GP Funding: South-west England

Martin Wrigley Excerpts

Wednesday 25th June 2025 Westminster Hall

[Martin Wrigley (Newton Abbot) (LD)]

I beg to move,

That this House has considered GP funding in the South West.

It is a pleasure to serve under your chairship, Dame Siobhain. GPs are the front door of the NHS. They diagnose and treat illness, prevent disease and provide vital mental health support. As Lord Darzi once observed, general practice displays “the best financial discipline” in the NHS family while constantly innovating to keep patients out of hospital. However, GP funding is complex, obscure and insufficient. The bottom line is that the amount of money GPs receive is insufficient to deliver the obligations they carry. That is a view held by every single one of the 28 practice managers I met in and around my district, who tell me the situation is unfunded, unsustainable and unsafe.

GP funding is broadly based on two elements: a so-called global sum for core service costs, and additional quality and outcomes framework payments. The global sum starts with a payment per patient per year of £121.79—that is less than we might pay for our dog to go to the vet for an annual check-up, or about a third of the cost of servicing a Renault Megane. It is no wonder that practice managers spend their evenings juggling spreadsheets simply to keep the lights on.

It gets worse. That paltry sum is then modified by something known as the Carr-Hill formula. Carr-Hill was designed for a different era. It weighs patient numbers and postcodes but underrates deprivation, multimorbidity and today’s population health priorities. The consequences are stark and deliver what is known as the inverse care law. In my constituency, the Buckland surgery looks after some 4,000 patients on its list but is effectively funded for 3,200.

[Will Stone (Swindon North) (Lab)]

The hon. Member talks about the number of patients that GP practices have on their books. We have an ambitious plan for building more houses. Does he agree that we need to consider not just existing GP practices but funding the infrastructure for future practices, so that we have adequate services for people? There are places in Swindon that will be expected to take on thousands more patients, and the infrastructure is simply not there right now.

[Martin Wrigley]

The hon. Member is absolutely right: we have to consider these things. I have spent many hours persuading my local hospital trusts and the integrated care board to talk to the local authorities and work in the cycles of the local plan, so that they get their requirements into that plan. All too often they say, “A new housing development has just been built. We need a new GP practice with it,” and that is too late. The cycles do not add up. The system is broken, and we need to change that.

The Buckland surgery is underfunded by some 800 patients every year. It is part of the Templer primary care network, in which 2,500 patients are effectively treated for nothing. This means that the Buckland practice faces an annual shortfall of approximately £84,000—money that would cover another GP. If we then look at the changing number of patients per GP, in 2019 each GP was supporting 1,800 patients, compared with around 2,400 today.

[Sir Ashley Fox (Bridgwater) (Con)]

My constituents tell me of their difficulty in getting an appointment with their GP. Does the hon. Member share my view that GP practices should get a bigger share of NHS funding, which would enable them to improve the health of our constituents? And does he share my concern that much of the extra money allocated by the Government risks being swallowed by increased national insurance contributions, inflation and pay awards?

[Martin Wrigley]

Practice managers tell me that that has already happened and they are less funded now than they were last year.

On the changing numbers, each GP was supporting 1,800 patients in 2019 and is supporting 2,400 today, but safe care is often estimated to be closer to 1,400 per GP. So we are overloading GPs with patients. Practices make heroic use of pharmacists, physios and nurse practitioners, but the arithmetic does not add up. Meanwhile, the other part of their funding, the quality and outcomes framework scheme, has faced changes that have negatively impacted primary care. This meant that, nationally, £298 million was redistributed from the QOF into the global sum—we can see how bizarre this funding set-up gets; the names are just weird—and into cardiovascular disease prevention funding. Another £100 million of funding was repurposed but does not put extra capacity into the system. Rather than providing new money to support GPs, this felt to practice managers that the Government had been rearranging the deckchairs.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate. He is right to address this issue—I spoke to him just before his introduction. We have great difficulty across all this United Kingdom of Great Britain and Northern Ireland when it comes to securing GPs for practices. In recent years, I have been trying to ensure, with the health service, that action can be taken regarding the student loans of young medical students, if they give a commitment to remain in a GP practice for a set period of, say, five years. That would enable more GPs to stay in the system. Does he feel that that is something the Minister and the Government should take on board?

[Martin Wrigley]

All those things help, along with things like bringing back nurses’ bursaries. On rearranging the deckchairs, it is no wonder that practice managers described this year’s settlement as unfunded, unsustainable and unsafe.

[Steve Yemm (Mansfield) (Lab)]

Does the hon. Member agree that the increase of over 7% in GP contract funding for 2025-26, which the Government put in place, represents the biggest investment in GPs for more than 10 years? We always want to get more money for GPs and the Government are committed to that, but does he think that the largest increase in 10 years should make at least some difference for his constituents in Newton Abbot as well as mine in Mansfield?

[Martin Wrigley]

I thank the hon. Gentleman for that intervention, but sadly, I must disagree. That is not what practice managers are telling me. Their costs have gone up so much that all of the increase has been swallowed up, and they are not sure they can keep the lights on. They are really struggling. I have partners in GP practices who are paying themselves less than the minimum wage, which is not sustainable.

Patient demand has also increased post pandemic, and continued cuts have seen the removal of many services and social care that have supported what GPs do. On top of the cuts to Sure Start and a 40% drop in health visitors since 2015, carers already stretched thin face the prospect of losing personal independence payment support, which will inevitably rebound on general practice—the first line of defence. That is not to mention long covid and pandemic backlogs. All of those drive more people to want to see their GP. The cost of living crisis is compounding multimorbidity, where the most vulnerable in society with chronic illnesses are further pressured.

And then, we get the new requirement to run the appointment schedule from 8 am to 6 pm, filling every single slot. From October, practices must hold digital front doors, open all day, for non-urgent requests. With 100% booked appointments, there is no spare capacity for the person who falls in the care home or for the child who needs attention after school. Partners in the Albany surgery in Newton Abbot warn me that an unlimited invitation will flood a service that simply cannot be limitless. This is unsafe—unfunded, unsustainable and unsafe.

Talented doctors are leaving. The partnership model, still the cheapest and most community-rooted option, is no longer attractive when partners shoulder unlimited liability for premises, pensions and payroll, yet cannot guarantee safe staffing levels. The Royal College of GPs reports a 25% fall in GP partners over the past decade. The chair, Professor Kamila Hawthorne, put it bluntly:

“It makes no sense that trained GPs cannot find sustainable posts while patients wait weeks for appointments.”

[Ian Roome (North Devon) (LD)]

I thank my hon. Friend for securing the debate. Patients in Lynton, one of the remotest communities in North Devon, will soon have access to a GP, but that only happened because of a spirited campaign by local patients. Does he agree that if we are relying on an active community to highlight gaps in provision, it will always be the marginalised communities who find it hard to see a GP?

[Martin Wrigley]

My hon. Friend is absolutely right. I commend him on obtaining a ministerial visit to his hospital in North Devon. North Devon district hospital is fantastic and we need to ensure that it gets the investment it needs—just so long as we can get some south Devon patients there as well.

In Teignmouth, the previous four practices have merged into one, mostly due to not being able to find new partners. In Newton Abbot, one practice was on the verge of handing back its patient list due to not being able to replace retiring partners. We have not even talked about specific issues facing some of these surgeries, such as the unbreakable lease on a building that is not fit for use as a GP surgery, where the only possible course of action they could see was to declare themselves bankrupt. As doctors, that ends their careers.

And yet, these practices are doing amazing things. The Kingsteignton medical practice, partnering with the charity Kingscare, has created a model that is delivering for patients. Just think what could be done with a better funding model. Buckland surgery would like to link with the local school to tackle adverse childhood experiences before they turn into permanent ill health, providing better family support—much as it has already done with its links to a number of local support services through the Buckland hub.

Prior to the election, the now Health Secretary often quoted that a GP visit cost £40, whereas an A&E visit cost £400. I am not sure I agree with the absolute numbers, but the principle is fine: it is 10 times more expensive to put somebody through A&E than it is to put them through a GP. If we talk to Devon integrated care board on GP resilience and prevention, the evidence is crystal clear: prevention saves money. And yet, as Torbay and South Devon NHS foundation trust remains in NHS operational framework 4—we might perhaps equate it to “unsatisfactory” if it was a school—because of historical deficits, it is tasked with huge efficiency savings and is understandably risk-averse. Community services that once propped up primary and secondary care—the stroke recovery group, Devon Carers hospital service, the Torbay and Devon dementia adviser service—have vanished as funding evaporates. Closing gaps in prevention only widens cracks elsewhere. It is not getting better.

To sum up, the funding formula is broken. It delivers the inverse care law that the availability of good healthcare tends to be inversely proportional to the need for it within a population. We need to fix it. I am asking the Government today to: end the Carr-Hill formula, and make deprivation, rurality and workload properly weighted; invest in core general practice, not just peripheral schemes, so that partnerships remain viable; protect prevention budgets in the next spending round, as it is cheaper to keep people well than to rescue them later; support premises and digital infrastructure so that online access enhances rather than overwhelms safe care; and publish a workforce plan that retains experienced GPs, accelerates training and makes partnership an attractive career again.

[Several hon. Members rose—]

--- Later in debate ---

[Martin Wrigley]

I am not quite sure what to say now that the Minister has actually said that my prime ask will be delivered. That is fantastic, and shows the emphasis of these debates.

I thank colleagues from across the House for their contributions. We all agree on the importance of GPs and the need to fix their funding. It is vital to recognise the many good things that GPs and GP practices have been doing in what have been difficult circumstances for a good number of years.

It has been delightful to hear that MPs have been interacting with their local GP practices to understand the problems with the funding formula. Delighted as I am to hear the Minister announce changes to the Carr-Hill formula, GP funding is still complex. I tried to show how complex it is by focusing on just on two of its elements, but we have heard from other hon. Members that the extra funds are even more complex. The fact that the 7% increase is eaten up by the 6% increase in wages, NICs and so on shows that it is not simple.

I thank the Minister for being here—

[Stephen Kinnock]

Will the hon. Gentleman give way?

[Martin Wrigley]

I have never been interrupted by a Minister before—I would be delighted.

[Stephen Kinnock]

I do not even know whether an intervention is allowed here, Dame Siobhain—this is a revolutionary step—but the hon. Gentleman raised some concerns about the quality and outcomes framework, and I wanted to say that we have retired 32 out of the 76 quality and outcomes framework indicators, reflecting the fact that we agree with him: it was way too complex and there were too many indicators. By retiring those, we freed up £298 million, £100 million of which will go into the global sum, maximising the flexibility for practices to do what is right for their patients. The remaining £198 million will be repurposed to target cardiovascular disease prevention.

--- Later in debate ---

[Martin Wrigley]

I thank the Minister for the intervention. I am not quite sure what the protocol is; I do not think that that has ever happened. This is a most fantastic debate.

Capital investment in GP practices and buildings is welcome, but we have heard from across the Chamber that we need more. The problems with ICBs and the difficulties with trusts that are in NHS oversight framework segment 4 still impact GPs and how their funding works.

I will push my luck, because the Minister has been very generous with his time and very patient with us all: will he meet me and some practice managers to talk about the complexities of managing the practices with such a level of complication in funding, and to see whether the Government can identify further ways of making it easier to run these businesses, so that they can get on with delivering what they are there to deliver: healthcare for the greatest number of people with the maximum possible benefit? That would be helpful. I thank all hon. Members for their contributions.

[Dame Siobhain McDonagh (in the Chair)]

I respectfully say to Members that, while I do not have the power to stop interventions from people who turn up 45 minutes, an hour, or an hour and three quarters into a debate, speaking on a personal level—I am not the most formal of Chairs—I think it very impolite to make an intervention when you have not had the opportunity to hear from other Members. I do not have the power to enforce that, but if I could, I would.

Question put and agreed to.

Resolved,

That this House has considered GP funding in the south-west.

NHS Funding: South-west

Martin Wrigley Excerpts

Wednesday 11th June 2025 Westminster Hall

[Martin Wrigley (Newton Abbot) (LD)]

It is a pleasure to serve under your chairship, Dr Huq, and I congratulate my hon. Friend the Member for Torbay (Steve Darling) on securing the debate.

GP funding is in crisis. I have met representatives of individual practices in my Newton Abbot constituency, as well as the 28 practice managers from around the district. They all have a funding crisis. The recent GP settlement was described to me as unsafe, unsustainable and unfunded.

GP funding is complex, but in essence it has two parts: the global sum and the quality outcomes framework. The global sum is meant to cover basic costs, including salaries, facilities, and so on, and the QOF extra services, but it does not cover any of it. Practice managers across south Devon have told me that the global sum is £121.79 per patient per year. That works out as less than paying to take a dog to the vet for an annual check-up, or about a third of the cost of servicing a modest car, such as a Renault Megane. That sum is also then modified by the Carr-Hill formula, which, perversely, can reduce the sum in areas of deprivation. The Royal College of General Practitioners wrote in an open letter to Government last year that this formula is no longer fit for purpose and has contributed to the widening health inequalities across the country.

Practices in the areas of greatest deprivation have patients with more complex needs, yet they do not receive proportional funding to address those needs. For example, Buckland surgery in my constituency has 4,000 patients, but the Carr-Hill formula reduces the funding to the equivalent for 3,200 patients. Practice managers are juggling numbers to make things work. Some surgeries are short of a full-time GP; just imagine the impact that has on patients. No wonder it is difficult to get an appointment. That is unsafe. The Government have said that from October GPs must offer an open access service; that means that all available slots are booked, so emergency appointments cannot be seen. That is not sustainable.

Hospitals

Martin Wrigley Excerpts

Wednesday 23rd April 2025 Commons Chamber

[Stephen Kinnock]

I thank the hon. Lady for that intervention. Baroness Casey is working at pace to get the commission up and running, and that will be launched this month. On her point about Think Ahead, the fundamental challenge we had with that programme was its relatively high unit costs. We are aiming to ensure that we deliver value for money for the taxpayer—I am sure that the hon. Lady shares that objective. We have to ensure that we deliver a programme for mental health social care work that delivers not only the best possible outcomes for our communities, but the best possible value for taxpayer money.

A lot has been done in the nine months since the election, but there is a huge amount more to do, and this Government are getting on with the job. Alongside the work I have described, the Government are putting record levels of investment into healthcare, with capital spending rising to £13.6 billion over this year and the next. That includes £1.5 billion for new surgical hubs, diagnostic scanners and beds across the NHS estate, as well as new radiotherapy machines to improve cancer treatment; over £1 billion to tackle RAAC and make inroads into the backlog of critical maintenance, repairs and upgrades across the NHS estate; and over £2 billion to be invested in NHS technology and digital. We are also taking the pressure off our hospitals through care in the community, and I am sure the whole House will welcome the fact that we have recruited 1,500 extra GPs on to the frontline.

[Martin Wrigley (Newton Abbot) (LD)]

Coming back to community hospitals, I came to this House to try to save Teignmouth community hospital, which has been under threat of closure because Torbay, its parent hospital, has such a massive maintenance backlog that it cannot afford to maintain both itself and Teignmouth hospital, so it is shutting down community hospitals. In Devon, we have just three principal hospitals: North Devon, which we understand is under pressure, Torbay, which is under pressure, and Exeter. We need the community hospitals. Will the Minister stop Teignmouth hospital from being shut, so that we can maintain it until it can be rebuilt?

[Stephen Kinnock]

These decisions are the responsibility of ICBs, and the ICB is having to balance a range of pressures, as the hon. Member points out, created largely by the neglect and incompetence of the previous Government. It is now a question of ICBs having to cut their cloth to make the finances work with the limited resources they have. I am afraid that is symptomatic of the mess we found when we took over on 4 July.

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

Martin Wrigley Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Martin Wrigley (Newton Abbot) (LD)]

Will the hon. Lady give way?

[Antonia Bance]

I will not—I have only a little time.

It is not just the health system that will take on new costs. Our civil courts are groaning under the strain of years of Tory underfunding, although my right hon. Friend the Justice Secretary is doing a brilliant job of putting our court system back to rights. However, this Bill will impose new unfunded and unknown costs on our courts. It blithely assumes that judges and courts will be available, yet the waiting time for a family court case at the moment is 10 months. That just will not work for the Bill. How much will the extra spending on courts cost?

Oral Answers to Questions

Martin Wrigley Excerpts

Tuesday 19th November 2024 Commons Chamber

[Andrew Gwynne]

We will confirm the 2025-26 local authority public health grant allocations in due course. Local government plays a critical role in delivering the Government’s health mission and driving action on the prevention of ill health. We are committed to working in partnership with local government to tackle the wider determinants of ill health.

[Martin Wrigley (Newton Abbot) (LD)]

T9. I have been shocked this week by all the major GP groups in my constituency detailing their financial situations. They are all close to the edge and are considering the options of bankruptcy, redundancies or handing in their contracts. What urgent respite can the Secretary of State give them?

[Wes Streeting]

I am in no doubt about the state that general practice was left in by our Conservative predecessors. That is why, in making decisions about funding allocations for the year ahead, we are taking into account all the pressures that general practice is under, as we clean up the mess left by the Conservatives.

Access to Primary Healthcare

Martin Wrigley Excerpts

Wednesday 16th October 2024 Commons Chamber

[Martin Wrigley (Newton Abbot) (LD)]

I congratulate my hon. and gallant Friend the Member for North Devon (Ian Roome) on his maiden speech. I start by thanking my long-suffering family, especially my children Zoe, Sam and Emily, who have been truly supportive throughout everything to get me to this place. Let me express my thanks to the amazing team in the constituency who worked so hard to get me here as well.

It is an honour to have been elected to represent my constituency of Newton Abbot, an area that I have called home for some 25 years. I tend to find that people in Westminster either ask, “Where is Newton Abbot?” or they say that they know it well through personal experience. We are on the south coast of Devon between Exeter and Torbay, between the sea and the gateway to Dartmoor with the Rivers Teign and Exe. The constituency name reflects our largest market town, but it could add Dawlish, Teignmouth, Kingsteignton, let alone the many villages from Starcross, Kenton, Bishopsteignton, Abbotskerswell, Ogwell, Denbury, Ipplepen, Broadhempston and many more.

I have been wondering what to tell hon. Members about my constituency. Perhaps the creative and innovative people, including Newton Abbot’s own Ollie Watkins, the members of Muse, or Peter Cross, usually seen at England rugby fixtures with his resplendent cross of St George hat and coat. Or the history of Brunel’s engineering of the coastal railway, today’s mining of ball clay or, previously, the granite used to rebuild London bridge, the British Museum and others, quarried from Dartmoor and transported via the Templer Way—a tramway itself created from granite—all shipped via the port of Teignmouth. Or the story of Dawlish violets, Jane Austen’s visits, Keats’ poem or how Dawlish became the home of black swans. Perhaps the protected shores of the Exe estuary and Dawlish Warren, home to many thousands of wildfowl and wading birds each winter. Suffice it to say, the area is steeped in history, fame and natural beauty. Members will find much more than Devon cream teas and scones—with cream and jam the right way up, of course.

Growing up in a Royal Navy family, we moved around an awful lot. Moving to Dawlish was a natural choice, but I suspect it was also my parent’s influence that caused me to set my sights on this place. In the 1950s, they met in Downing Street when my mother worked in Churchill’s office. My father told us stories of racing to the parking place outside No. 10 in his old MG.

Speaking of previous politicians, I pay tribute to my predecessor, Anne Marie Morris, and her dedication to the constituency. Her maiden speech told of the waves gently breaking over the trains on the Dawlish seawall. The 2014 storm, however, showed us that the force of the sea and the increased storms due to climate change were both serious and urgent. Since then, Network Rail has constructed a new seawall, rebuilt the station and more. However, it was the catastrophic cliff collapse near Teignmouth that caused the longest interruption of rail services, cutting London off from the south-west peninsular. We are still waiting for funds to be confirmed for that work. Climate change is a real and present threat to us on the coast, and we cannot stop it with just flood defences and mitigations. We must do everything we can to reduce the use of fossil fuels and carbon dioxide emissions.

Turning to healthcare, Devon has both an ageing population and fewer hospital beds per head of population than the national average. Local hospitals are falling into disrepair and are often overlooked in the model of care. It was during my first week in this place that I heard from the local NHS trust that it was cancelling the planned new Teignmouth health and wellbeing centre that would have replaced the crumbling hospital. Due to increased costs and a recent cap placed on its capital budget, bizarrely because of revenue overspend, the project was cancelled. The new centre was to have become the home to local GPs and local NHS services. I did write to my pen pal, the Secretary of State, but have yet to hear back.

In the meantime, I am working with the GPs to help them secure a new home and avoid putting primary care for 18,000 patients in jeopardy. Teignmouth hospital is still under the threat of closure, despite housing many NHS and voluntary sector services. Meeting recently with Volunteering in Health at the hospital with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey), we saw how its model of wraparound care had been copied internationally and that Singapore was now rolling it out as global best practice.

As an engineer and a Liberal, I know that we do not need to accept broken systems. We can fix them, and by empowering people we can build a brighter and better future. I will do everything I can in this place to fix systems and help my constituents, and help to protect the beautiful constituency, the environment and its biodiversity as long as I am here.