the average increase in spend across health services has been 31% but primary care had only 24%. The patient population has grown by over 7 million since 2015, yet the number of GP practices has fallen by about 20%, leaving some rural areas without accessible cover. I heard a case only this morning of a rural GP who retired from a single-doctor practice; patients had to travel 12 miles to get to the nearest GP and there were no buses. The average list size is now 40% higher than a decade ago. Primary care, including dentists, optometrists and community pharmacists, is part of the prevention agenda yet there are major funding gaps and important aspects of the service suffer.

GPs control the patient’s health records, and their patients have in the past benefited from continuity of care, but this no longer always happens and the benefits have been lost despite evidence that continuity is beneficial and can save money. GPs are the first port of call for patients, the point of first triage or suspected diagnosis and the gateway to more specialised services. If people cannot get to see their GP, as my noble friend Lady Janke said, they eventually turn up at A&E, usually with a much more serious condition and at greater cost to the NHS.

Diet and vaccinations are key aspects of prevention. Some GPs employ dieticians, but nowadays it seems that the main response to obesity is through treatment rather than prevention. These injectable medicines are quite effective but their long-term cost-effectiveness is not yet proven. We need more dietician services in the community. Access to a healthy diet is dependent on many factors beyond the scope of primary care. The Minister will therefore not be surprised that my first question to her, again, is: what progress is being made with publishing the consultation on the healthy food standards? Has the department even established the parameters of the consultation?

GP practices also deliver the core childhood vaccination programme, mostly given by the practice nurses, and they are the most trusted people to answer patients’ questions. But some communities are hard to reach, leading to inequality of coverage. Reaching them costs a lot more time and money, but the benefit of doing so is felt not just by those patients but by the whole community when herd immunity levels can be reached. Dangerously, this is not being achieved, partly through lack of consistent funding. In transferring vaccination commissioning to ICBs, will the Government ensure consistent funding for outreach according to the need in the area?

Midwives, health visitors and school nurses have a role in advising patients about diet and vaccination, but all those services have experienced cuts. Many schools no longer have a school nurse, and newly qualified midwives are not able to find posts. The number of health visitors has reduced by 43% since 2015. This makes it difficult to ask them to do catch-up vaccinations in the home. Does the Minister have any results from the recent pilot on this? All these health professionals have a contribution to the preventive agenda and saving money.

We have all heard of dental deserts and community optometrist deserts. Both could save the NHS money given appropriate levels of funding. The main reason children go into hospital is to have rotten teeth removed. This is because they eat too much sugar and are unable to see a dentist. What is being done to avoid dental deserts?

In eye care, we have the workforce and infrastructure in the community, yet access depends on where you live, which pushes avoidable demand into hospitals. One in four people cannot access a local optometrist and there are 600,000 people on hospital waiting lists, many of whom could have been managed in the community. What steps are the Government taking to ensure equitable access to optometrists across England?

We have a wonderful range of community and primary care services and yet their full potential is not being used to prevent ill health because of underfunding or inconsistent funding. That is very unwise, to say the least.