Access to Primary Healthcare

Karin Smyth Excerpts

Wednesday 16th October 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I beg to move an amendment, to leave out from “Parliament” to the end of the Question and add:

“; welcomes the urgency with which the new Government commissioned Lord Darzi to conduct an independent investigation of the NHS in England; recognises that within weeks of taking office the Government invested £82 million to recruit 1,000 newly qualified GPs; notes the Government commitment to tackle the dental crisis by providing 700,000 urgent dental appointments and recruiting new dentists to the areas that need them; approves the Government’s commitment to expand the role of pharmacies and better utilise the skills of pharmacists and pharmacy technicians; and welcomes the Government’s commitment to further reduce unnecessary bureaucracy as care shifts from hospital to community.”

I recognise that many people want to speak, so I will be as brief as possible. I begin by thanking the hon. Member for North Shropshire (Helen Morgan) for starting this debate. I think she spoke for us all when she said that she spent a lot of time looking for her glasses— I recently decided to go for the varifocal option just to avoid that problem. She also spoke for us all when she said that we all know how great it is when primary care is there for us. I am proud to have worked with primary care across the piece in south Bristol for many years. Although the hon. Lady and I are on opposite sides of the Chamber, I think we can agree that the last Government broke primary care at the same time as they were breaking the NHS.

Throughout my time in opposition, and in my first three months in government, I simply have not met or spoken to a GP, a pharmacist, a dentist or, indeed, anyone else working in primary care who has said, “Everything is going swimmingly. My patients are happy, and this is exactly what I signed up for.” Lord Darzi’s review tells the same story and sets out an enormous charge sheet, and we still have not heard whether the Conservative party agrees or, indeed, whether it will apologise. The list is far too long to repeat in full. Hospital workforces and budgets have shot up, yet full-time equivalent GP numbers have been allowed to shrink by over 1,500 over the last seven years.

Promises to shift resources to the community have been repeatedly broken, and our primary care estate is not fit for purpose. Shockingly, one in five general practice buildings is older than the NHS itself.

[Daisy Cooper (St Albans) (LD)]

The Minister may be aware that I lobbied Health and Treasury Ministers in the previous Government for the best part of a year and a half to review outdated Treasury rules that prevent GP practices that want to move from staying within a city centre—the outdated rules force them to move to ring-road locations, away from the populations they serve. Will the Minister look at this issue with fresh eyes, with her new glasses, and work with Treasury colleagues to review these outdated rules?

[Karin Smyth]

I thank the hon. Lady for her assiduous work in opposition. Looking at the capital estate is one of my favourite new responsibilities, and our commitment to a neighbourhood service means that we need to bring services together. We need to look at this across the piece, to make sure that primary care is provided where it is needed. We often hear about hard-to-reach groups, but I do not think they are that hard to reach. Frankly, services are sometimes located in the wrong area. One of our key commitments is to shift services into communities, and the neighbourhood service programme is part of that.

Just three in 10 NHS dentists are accepting new adult patients, and geographical inequalities are vast. More than 1,200 pharmacies have shut their doors for good since 2017. Again, the record speaks for itself: public satisfaction with general practice has fallen from 80% in 2009 to just 35% last year. If there is any reason why the Conservative Benches are empty, it is because dissatisfaction with access to primary care is so stark, as we learned in July’s general election.

It is absolutely clear that primary care is broken, but NHS staff working in primary care did not break it; the last Government did. They cut funding for the community pharmacy contract, they failed to incentivise enough dentists to perform NHS work, and they pursued a disastrous top-down reorganisation of the NHS, with which we are still living.

The last Government might have broken the NHS, but it is not beaten. NHS staff remain as passionate, dedicated and skilful as ever, and this Government will work in lockstep with them, their counterparts in social care and local partners across the country to fix the NHS.

[Christine Jardine (Edinburgh West) (LD)]

Will the Minister give way?

[Karin Smyth]

I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.

Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will the Minister give way?

[Karin Smyth]

Yes, as that will be one from each side of the aisle.

[Dr Evans]

One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.

[Karin Smyth]

I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.

[Andrew George (St Ives) (LD)]

On that point, will the Minister give way?

[Karin Smyth]

No, I want to move on. I will take one more intervention from the Government Benches at some point and then it is all fair, but I want to allow time for hon. Members to speak.

In our first week, we pledged to increase the proportion of NHS resources going into primary care, and in our first month, the Government made a down payment on that pledge, providing GP practices with their biggest funding increase in years. But we are not just increasing funding; we are also cutting the red tape that stops many staff doing their jobs.

Some GP practices currently have to fill in more than 150 different forms to refer patients into secondary care services. They are spending as much as 20% of their time on work created by poor communications with their secondary care colleagues. That is totally nonsensical in 2024 and it has to change.

Time spent doing needless paperwork and bureaucracy means appointments lost for patients, which is why we have launched a red tape challenge to bulldoze bureaucracy and free up GPs to deliver more appointments. It will be led by Claire Fuller and Stella Vig, established leaders in primary and secondary care. They will check with staff what is working well and what needs to change, so we can take the best of the NHS to the rest of the NHS.

Initiatives like Consultant Connect in south London allow GPs to talk to mental health consultants in real time, reducing the number of referrals they have to make by 40%. Delivered across the country, such schemes could save thousands of hours of time and create thousands of new appointments—that is what our red tape challenge is all about.

We want to help patients see specialists faster. Starting in November, 111 online will pilot directly referring women with a worrying lump to a breast clinic. That means faster diagnosis for cancer patients and more GP appointments freed up, which is better for patients and better for GPs.

On dentistry, as the hon. Member for North Shropshire outlined, we inherited an NHS dentistry system in disrepair thanks to 14 years of chaos, failure and neglect. As we have to keep reminding Conservative Members, it is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds. We all see that in our constituencies. The last Government broke their relationship with the British Dental Association, as they broke so many relationships. During the election campaign, we pledged to meet the BDA immediately upon taking office to start rebuilding the relationship, and that is exactly what we did.

The BDA is right that the last Government’s dentistry recovery plan did not go far enough. We are keeping parts of it that are the right solutions, including the golden hello and some other measures, but we want to go further to deliver an NHS rescue plan that gets dentistry back on its feet. We are working around the clock to end the truly Dickensian tooth decay that is blighting our children. As well as our additional urgent appointments for all ages, we will work with local authorities to introduce supervised tooth brushing for three to five-year-olds in our most deprived communities. We will see the difference getting them into healthy habits can make, protecting their teeth from decay and ending the national scandal the last Government presided over.

On pharmacy, previous Governments dithered and delayed, failing to find a sustainable and long-term funding solution. NHS England is working with the sector to assess the cost of providing pharmaceutical services, and we look forward to seeing its outcome. Consultation around this year’s funding and contractual arrangements with Community Pharmacy England did not make it over the line before the election was called, so we are looking at that as a matter of urgency.

We want to continue to make it easier for pharmacists to take referrals and support people with common conditions, using prescribing skills to treat a wider range of conditions and patients. Pharmacists are highly skilled people in our communities. Allowing patients to get the care they need in the community, saving time and freeing up GP appointments by using the skills of pharmacists, will be really helpful for the wider system.

Those are our first steps. Primary care is central to the three big shifts that underpin our ten-year plan to make the NHS fit for the future, taking it from analogue to digital, from sickness to prevention, and from hospital to community.

We will soon begin a public consultation that will be the biggest listening exercise in NHS history. I look forward to taking part in that and I urge all right hon. and hon. Members, their constituents, and staff across primary care to tell us what is working and what needs to change. We will use their responses to take the best of the NHS to the rest of the NHS and build a neighbourhood health service.

Technology will help doctors, dentists and pharmacists meet demand for same-day appointments, giving patients a digital front door to end the 8 am scramble. Big data will end the cruel postcode lottery of health inequality, so that we can take screening, checks and care directly to the communities that need it most, intervening early to prevent ill health and deterioration. We want colleagues from across primary care to come together with their partners in social care and mental health to work in lockstep, as one team, to treat patients in the comfort of their own homes, which is where those patients want to be. That is the neighbourhood health service that we want to build. That is the future that our constituents want to see.

In the interests of time, Madam Deputy Speaker, I will conclude. Our constituents were let down by the previous Government. They were let down by broken promises, underfunding and a failure to listen to patients and staff. We will repair the damage. We have already begun investing in GPs and pharmacies to fix what is broken. We will cut the red tape, speed up treatment, and build a neighbourhood health service that works for everyone. The NHS may be broken, but it is not beaten. We are determined to rebuild it for our people, our communities and our country.