Access to Dentistry: Somerset

Rachel Gilmour Excerpts

Tuesday 1st April 2025 Westminster Hall

[Anna Sabine]

I totally agree. I was coming on to say something similar: the roll-out of the 700,000 extra urgent appointments is a positive start, but it covers less than a third of the need for urgent care appointments. The Government must put more money into dentistry so that people can get the help they need.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

The area around Minehead, in my constituency, has the smallest number of dentists in the country. Does my hon. Friend agree that the fact that the area is both rural and coastal presents a unique set of problems because of deprivation and neglect, which means that the dental desert there is felt very acutely indeed?

[Anna Sabine]

I absolutely agree. Given the time limitations, I have not come on to discuss the challenges that places such as Somerset face due to their rurality, including the difficulties in getting to services, but my hon. Friend is absolutely right.

The BDA’s asks and policy proposals are clear: the Government must invest in dental services and secure a long-term funding settlement for NHS dentistry that keeps pace with demand, and budgets allocated to NHS dentistry must be ringfenced. The BDA also agrees with the Liberal Democrats that NHS dental practices must be offered relief on the national insurance contributions rise announced in the most recent Budget. The Lib Dems believe that such relief should be extended to the wider health and social care sector, including GP surgeries, care homes, hospitals and pharmacies.

Parents and families across Somerset are crying out for extra support with accessing affordable and reliable dentistry, and access to an NHS dentist should be guaranteed to everyone needing urgent and emergency care. To catch up with the national average, Somerset needs extra investment, and it needs it quickly.

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[Stephen Kinnock]

I take the hon. Gentleman’s point about the ringfence, but in a way, ringfencing addresses the symptoms, rather than the cause, of the problem. The fundamental cause of the problem is the amateurish way in which the previous Government set up the NHS dentistry contract so that it does not incentivise dentists to do NHS work. That is what leads them to drift off. In a sense, we can do all the ringfencing we like, but if the workforce that we need is not incentivised to do the work that we need them to do, we are going to have that problem, because they vote with their feet. That is why the radical overhaul of the dentistry contract is the key point. However, I agree with the hon. Gentleman that once we have got a contract that works, we must ensure that every penny that is committed to NHS dentistry is spent on NHS dentistry, rather than the absurd situation that we have now, in which we constantly have underspends in the NHS dentistry contract while demand for NHS dentistry goes through the roof. It is a truly bizarre situation.

I return to the subject of the dentistry recovery plan. The new patient premium, introduced by the previous Government, aimed to increase the number of new patients seen, but that has not happened. In reality, since the introduction of the previous Government’s plan, there has been a 3% reduction in the number of treatments delivered to new patients. It is clear to this Government that stronger action is needed, and we are prepared to act to stop the decay.

[Rachel Gilmour]

In Minehead, in my constituency, a dental surgery responded to the ICB in October and said that it would provide 12 NHS appointments a week for people who currently do not have a dentist. I have chased that ICB on five occasions, but we still do not have a result. That is 48 appointments a month that my constituents are missing out on. Would the Minister please agree to write a letter, on my constituents’ behalf, to the Somerset ICB?

[Stephen Kinnock]

We are very keen to ensure that targets are being met, and the ICB clearly needs to ensure that that is happening, so I would be happy to do that. Perhaps the hon. Lady could write to me so that we can get all the facts on the table, then we can take action accordingly.

We will make the difficult decisions necessary to restore NHS dentistry to ensure that patients can access the care that they need, at the best value for taxpayers. Since coming into office, we have focused on implementing new initiatives and stopping the things that are not working. From today, 1 April 2025, the public will see 700,000 additional urgent dental appointments being delivered every year, as we promised in our manifesto. The urgent appointments will be available to NHS patients who are experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Somerset integrated care board has been asked to deliver 13,498 of those appointments. That is 13,498 more chances for the hon. Lady’s constituents to get the urgent dental support that they need, every single year.

Across the south-west region, there will be 106,776 extra appointments—that is more chances for patients in urgent need of care. However, to have a truly effective dental system, we cannot focus just on those who are already in pain; we must have a system that prioritises prevention. A cornerstone of the Government’s mission to prevent ill health is supporting children to live healthier lives. We want to ease the strain on the NHS and create the healthiest generation of children ever. As colleagues will be aware, too many children are growing up with tooth decay, which is largely preventable. That is why we have invested £11.4 million to roll out a national supervised toothbrushing programme for three to five-year-olds that will reach up to 600,000 children a year in the most deprived areas of England.

The latest data shows that the rate of tooth decay for five-year-olds in Somerset is 20.2%, which is lower than the 22.4% for England but still far too high. We are taking a targeted approach to support those in the most deprived areas, which is why we have been able to allocate £50,000 of funding to Somerset to support around 2,000 three to five-year-olds. Our additional funding will help to secure and expand supervised toothbrushing based on local needs. This is extra resourcing to support targeted work by the local authority and its partners.

I am determined that we will reduce inequalities faced by children living in the most deprived areas, helping them to brush their teeth daily in the nurseries and schools that they attend. Alongside this, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. This is of incredible value for the taxpayer, and a fantastic example of how business and Government can work in partnership for the public good.

A strong dentistry system needs a strong workforce. We recognise the incredible work that dentists and dental professionals do, and we know that the current NHS dentistry contract is not fit for purpose. We need to build an NHS system that works for patients and their dentists. A central part of our 10-year plan will be workforce, and we will ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities. We will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade, and to treat patients on time again.

We know that some areas face challenges in recruiting and retaining the dental workforce they need. The golden hello scheme offers 240 dentists a £20,000 joining bonus to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in these areas as we speak.

Accessibility of Radiotherapy

Rachel Gilmour Excerpts

Tuesday 4th February 2025 Westminster Hall

[Tim Farron]

Yes. By definition, almost all of the radiotherapy deserts—those places that are beyond sensible and safe travelling times—are rural communities. As a result, they have terrible public transport. It is not just about the cost. The increase in the bus fare cap is hugely damaging, but for many of our communities—my hon. Friend’s and mine alike—it almost does not matter what the bus cap is; if there is no bus to spend the fare on, people are stuffed, really. That has a huge impact on their cancer outcomes, which means whether they survive or not.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

Could the reason that radiotherapy is used in only 35% of cases, rather than 50% of cases, be that local transport just does not exist to take people to have the treatments that they need?

[Tim Farron]

My hon. Friend makes a good point. There is a combination of reasons, which I will come on to in a moment, but distance from treatment is undoubtedly the critical point that decides whether people can access and take advantage of lifesaving and life-prolonging treatment.

NHS Backlog

Rachel Gilmour Excerpts

Monday 6th January 2025 Commons Chamber

[Dr Johnson]

I will not, because I have a time limit.

I was pleased to hear that the Government will continue many Conservative initiatives, such as expanding the surgical hubs programme and extending the work of community diagnostic centres, but some of the other parts were a little confusing. Patients are to have a choice of where they are treated, but they already do. They are also to receive text messages to remind them of appointment times. That is great, but it is already happening. In fact, a look back through my phone revealed that the earliest text message I could find reminding me of an appointment for my child at Peterborough city hospital was sent on 28 July 2015, so this is not a new initiative. Patients are to get results online. Well, again, they already do. If the Minister has not seen that, I urge her to visit Addenbrooke’s hospital, where, via the MyChart system, patients can already log on and read their MRI or blood results or reports. Spreading good practice is to be welcomed, but it is not a revolution. It also faces significant headwinds.

The Government are to direct activity to general practice, but GPs are already rather busy and facing financial challenges caused by national insurance contributions. How will shifting pressure improve capacity? When will GPs be able to budget? Will the funding settlement be greater than their increased costs from national insurance contributions? If resources are moved to general practice, how will that deliver more secondary care appointments? One person can only do so much work. What is the Government’s plan for the workforce, which will be so key?

Of course, it is not just GPs who are affected by the national insurance contributions. The Secretary of State talked about record investment in hospices, but before Christmas the Minister was repeatedly unable to say whether that record investment would cover the rise in national insurance contributions that those same hospices are facing. Can she update the House now?

Patients are to have the choice on whether to have follow-up appointments, which will apparently reduce a million unnecessary appointments every year. Will that be a choice for patients to have a desired follow-up appointment that is not recommended by clinical staff—in which case, that could actually increase the number of appointments required—or will it be a choice not to have an appointment that a doctor or clinician has recommended? In that case, is that wise?

It is cold outside, Madam Deputy Speaker. In fact, this morning I woke up to blizzard conditions at my window. What estimate has the Minister made of the number of extra admissions that have occurred this winter for elderly patients who have been cold due to the removal of their winter fuel allowance?

[Rachel Gilmour (Tiverton and Minehead) (LD)]

Will the hon. Lady give way? She has heard me.

[Dr Johnson]

I have heard the hon. Lady but will not give way, because the Deputy Speaker has been clear about the time constraints in the debate.

Has the Minister made an estimate of the number of extra admissions caused by elderly people who are cold due to the removal of the winter fuel allowance, what impact that is having on hospitals, and how many elective appointments that would otherwise have occurred have been cancelled as a result? We heard the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talk about his cancelled ENT list from this morning.

We have had six months of a Labour Government. They have cancelled the building of 24 hospitals, they have launched a series of reviews, they have significantly increased costs on indirectly provided NHS services because of national insurance, and they have re-announced what has already been happening, in some cases for many years. I am a doctor and I am a patient, and I really want the Government to succeed in improving the NHS; we all do—we have heard too many troubling tales from our constituents and again this evening—but stating aims does not make them happen, and launching reviews and press releases is simply not enough.

Community Pharmacies: Devon and the South-west

Rachel Gilmour Excerpts

Tuesday 17th December 2024 Westminster Hall

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I beg to move,

That this House has considered Government support for community pharmacies in Devon and the South West.

I am delighted to have secured my first Westminster Hall debate. It is an honour to speak under your chairmanship, Mr Betts. At a time such as this, when we repeatedly hear from the Government and our communities that the national health service is under strain, is heading into yet another winter crisis and is struggling with capacity, community pharmacies need the greatest consideration for further Government support. I will start by focusing on the role of pharmacies in our society, and then I will outline the challenges and end on what we might be able to do with the right support and engagement.

I wish to thank all pharmacists and their staff in Tiverton and Minehead for the invaluable work they do day in, day out. In particular, I commend Neil and Anna, who have run Bampton pharmacy in my home village for decades, and have, along with the owners of Wiveliscombe pharmacy and Alcombe pharmacy, provided me with first-hand, real-life insights into the challenges they face.

The 15 pharmacies in my constituency of Tiverton and Minehead provide a vital service to their communities —something they share with every pharmacy across Devon, Somerset, the south-west and, indeed, the whole of the United Kingdom. As I am sure we will hear from other hon. Members, pharmacies are under threat from the economic environment in which they now operate. Core pharmacy funding has decreased in real terms by more than 30% since 2016, and costs have gone in exactly the opposite direction. The number of pharmacies open in England is lower than it has been in any year since 2008-09, even though their workload is 40% higher, in terms of annual prescriptions.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I thank my hon. Friend for securing this really important debate. As she was laying out, community pharmacies face large funding gaps, but the rate of pharmacy closure is Glastonbury and Somerton is nearly double the national average. Does she agree that the Government should commit to publishing the independent economic analysis commissioned by NHS England in early 2025, when the work is concluded? Does she also agree that we must reform community pharmacy funding and put in place a sustainable, long-term funding model?

[Rachel Gilmour]

I agree with both courses of action, and I thank my hon. Friend very much for that important and interesting contribution.

The increase in workload is not sustainable, but that workload is too important not to receive proper backing from central Government as they make headway on their ambition to create what they have referred to, on occasion, as a neighbourhood health service.

Being a Devonian, I would like to go through things logically. First, I will talk about prescriptions. In Tiverton and Minehead, each pharmacy dispenses an average of 7,540 prescriptions every month. Across all 15 pharmacies, that is an average of 113,175 prescriptions each month across the constituency. That is 20,000 more prescriptions each month than the House of Commons Library says there are people in the entire constituency. Prescriptions that provide life-altering medications for constituents are the front door to the work of pharmacies. They are what most people think pharmacies do most often, but our pharmacies do a lot more work in our villages, towns and cities.

[Ann Davies (Caerfyrddin) (PC)]

It matters not whether the community pharmacy is in Devon or my constituency of Caerfyrddin; drug tariffs, which put such a strain on our pharmacists, need to be reviewed, and an uplift is long overdue. Would the hon. Member agree that we need to highlight that financial shortfall to the Government, and that something needs to be done immediately?

[Rachel Gilmour]

I agree that we need to do that as often as possible. I will move on to the workload. This is not a typical example: along with prescriptions, in Tiverton and Minehead each pharmacy conducted 398 flu vaccines on average during the 2023-24 season, higher than the national average of 355.

If Members are unfortunate enough to need their blood pressure checked, they can go to a pharmacy. Across the UK, 930,000 hypertension blood pressure checks are undertaken in just one year. With public health as a driving mission for the Government, I would hope that this was something they could support wherever it takes place. Pharmacies also offer a range of other clinical and public health services, including providing flu and covid-19 vaccinations, and if further services were to be commissioned from community pharmacies in the context of sustainable core funding, the sector could do even more to improve access to primary care.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this debate forward. She has touched on the issue of funding. In Northern Ireland, we have already made that commitment as it is a devolved matter; an additional £15 million has been set aside for community and GP pharmacies, with extra money beyond April 2027. We all want to achieve what the hon. Lady wants, but does she agree that to achieve that the Government and the Minister have to invest accordingly?

[Rachel Gilmour]

I do agree. In addition to delivering formally commissioned services, pharmacies provide an alternative point of contact for the public for informal clinical advice. The 2024 pharmacy advice audit found that the average pharmacy carries out around 22 informal consultations per day, which is the equivalent of 1.3 million informal consultations taking place in community pharmacies every week.

[Steve Race (Exeter) (Lab)]

I congratulate the hon. Member on securing the debate. From the first day we met we have talked about getting this debate, so I am very pleased that it is happening. I am the chair of the all-party parliamentary group on pharmacy. Does she agree that community pharmacies have a huge amount of potential to support patients with a range of services, which will support the NHS ten-year plan to move more care into the community and help prevent ill health in the first place? That is one of the main roles they can play in the future.

--- Later in debate ---

[Rachel Gilmour]

As the hon. Member knows, I am keen on strategies, particularly the one that he has just mentioned.

Pharmacies are not paid for the informal advice sessions. In over half of such occasions, if the patient had not been able to access their local community pharmacy they would have instead visited their GP surgery. That suggests that we have freed up 37.7 million GP appointments over the course of a year simply by patients having access to their local community pharmacy, which speaks to the point that the hon. Member just made.

Such a workload is commendable, but it is not sustainable in the current funding model. That has meant that over the autumn the National Pharmacy Association found that pharmacies are overwhelmingly willing to reduce services in order to protect patient safety and preserve access to pharmacies, if funding is not provided to protect the network. Pharmacies do not want to do that; they know the impact that reducing their services can have on a community, but if the other option involves continuing in an overstretched, under-supported environment, for pharmacists and anyone committed to delivering health and health-related services to vulnerable people, it is not a real choice.

[Sir Ashley Fox (Bridgwater) (Con)]

I thank the hon. Lady, my neighbour, for securing the debate. Does she agree that the many benefits that community pharmacies provide are in danger, because in many cases the pharmacist is not reimbursed even for the cost of prescription drugs? Will she, with me, ask the Minister to reply specifically on that point?

[Rachel Gilmour]

I will of course do that.

[Adam Dance (Yeovil) (LD)]

I congratulate you on securing this vital debate. In my constituency of Yeovil, pharmacies provide vital services, including more than 6,700 prescriptions per month—not quite as many as in your constituency, Rachel.

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[Adam Dance]

Will my hon. Friend join me in urging the Minister to provide a clear timeline for the consultation to start?

[Rachel Gilmour]

I thank my hon. Friend for his not particularly concise, but erudite, intervention.

I will turn briefly to the funding model of pharmacies. Some 90% of a pharmacy’s income is derived directly from NHS funding, but when it comes to how that funding is allocated, the system is broken. Community pharmacies across the UK dispense more than 1.1 billion items a year and deal with shortage issues on a daily basis. The Department of Health and Social Care sets reimbursement prices in our system, but due to the reimbursement prices being so low and pharmacies being unable to compete on the international stage, the global market is now a safer bet for pharmaceutical companies than the UK. That means that people in the UK sometimes are not able to get the right medication due to shortages and that even when the DHSC puts together a price concession and allows for a greater reimbursement rate to allow UK pharmacies to compete for those life-aiding medications, there are extraordinary pressures on the NHS and the taxpayer. The realities of the funding model mean that community pharmacies are trying to push up water uphill using tools riddled with holes—in other words, sieves.

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

Does my hon. Friend agree that in addition to the issues with the cost of drugs, the funding model for providing all the other services that pharmacies are expected to provide, including the Pharmacy First approach to avoiding GP appointments, needs addressing?

[Rachel Gilmour]

I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.

The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.

Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.

Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.

[Andrew George (St Ives) (LD)]

Further to the point made by the hon. Member for Exeter (Steve Race), is that not the nub of the argument? If the Government are to make the three shifts—including, importantly, the shift from hospital to community—they must not only stem the loss of pharmacies, but build them up.

[Rachel Gilmour]

I see it as a pyramid, with pharmacies at the bottom, right up to operations and A&E at the top.

According to the CCA, between September 2022 and June 2024 nearly 200,000 hours of pharmacy time was lost due to pharmacies closing their doors permanently. Over 1,000 pharmacies have closed since 2016, with a net loss of 136 pharmacies in the south-west over the last decade—including in Tiverton and Minehead, where we did not have many pharmacies to begin with. The number of pharmacies operating in England is now the lowest since 2008-09. There are reports across the sector of sustained difficulties in even staffing the pharmacies that remain open. The sector cannot sustain these exits, nor can communities where pharmacies are so vital. Pharmacies across the south-west and Devon need proper investment to safeguard and fix our broken pharmacy system, and to ensure that our health system is up to scratch and our social care system is supported.

[Several hon. Members rose—]

--- Later in debate ---

[Rachel Gilmour]

The Health and Social Care Committee reported in May that

“the undoubted potential for pharmacy to improve access to health care, crucially including immunisations, and reduce pressure on general practice and other areas of the health system can only be realised with the right support and the right investment of public funding.”

Why, then, are we not hearing anything from the Government about support for pharmacies? In under a decade, the proportion of NHS funding for pharmacies has fallen from 2.4% to 1.6%. An average pharmacy relies on NHS funding for 90% of its income.

It does not have to be like this. The sector is ready, it just needs backing. We know that pharmacies across the country and the region, and especially in Tiverton and Honiton—whoops: Tiverton and Minehead—are willing to provide these services. Pharmacy First—

NHS Dentistry: South-west

Rachel Gilmour Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

My hon. Friend makes an excellent point. Prevention is clearly cheaper than dealing with the problems down the line. There is no better example than offering check-ups for children’s dentistry.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

I find it absolutely shocking—I am sure my hon. Friend will agree—that the recommendations of a report published 15 years ago by the previous Health and Social Care Committee have still not been implemented.

[Richard Foord]

The hon. Member for Tiverton and Minehead has clearly done her homework. It is quite staggering that recommendations from that long ago are still not implemented.