GP Funding: South-west England

Brian Mathew Excerpts

Wednesday 25th June 2025 Westminster Hall

[Brian Mathew (Melksham and Devizes) (LD)]

It is an honour to serve under your chairship, Dame Siobhain. I thank my hon. Friend the Member for Newton Abbot (Martin Wrigley) for securing this important and timely debate.

I will quote a GP in Melksham and Devizes who also covers part of the neighbouring constituency. He wrote in an email to me this week:

“Without a significant improvement in GP contract payments, the ICB will push us into a position where we have to reduce the hours our surgeries are open. This for us at best means closing sites 1-2 days per week to try to minimise our staff wage bill which is our largest expense. Depending on what happens in 1-2 years, one or more sites would have to close.”

[Claire Young (Thornbury and Yate) (LD)]

My hon. Friend is making a strong case for Three Shires medical practice, which has three surgeries in my constituency. Does he agree that if any of the surgeries were to close, it would be a disaster for patients because of the poor public transport links? Does he agree more generally that it is more expensive to deliver GP services in rural areas because we cannot centralise to save money without dramatically reducing patient access?

[Brian Mathew]

I totally agree with my hon. Friend.

On funding, although the general medical services baseline is around two thirds of our income, it has gone up by 7.2%, with 6% eaten up by the increases in employer national insurance contributions and the national living wage. Our other income streams—dispensing, QOF and enhanced services—have gone up very little. Our emergency section 96 one-off funding has helped us to postpone that decision, and further tightening our belts has stabilised our financial position. However, partner income remains lower than it was two years ago, and it is little more than that of salaried GPs, making reappointment difficult.

Most of the new money is tied to the primary care network, so it is centralised, or it is delivered via the additional roles reimbursement scheme, which is mainly restricted to non-GP roles such as pharmacists. There has been a scheme to allow PCNs, not practices, to employ newly qualified GPs in a temporary capacity—for example, at a central hub practice. That arrangement disadvantages rural practices, as resources are centralised towards urban centres.

At Three Shires, we have reduced our use of locums to cover GP absences by about 60%, resulting in fewer appointments overall. We have allowed retiring nurses and salaried GPs to leave without replacement, or only be partly replaced, to make savings. That has meant offering fewer appointments and greater work for remaining staff. Our patient participation group has been amazing. It formed the Friends of Three Shires, which has fundraised for new equipment, such as ECG machines and examination couches, helping to keep facilities up to scratch for patients.

The integrated care board has effectively imposed a deadline at the end of September for us to demonstrate that we can continue. Would the Minister be prepared to meet me and GPs from my constituency to hear directly from them about the stark realities of rural GP practices, so that they can help?

Dementia Care

Brian Mathew Excerpts

Tuesday 3rd June 2025 Commons Chamber

[Brian Mathew (Melksham and Devizes) (LD)]

I thank my hon. Friend the Member for South Devon (Caroline Voaden) for securing this important debate. In my constituency, an estimated 1,638 people are living with dementia, which is above the national average. However, beyond those numbers are the stories of individual people, each with their own unique experience of living with dementia. Dementia does not discriminate; it can impact anyone, robbing them of their best memories and devastating families and friends in its wake.

I also commend those who dedicate themselves to caring for and supporting those with dementia. I have been lucky enough to meet some of them in Melksham and Devizes. Recently, I visited a branch of the Nationwide bank in Devizes, which has been hosting dementia-friendly sessions and acting as a support hub for those with dementia. It was truly heartwarming to see the friendships and bonds formed between the regular customers and the staff, who have undertaken special training to help them.

However, I must also point out the impact that the hike in employers’ national insurance contributions is having on care providers, including those providing care for people with dementia. The care sector already operates on a razor-thin margin, and these rises have increased operational costs drastically, affecting not only the budgets of the individuals and local authorities who will be picking up the added burden, but hospices, which are being faced with difficult choices over who they can care for and for how long, and how to raise sufficient funds to continue operating.

Hospitals

Brian Mathew Excerpts

Wednesday 23rd April 2025 Commons Chamber

[Brian Mathew (Melksham and Devizes) (LD)]

I fully support reversing the delays to the new hospital programme and want to emphasise the importance of investment in community health provision, which offers multiple benefits to patients and the health service.

There is currently no out-of-hours healthcare provision anywhere in my constituency. Patients typically have to travel to Swindon, Bath or Salisbury for urgent medical treatment or, at best, the minor injury units in Chippenham or Trowbridge. Most of the constituency, including Melksham and Devizes towns, has limited public transport options to get to major hospitals, with patients unable to travel by car facing lengthy bus journeys.

In Melksham, we already have a working community hospital that offers a range of healthcare services, from physio to consultant out-patient appointments, but it has been without a minor injuries unit since 2008. On occasion, people in need of urgent treatment for cuts and broken bones turn up at the hospital only to be turned away without so much as a sticking plaster. That simply is not good enough.

Melksham is seeing ongoing development in and around the town, which is driving population growth, yet we have not seen the investment in services and infrastructure to match. If the long-term strategic goal is to shift more care out of larger hospitals and into community hubs, is there not a clear case to consider expanding services at under-utilised sites, such as at Melksham community hospital? Investment in services, such as in a minor injuries unit at a Melksham community site, not only offer greater convenience and potentially improved outcomes for patients, but is cost-effective, decreasing demand on overstretched services at major hospitals and reducing congestion on our roads.

I very much hope that the Department will consider the compelling case for upgrading community hospitals, and I would welcome the chance to meet the Minister to discuss the specific case for Melksham and to bring representatives from the Friends of Melksham Hospital with me.

Terminally Ill Adults (End of Life) Bill (Money)

Brian Mathew Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Brian Mathew (Melksham and Devizes) (LD)]

Let me start by saying that I am in in favour of the motion, so I will vote for it, if it comes to that. However, would the hon. Member for Spen Valley (Kim Leadbeater) and the Minister consider the inclusion of two social workers on the group, made up of two GPs and a High Court judge, that assesses requests for assisted dying?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Your contribution has to be within the scope of what we are discussing, which is the financial organisation of the Bill.

[Brian Mathew]

I was making a point about the added expense.

[Madam Deputy Speaker]

You need to get to that point very quickly.

[Brian Mathew]

There would be added expense. Social workers are trained in understanding family dynamics, and need desperately to be involved in these situations.

[Kim Leadbeater]

I take that point on board. I had a very productive meeting with the Association of Palliative Care Social Workers yesterday, and we had a useful conversation on that issue.

[Brian Mathew]

I thank the hon. Lady.

Hospice and Palliative Care

Brian Mathew Excerpts

Monday 13th January 2025 Commons Chamber

[Brian Mathew (Melksham and Devizes) (LD)]

I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for bringing forward this important debate, and all hon. Members for speaking with such compassion.

Although the £100 million for hospice capital projects is to be welcomed, it is cash that is most needed. Julia’s House, a children’s hospice in my constituency that has already been mentioned, will find itself out of pocket by £242,000 per year because of the rise in national insurance. Dorothy House hospice, which is also in my constituency, will lose even more. That is a lot of sponsored walks and parachute jumps—perhaps too many—if the hospices are to avoid cutting their services. I urge the Minister to think again, and to provide the funds that our hospices need.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

NHS Dentistry: Rural Areas

Brian Mathew Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

I do agree with my hon. Friend, and I will mention that point later in my speech. It is no surprise to me that children in her constituency are having similar problems to children in my constituency.

According to NHS England, only 33% of adults under the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board have seen a dentist in the past two years. According to a freedom of information request by the British Dental Association, my local ICB’s projected dentistry underspend equates to £4.6 million.

When Hathaway closed its door to NHS patients last Friday, this was a major blow to my constituents.

[Brian Mathew (Melksham and Devizes) (LD)]

Some of my constituents in Melksham and Devizes, who until recently have had an NHS dentist in Chippenham, now find that the service has been stripped away from them. They now have to pay a monthly fee, which totals up to more than £150 a year at a minimum. Does my hon. Friend agree that that and the state of children’s dentistry are becoming a source of national shame? Urgent funding is needed now to revive vital services and to ensure that the oral health of the nation’s children and adults is protected.

[Sarah Gibson]

I agree with my hon. Friend; that speaks to the fact that we are being left with a dental desert, with no sign of relief.