Rural GPs: Funding

Karin Smyth Excerpts

Wednesday 11th February 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. I thank the right hon. Member for Tatton (Esther McVey) for securing the debate and raising a critical issue that I know is important to many hon. Members. I am pleased to be here on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who is working hard on the issue.

This Government have made primary care a pillar of NHS reform, to make the left shift and put more healthcare into the community. In our 10-year plan, we specifically highlighted our commitment to people in rural and coastal areas, because they have been left behind. As the hon. Member for Chester South and Eddisbury (Aphra Brandreth) highlighted, the infrastructure is appalling in many places, and some of those areas have the worst deprivation in the country. Last week, I was pleased to visit Redruth in Cornwall and talk to a GP practice about the deprivation it faces and the work it is doing. We do understand that, which is why we highlighted it in our 10-year plan.

Over the last 18 months, we have taken a number of measures to increase funding, support our workforce and improve patient access, so that we can rebuild the front door to the NHS and create a neighbourhood health service. It is important to remember that when we came into office 18 months ago, we found GP services in an appalling state: underfunded, understaffed and in crisis. First, we inherited an absurd state of affairs where patients could not book appointments, while GPs could not find work. We took immediate action to put GPs to work so that patients could get the care they need. We promised to recruit 1,000 more GPs through the additional roles reimbursement scheme, and we recruited not 1,000 or 2,000, but 3,000. In the right hon. Lady’s ICB area of Cheshire and Merseyside, there were 102 more GPs on the frontline at the end of last year compared with when we took office.

Secondly, for the first time in more than a decade, we have agreed a GP contract, which means more than £1 billion extra for general practices, bringing total spend on the contract to £13.4 billion this financial year. That is the biggest cash increase in more than a decade. Thirdly, the previous Government left GP surgeries across the country with leaky pipes, falling roofs and buckets catching rainwater. We are investing £102 million to fix GP surgeries this year, and over the next four years, we are committed to investing another £426 million on GP estates and refurbishing neighbourhood health centres. On top of that, ICBs will have £195 million every year to support strategic primary care investments, with a focus on replacing crumbling infrastructure —an issue that many Members have raised today.

I am proud to say we can now see some green shoots of recovery in primary care. According to the Office for National Statistics, patient satisfaction has gone from 60% to 73% since this Government took office. A lot has been done, but we absolutely recognise that there is a lot more to do, especially as GPs become the cornerstone of our neighbourhood health services. Over the course of this Parliament, we will train thousands more GPs. We have already made an additional 250 training places available this year, taking the total to 4,250 places, with plans to expand that further.

Let me turn to the specific points raised by the right hon. Member for Tatton, starting with Knutsford—as she said, we met about that last year. On the medical centre, East Cheshire trust is working on the outline business case, which it needs to submit to the ICB. The ICB needs to be satisfied with the submission, which would progress to a full business case, which would take some time to secure the necessary planning permissions. It also needs to look at how the clinical services work for both the general practice and the trust, and how they will be delivered, while ensuring that it is value for taxpayers’ money and lines up with the overall development that we want to see towards neighbourhood health services.

As I have said to the right hon. Lady and many hon. Members, we expect ICBs to be collaborative and to keep their local MPs up to date and in the loop regarding plans for their constituencies. That is the situation at the moment: the trust is working on the outline business case with the medical centre, which is where that conversation needs to progress.

On the main subject of the debate and the Carr-Hill formula, I must confess that I have seen this over many years in my time working as a manager in the NHS. It is a difficult issue, and one we are taking seriously, particularly when it comes to wider access in rural areas. Rural and remote areas face specific pressures, whether that is recruitment challenges, longer travel times or population fluctuations for various reasons, including tourism in some places. That is why the previous Labour Government introduced the formula in 2004, but we believe the formula is no longer fit for purpose today.

A lot has happened in those 20 years and the research underpinning the formula was done in the 2000s, which means that so-called workload coefficients were estimated on the basis of data that may reflect clinical practice, such as patterns of home visits, from as far back as the early 1990s. Clinical practice and population health have changed markedly since that time. GP practices serving more deprived areas receive 9.8% less funding on average per needs-adjusted patient than those in less deprived communities. That is despite having greater health needs and significantly higher patient-to-GP ratios.

We are asking experts to help us to design a formula that reflects patient need more accurately, working on the principle that funding for core services should be distributed equitably between patients across the country. Deprivation is a factor, but not the only one. Let me be clear, this is not about taking GPs away from urban areas or robbing Peter to pay Paul. It is about ensuring that funding is fairly distributed.

The right hon. Lady rightly said that the review is being conducted by the National Institute for Health and Care Research. The review team has already engaged with partners at the Royal College of GPs, the general practice committee of the British Medical Association and the NHS Confederation, among others. Although I cannot pre-empt the review, the point is to ensure that funding is targeted towards areas that need it most. That means considering a broad range of factors relevant to the delivery of primary care services, including difficulties delivering services in rural areas, as she and others have outlined. We expect the first phase of that to conclude in March.

We will then see whether there is a need for further work to technically develop and model any proposed changes to the formula. In response to the right hon. Lady’s question, we will of course look to understand the impact of any changes to the current formula on practices across the country ahead of implementation. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg, will update the House on the progress and outcomes of the review in the normal way.

Lastly, although many hon. Members will know this, it is worth highlighting that some 40% to 50% of GP practice funding is currently not determined by this formula. The income into GP practices is based on a number of other areas as well. We will obviously develop our neighbourhood health services in future, so we need to take notice of all those factors.

I want to comment on the point that the right hon. Lady raised about analogue and digital. That is a key part of our 10-year plan. As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), said last week, wherever people live in our country, they deserve the same access to healthcare as everyone else. Wealth should not determine health, nor should a postcode.

I understand the point that the right hon. Lady and others have made—it has been made to me very often—about infrastructure and access, particularly digital. However, using digital based on geography offers huge potential to fight inequalities. For example, because of the online services for GPs that we launched in October, patients can now contact GPs through online services to request an appointment or raise a non-urgent query, which is in addition to telephone and in-person requests. That is tackling the 8 am scramble that we committed to addressing when we came into power, so that patients no longer have to wait by their phone to call GPs at a time of day when many go to work or get their kids ready for school.

The right hon. Lady correctly says that rural communities largely have older populations. We want to be digital by default—and many older people are very digital—but human where it matters. That means that people in rural areas and elsewhere will still be able to use the phone if they want to, and they will not be waiting nearly as long because the other phone lines are being freed up. We are seeing real progress in that area.

When we came into government, the front door of the NHS was hanging off its hinges. In these 18 short months, we are seeing the green shoots of recovery in general practice and recovery and reform in primary care. Our plan for change is creating a neighbourhood health service that puts GPs at its heart, so that the NHS is there for everyone, wherever they need it. We know that is not going to be easy and we want to work with it to develop that. I hope that today we have set out how we are trying to get there. Yes, there is more investment, but there is also fundamental reform, and my hon. Friend the Member for Aberafan Maesteg will be happy to keep in contact with Members as we progress this issue.

Question put and agreed to.