HCRG Care Group: Performance in the South-west

Sarah Gibson Excerpts

Wednesday 28th October 2026 Westminster Hall

[Emma Lewell (in the Chair)]

I remind hon. Members that they may make a speech only with the prior permission of the Member in charge of the debate and the Minister. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates. I call Sarah Gibson to move the motion.

[Sarah Gibson (Chippenham) (LD)]

I beg to move,

That this House has considered the performance of HCRG Care Group in the south-west.

It is a pleasure to serve under your chairmanship, Ms Lewell. I am grateful for having secured this debate about the performance of HCRG in the south-west, and Wiltshire in particular. Over recent months, a growing number of constituents, carers and healthcare professionals have contacted me. I want to open by thanking the staff who have stuck their heads above the parapet and asked their elected representatives to put HCRG’s performance on the Minister’s radar. Some of those staff are sitting in the Gallery, and I thank them for coming.

The communities served by the HCRG contract are diverse: Bath and North East Somerset, Swindon and Wiltshire. Each has its own challenges, demographics and patterns of service use. The issue is not whether one area matters more than another; it is whether local circumstances are properly understood. District nurses covering rural Wiltshire face challenges very different from those of nurses working in more urban areas, yet many of the staff who contacted me feel that those differences have not been properly recognised.

Wiltshire is a large, rural county, where patients can live miles from healthcare facilities. Community nursing teams often spend significant amounts of the day travelling between appointments. Aggregate figures for a large contract area tell part of the story, but they can also obscure local pressures and problems. A successful service model is one that understands those differences and responds to them. I am afraid that I have concluded that HCRG does not understand those differences.

When responsibility for community health services was awarded to HCRG in October 2024, patients were promised more joined-up care, easier access to services and simpler overall experiences.

[Will Stone (Swindon North) (Lab)]

I also thank the members of staff who have taken the time to come here and put themselves forward. Does the hon. Lady agree that HCRG’s promise of improving services through a single access point has been a historic failure and that, if it does not manage to get back on track, we should look at re-evaluating its contracts?

[Sarah Gibson]

The hon. Member is absolutely right. There is serious concern about what was promised and what has been delivered. The central part of that vision and delivery was the single point of access. As he has highlighted, that is an attractive idea on paper but the reality is completely different. Constituents repeatedly tell me about the long waits on phones, missed callbacks, referrals that are difficult to track and urgent cases not reaching the right team quickly enough.

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

Does my hon. Friend agree that one of the most disruptive changes for frontline staff and patients has been the loss of dedicated admin support in favour of the so-called single point of access—or SPA—that simply does not work? If HCRG is serious about improving services, restoring adequate admin support for clinical teams must surely be part of the solution. Time spent on admin by clinical staff is time spent away from patients.

[Sarah Gibson]

I absolutely agree with my hon. Friend and will come to that point. The biggest concern for staff is patient safety, which they have clearly highlighted to us. One Chippenham resident told me they waited an hour to get through to the single point of access, only to be told to expect a callback, which did not arrive until the following day. A constituent from Calne described spending a week making calls, leaving messages and sending emails simply to secure a podiatry appointment. I understand that, in the end, he was so desperate that he just went into the offices, but not everyone can do that. I appreciate that the integrated care board, the commissioner, has the single point of access under surveillance. But as I will return to later, being under surveillance is just not enough for our residents.

Many of the concerns raised with me have come not only from patients but from staff. I have heard concerns about growing caseloads, vacancies, the loss of experienced staff and, as my hon. Friend the Member for Melksham and Devizes (Brian Mathew) mentioned, the reduction of administrative support.

One nurse reported that what had previously been 10 visits per day had increased to approximately 15. Another described seeing 14 patients during a shift that overran by 90 minutes. Staff speak of chronic understaffing, excessive workloads, and concerns about the impact that the pressures are having on patients and the workforce.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing this debate. The HCRG took over a substantial NHS contract to run the community health service in the south-west of England. I share her concerns about the long delays faced by patients: similar issues have come up in my constituency in Northern Ireland, where the group struggles to provide services due to worker shortages and lack of funding. Does the hon. Lady agree that the ability of private care providers to deliver NHS-contracted services effectively and reliably must be more thoroughly assessed before the contracts are handed out?

[Sarah Gibson]

The hon. Member is quite right. We are seeing promises not being delivered; whether that is because HCRG is a private service or because of the management of the system is not for me to say. I hope that the Minister will be able to look into the matter.

I personally spend a lot of time in the NHS—not out of choice, but as a patient and a carer for my husband. The frontline staff are fabulous. They go above and beyond to support the patient, regardless of whether that patient happens to be their MP. But as their MP, I do find that the staff tend to approach me in confidence to say that they fear using the formal channels for feedback. Patients and staff working across the community-based healthcare system are raising the same issues with me: delays, difficulty navigating the referral pathway and concerns about whether requests always reach the right clinical team. I think Ministers have a responsibility to take those concerns as seriously as the Members sitting next to me.

Patient safety is my chief concern since HCRG took over. One community nurse described families contacting nursing teams because a loved one approaching the end of life was experiencing severe pain despite being told that help would be available. The nurse reported instances of when no referral appeared to have reached the community nursing team at all. Visits were eventually arranged, but the patient spent several hours without adequate pain relief. A former community nurse separately described trying to obtain additional medication for palliative patients and not being able to get it. Nobody approaching the end of their life should spend hours in avoidable pain because the system is inadequate.

I have also heard concerns about delayed wound care, time-critical medication and urgent catheter issues. One district nurse described attending a patient whose leg wounds had leaked through his dressing. His daughter had contacted the service twice over the weekend without receiving assistance. By the time the nurse arrived, the patient had resorted to wrapping plastic bags around his legs—and I understand that the same problem occurred the following weekend.

The concerns I have received are not limited to community nursing. A physiotherapist working in Chippenham hospital described concerns about the introduction of the new referral system. According to the information, staff noticed that referrals were dropping dramatically under the new system. But when those delayed referrals were eventually identified and processed, clinicians faced a sudden influx of cases, including urgent post-operative patients.

We are talking about knee replacements not being seen in a timely manner, in which case they will end up being re-done. That is a cost for no reason. Clinicians describe patients waiting around eight weeks after knee replacement surgeries, despite the treatment being expected much sooner. The concerns raised are not simply about waiting times, but about the possibility of avoidable deterioration and long-term impacts on recovery. They are not simply administrative inconveniences; they are potentially about patient safety.

I want to touch briefly on wheelchair services. I understand that Wiltshire currently has one wheelchair technician, although it had originally been intended to have four. One constituent from Calne told me that she was supplied with an unsuitable wheelchair without being properly measured. She raised concerns about the difficulty, her safety and the fact that she could not get on to the bus. Despite repeated attempts over months to resolve the matter, she is getting nowhere. Another constituent reported from Chippenham that their replacement battery and updated seating did not arrive, which meant that they were unable to get to college. When repair and maintenance services are not functioning as they should, the consequences for the patient are immediate and profound.

Something that particularly troubled me was a comment made to me by some patients who were no longer bothering to complain because they had become accustomed to the delays and difficulties. Sometimes, the absence of formal complaints reflects a loss of confidence rather than anything else. That is particularly concerning when we think about older patients, disabled patients and those already struggling to navigate a complex health system. The people who find it the hardest to access services are often the people least likely to make their voices heard. That is why scrutiny and transparency matter.

When constituents raise concerns about HCRG services, they expect clear, simple answers. Who is responsible? We have an ICBC contract oversight group that reports to the ICBC collaborative oversight forum. We have the BSW community delivery group, which oversees transformation across the system. We have joint contract oversight groups, quality boards and safeguarding groups that all scrutinise performance, but many of the same organisations sit across multiple levels of that oversight. The integrated care board, the local authority commissions and the HCRG itself are involved throughout that governance structure. The organisations commissioning the contract and managing the contract are also scrutinising the contract—all of them seem to be on the same table. Frankly, even we elected representatives struggle to work out who is accountable.

When everyone is involved in the oversight, it can be remarkably difficult to identify who is responsible for acting when problems emerge. There is a risk that organisations end up marking their own homework, with concerns passing between governance groups rather than being subject to genuinely independent challenge. Patients deserve a system in which responsibility is visible, understandable and transparent from the outset. Where persistent concerns are being raised about access to care, referral pathways and patient safety, it is entirely reasonable to ask whether the Care Quality Commission should take a closer look. We should not worry about independent scrutiny; we should welcome it, because it will lead to improvements.

I would be grateful if the Minister addressed two specific points. First, will she ask BSW’s ICB and the HCRG to publish some comparable pre-transformation and post-transformation performance data that includes call waiting times, callback performance, referral processing times, complaints and patient outcome, broken down where possible to a local level? In that way, patients and parliamentarians will be able to see whether the promised improvements have actually been delivered a year and a half into the contract, despite the fact that the group had six months before the contract started to provide for the transition.

Secondly, will the Minister engage with the Care Quality Commission about a case for further independent scrutiny of HCRG’s Wiltshire services and clarify what further regulatory action may be available if the persistent concerns about access, referrals and patient safety continue, as was referenced by my hon. Friend the Member for Melksham and Devizes?

Patients do not really care how many committees or meetings are called; they want answers. Their concern is whether they are getting the care they need, when they need it.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. I thank the hon. Member for Chippenham (Sarah Gibson) for securing this debate and for her well-informed and considered set of proposals about a contract of which I am aware. I will try to address most of her points. The contract was signed just after the general election, but it was on my radar before then, partly as a local MP. As I think the hon. Lady said, there are staff here today, and I am conscious that this remains a concern for staff and some of the trade unions—not least because my hon. Friend the Member for Swindon North (Will Stone) has kept it on my radar. I am absolutely aware of the genesis of the process by which this contract came forward, and I want to make sure that people know that. I will not rehearse it, however; we are where we are now.

As I think the hon. Lady said, now we need to make sure that what was promised is delivered. That is what we all want to see for the people of her community and across the wider ICB. I want to be clear on our general expectations of community services: they are really vital to the left shift, particularly in rural areas. A wide range of services is delivered under that umbrella—from district nurses to services provided by allied health professionals, such as physiotherapy and occupational therapy—for adults and children where they live, in local communities. They also provide really good local jobs.

Those services are vital to supporting our ambitions for neighbourhood health, which is why we set out clear ambitions for them in our medium-term planning framework. For the first time, we have set a target for systems to reduce long waits for community health services: by 2028-29, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing community health services in line with targets for elective care. We have also published guidance outlining the core components of community health services for children, young people and adults that ICBs should provide. That guidance is hugely important for many of the issues that the hon. Member for Chippenham has raised today. We know that there is variation in the services available across the country, and that people are waiting too long to access community health services. That is why this Government are taking action to reduce unwarranted variation, cut waits and improve access to high-quality community services. That is where we want to get to.

Moving on to HCRG Care Group’s performance, as we know, it has taken on the contract to bring together more than 130 community health and care services across the ICB area. It is a large-scale “transformation” programme, as it is called. Since the contract was awarded, the ICB has obviously had to work very closely with it. The ICB is responsible for managing the contract, and I met it in advance of this debate to hear from it as well. As I understand it, the ICB has arrangements in place—the hon. Lady alluded to how many there are—to oversee quality, safety and performance across all those commissioned services, and performance is regularly monitored. I recognise the concerns about delays, callbacks and referrals across the teams, and about getting people through the single point of access. Single points of access have been worked on for many years under many different contracts. Generally, they should do what they say on the tin and actually help people move forward, so HCRG does need to make its work.

I understand that, as a result of some of the issues that have been raised, the ICB is increasing its oversight, bringing together the provider and the system to support improvement. It is really important that that work also brings together patients, carers, the local community, staff and other stakeholders as it develops. The ICB assures me that it remains committed to engaging openly with those communities, with MPs and with Healthwatch throughout the delivery and development of those community services.

[Sarah Gibson]

Does the Minister agree that the complexity of the oversight system, with the same people in every single one of its groups, does not help staff or patients to feel that there is genuine, independent scrutiny of what is happening? We are getting the same answers from the same people.

[Karin Smyth]

I will come on to some of that, because it is also tied up with the Health Bill and the things that we are proposing to do for the future. The hon. Lady also touched on one of my favourite subjects: the accountability of local health systems.

The hospital at home services are also important—as it says on the tin—to keep people out of hospital when they do not need to be there and to support early discharge. They remain an important part of the community services offer across Bath and North East Somerset, Swindon and Wiltshire ICB. There have been changes to the service provision and I am assured by the ICB that there are no plans to reduce capacity or withdraw the hospital at home service—I am sure that the hon. Lady will correct me if that is wrong. The ICB is currently undertaking a review of the services following concerns raised, and will continue to monitor the impact of those changes to ensure that safe and effective care is maintained. Again, that is absolutely the direction of travel in that we want to see those services change and improve.

[Sarah Gibson]

At the risk of delaying her, will the Minister give way on that point?

[Karin Smyth]

I am going to finish my comments, if I may.

[Sarah Gibson]

It is just that that point is not true.

[Emma Lewell (in the Chair)]

Order. Will the hon. Member refrain from shouting out, please?

Healthcare in Rural Areas

Sarah Gibson Excerpts

Wednesday 4th March 2026 Westminster Hall

[Blake Stephenson (Mid Bedfordshire) (Con)]

I beg to move,

That this House has considered healthcare in rural areas.

It is a pleasure to serve under your chairship, Dr Huq. I hope that this debate can be a constructive discussion of the particular challenges that rural communities face in accessing healthcare. In that spirit, I will open the debate by saying some things that I hope no one will find controversial.

Rural communities are bigger and further apart than urban ones and have fewer people in a wider area, which makes the delivery of basic services much harder than in major conurbations. The time and money lost to travel is higher because the distance between places is larger, and it is more challenging to recruit and retain staff in public services such as healthcare. Accessing online support—often seen as a silver bullet for the future of healthcare—can be challenging in rural areas where high-quality broadband and mobile signal have not yet arrived. All that means that securing equal access to healthcare in rural areas as in urban areas is more challenging and expensive, which has practical implications. In the Health Secretary’s constituency of Ilford North, there are 20 main GP surgeries. In my constituency of Mid Bedfordshire, there are just nine. The age of the village doctor is gone.

When my constituents heard of the plans for a neighbourhood health service, with a neighbourhood health centre, within the Government’s 10-year health plan, there was some optimism that that age might return, even if not necessarily in the same way as before. In principle, neighbourhood health centres are absolutely the right step. They are a way to empower people to get the healthcare that they need on their doorstep and to keep them out hospitals, which could then focus on those who need the most specialised care.

[Sarah Gibson (Chippenham) (LD)]

Does the hon. Member agree that rural communities, such as mine and his, and villages such as Lyneham, which is famous for its serious airbase and is full of veterans, now find themselves with poor GP surgeries and no future for that? People in those villages are waiting longer and longer to get that care and feel completely left behind, as they have no access to any form of health service.

[Blake Stephenson]

I know Lyneham quite well; it is a beautiful part of the world—although of course, Mid Bedfordshire is far more beautiful. I have to agree with the hon. Lady. The situation is deeply concerning for those in rural communities who are struggling to access GPs, and, given the growth and development in our communities, access is becoming much more difficult as the years roll on.

Baby Loss

Sarah Gibson Excerpts

Monday 13th October 2025 Commons Chamber

[Sarah Gibson (Chippenham) (LD)]

My constituent’s sister was stillborn many years ago, in a situation in which my constituent’s mother was simply told, “Don’t worry, dear, you’ll have another one next year.” There was no bereavement counselling and, more importantly, no marked grave. My constituent found out some years later—quite recently—that his sister had been buried in a communal unmarked grave. It appears that, because this practice went on until the late 1980s, there are some 89,000 such children. These families have had the lifelong pain of not knowing where to grieve, how to grieve or where to focus their attention, with no chance of finding it.

These children deserve our support, and I hope that this House will share my view that the Government need to step in to provide a small memorial so that these families can have a focus for their grief, and some acknowledgment that these children existed. I would be grateful if the House shared this call, which I have tabled as an early-day motion. I know the Minister has kindly offered to meet these families, and I am extremely grateful for his support.

NHS Dentistry: South-west

Sarah Gibson Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.

[Sarah Gibson (Chippenham) (LD)]

Does my hon. Friend not agree that part of the problem is that we are only talking about emergencies? The Secretary of State, in his first week in the job, talked about working hard to look at preventive medicine. That should apply to dentistry as well. Does my hon. Friend not agree that we need to look at a serious timeline for reviewing the dental contract? We cannot only talk about emergencies all the time.

[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.

Income Tax (Charge)

Sarah Gibson Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson (Chippenham) (LD)]

Since the Budget, many healthcare providers in my constituency have told me how worried they are about last week’s announcement. These healthcare providers, which include GP surgeries, dental practices, healthcare operators and pharmacies, are small businesses operating in the heart of our communities. They did so much with so little over the last 14 years under the Conservatives.

Although I welcome the increased investment, this Labour Budget was supposed to be a breath of fresh air for primary care and for our health service. Instead, our GPs, pharmacists and dentists feel taken for granted. They feel let down, and they are scared.

The rise in employer’s national insurance contributions and the lowering of the earnings threshold is life-threatening for GP practices such as Rowden surgery in Chippenham. They do not have the profit margins to absorb these costs, and they cannot pass them on to their clients. Because they are designated as public authorities, they are not even eligible for the employment allowance, meaning that they will bear the full weight of this rise in employment costs, which they simply cannot afford.

A GP practice partner in my constituency told me over the weekend, “I love my job. I have never regretted becoming a GP until this week. Now I am seriously contemplating my future in this role.” This GP is one of eight partners in their practice, which delivers care to 19,000 patients in my constituency, but the financial pressure on them is bleak. If our GPs cannot afford to run their practice because of this Budget, they will have to reduce services, lose staff or, worse, cease to exist. My constituency cannot bear the loss of a single GP, let alone a whole practice. Will the Minister consider meeting me to look at options for mitigating the increased costs faced by GPs in my constituency due to the rise in national insurance contributions and the lowering of the earnings threshold for surgeries like Rowden?

NHS Dentistry: Rural Areas

Sarah Gibson Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson (Chippenham) (LD)]

I am grateful to have secured this evening’s Adjournment debate on access to NHS dentistry in rural areas.

In my first few months as the Member of Parliament for Chippenham, there has been one issue that has been raised with me almost every day: the decision by Hathaway dental practice in Chippenham to close its doors to NHS patients on 1 November. Today, I wish to put on the record why dentists like Hathaway are ceasing to offer NHS dental care, and why that is particularly devastating in rural communities such as the one I represent.

Since being elected, I have corresponded with hundreds of my constituents about the state of NHS dentistry in Wiltshire. I have met patients, one of the directors of Hathaway dental practice, representatives of our integrated care board, Denplan and the British Dental Association—anyone that could help me understand what was happening, why it was happening, and how we might save NHS dental care in Wiltshire from disappearing altogether.

Only a week into this Parliament, I was able to raise the issue with the Secretary of State for Health and Social Care during a briefing on preventive healthcare. Today, I hope to make the case to Ministers—yet again—that NHS dental care is in crisis. The failure to fix NHS dentistry is proving catastrophic in rural communities up and down the UK and is, unfortunately, not a problem unique to the south-west. I thought it might be helpful for colleagues if I took the time to relay some of the facts.

[Clive Jones (Wokingham) (LD)]

I thank my hon. Friend for giving way. At a time when tooth decay is the most common reason for hospital admission in children aged between six and 10, and when my constituents in rural areas such as Swallowfield and Hurst struggle to access dentists, does she agree that the Conservative party has fundamentally failed the country on dentistry?

[Sarah Gibson]

I agree that dentistry has been failed over the past 14 years.

According to the House of Commons Library, 51,000 children have not seen a dentist in Wiltshire in the past year.

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

My constituent in Ilton is now in debt because they had to take their son, who is eligible for free NHS dentistry, to a private dentist, as they could not find an NHS dentist in the whole of Somerset. Sadly, that comes as no surprise, given that four in 10 children in Somerset have not been able to see a dentist this past year. Does my hon. Friend agree that dentists need to be encouraged back into the NHS by reforming the broken NHS dental contract?

[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.

[David Smith (North Northumberland) (Lab)]

I commend the hon. Lady for securing this important debate. She mentioned that dental deserts can be a problem up and down the country. That is certainly the case in my constituency of North Northumberland. I welcome the Government’s dental rescue plan and the commitment to an additional 700,000 appointments per year. However, my situation is like hers: constituents in hundreds of square kilometres of my constituency tell me that they simply cannot access NHS dentistry. It is a real shame that no Conservative Members are here to hear this. Does the hon. Lady agree that rural residents should expect the same provision of NHS dentistry as those in urban areas?

[Sarah Gibson]

I do agree with the hon. Member. The real issue for rural areas is, again, access to public transport. Dental provision might be relatively close in theory, but public transport does not allow people to get to the dentist. The issue of rurality is important and needs to be addressed.

Analysis conducted by the Rural Services Network shows that someone living in a rural area is less likely to be able to access an NHS dentist than those living in an urban area, with 10% fewer dental practices taking on new adult NHS patients in rural areas. The analysis also shows that in rural areas, there are 16% fewer dental practices with an NHS contract per 100,000 people. That again points to the fact that rural areas are definitely in a worse situation than urban ones.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this issue forward; the number of people in the Chamber indicates the interest in it right across the United Kingdom of Great Britain and Northern Ireland. Does she agree that dentistry is on the brink and that the additional national insurance contributions are going to push even more dentists into refusing NHS contracts and taking private patients only? Should not the Government immediately instigate an increase in prices in rural areas, to save the few dentists left who are braving rural isolation and the increased costs of operation?

[Sarah Gibson]

I agree with the hon. Member. The disparity is clear. As he mentioned, rural areas are being hardest hit by our broken NHS dental contract system.

Unfortunately, there does not seem to be much hope on the horizon. Denplan tells me that 90% of dentists plan to reduce their NHS commitment in the next two years and that the UK has the lowest dentist-to-population ratio in the whole of Europe. Although all dentists are dedicated to improving the nation’s health, access to NHS dental services remains a persistent challenge under the current system, particularly in rural areas.

[Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)]

In lieu of the dental contract being renegotiated, could something not be done by the local integrated care boards that commission dentistry to make special provision for local contracts when dentists are considering giving up contracts in the short term? That could be done now, in lieu of that renegotiation.

[Sarah Gibson]

I agree. Hold on. [Interruption.] Sorry.

[Richard Foord (Honiton and Sidmouth) (LD)]

Will my hon. Friend give way?

[Sarah Gibson]

Yes—thank you, Richard.

[Richard Foord]

My hon. Friend is making an excellent speech. She has mentioned ICB commissioning. I wrote to the Minister to ask whether there were set criteria for knowing where a patient is on the waiting list, and I understand that that is entirely in the gift of individual practices. Does my hon. Friend think that it ought to be for ICBs, or for NHS Devon in my case, to determine where people are on the waiting list for NHS dental care?

[Sarah Gibson]

rose—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Let me give the hon. Lady a moment to gather her thoughts before she resumes her speech. It is best not to refer to a Member by their first name. She has a solid 30 minutes—although the Minister has to respond within those 30 minutes—so she can take her time.

[Sarah Gibson]

Thank you, Madam Deputy Speaker.

I remind the House that the Conservative Government had the last decade to reform the dental contract but failed to do so. I therefore implore the new Government to act now with two simple actions. First, they should introduce a timeline for reforming the NHS dental contracts system. The Secretary of State for Health and Social Care said that that was their intention, but I feel that there is an element of urgency about this—especially for rural areas—that has not been addressed. Secondly, I would like it to be a mandatory requirement for ICBs to appoint dentists to their boards. There is a strong feeling among dentists that ICB boards of directors do not understand the issues they face.

[Perran Moon (Camborne and Redruth) (Lab)]

Does the hon. Member think it indicative of the state of politics today that, although Members from both sides of the House are here, not a single one of the culprits—those responsible for the shameful state of dentistry across the UK, not least in my constituency—is here to listen to her very important speech?

[Sarah Gibson]

I agree with the hon. Gentleman. It is disappointing that those who have failed to address this issue over many years still do not seem to see it as important. Although the dental contract was introduced under a Labour Government, it was clear that, after a length of time, there was an obvious moment when it should have been reformed but was not. That is disappointing and noticeable.

[Andrew George (St Ives) (LD)]

To reinforce the points made by the hon. Members for Truro and Falmouth (Jayne Kirkham) and for Camborne and Redruth (Perran Moon), and by my hon. Friend, this is not purely down to money. Indeed, there is an underspend in the dentistry contracts of many ICBs, and not just in Cornwall. Fundamentally, we know that it is the nature of the contract itself that means we end up in situations such as that in Cornwall, where children can expect never to see an NHS dentist until adulthood.

[Sarah Gibson]

I agree with my hon. Friend. As I have mentioned, the ICB that represents my constituency has quite a significant underspend in its dental budget. That is quite often because dental practices do not wish to take up the contract as they find that the payments system, and its use of units of dental activity, fails to support them in a way that allows them to make a living. As we said earlier, small businesses are struggling across the country. They find that they are subsidising their NHS dentistry with private dentistry, to the point that it is no longer sustainable.

Another issue that is prevalent in most rural areas, and certainly in the south-west, is recruitment. While NHS dentistry does not pay, it is extremely difficult for dental practices to find dentists who will take on NHS contracts. Many of the dentists who took on NHS contracts have left—some were European citizens—or are simply no longer prepared to spend that many hours in a dental surgery and have decided either to retire or to take on easier work elsewhere. This ongoing problem will continue unless the dental contract is reformed quickly.

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

Does my hon. Friend agree that it is wrong that patients who have been forced to seek private care in an emergency are then refused NHS registration, because they are considered to already be registered as private patients? Should this not be addressed in any revised contract?

[Sarah Gibson]

My hon. Friend makes an interesting point that I was not aware of. From discussing this matter with dentists, it was my understanding that these days, nobody is actually registered with a dentist; they are merely allowed to come regularly, and if they do not, they are taken off that dentist’s lists. My understanding was that it is quite difficult to register, so that is an interesting point that I hope the Minister will note.

A particular concern to dental practices, and a point that Denplan made very clear to me, is that once a dental practitioner has handed in their NHS provider number, even if the dental contract is improved, they are unlikely to come back to the NHS because of the complications involved in getting that provider number reinstated. That is why we need the Government to act now, before more dentists leave the NHS. Another issue for dental practices is that when qualified dentists come over from the EU, their qualifications are valid, but they have to spend an extra year training before they are allowed to register as NHS practitioners. That is slowing down any chance of increasing our intake from our European partners.

[Adrian Ramsay (Waveney Valley) (Green)]

I am very grateful to the hon. Lady for securing this debate, and particularly for highlighting the added impact that the loss of dentists has in rural areas, where, if people lose their dentist, there is often no other dentist nearby. In my constituency, people frequently say that they struggle to find any dentist taking new NHS patients. She is right to highlight that the dental contract is the root cause of the issue, and to press for a clear timescale. Does she agree that by the end of this calendar year, the Government should have set out a timescale for starting crucial negotiations on the contract?

[Sarah Gibson]

I agree that a timeline for reforming the dental contract is vital; that is what I am asking for. If we lose this opportunity and our NHS dentists leave the system, we will be in an increasingly difficult place. Across Wiltshire, for those not already registered with an NHS dentist, it is absolutely impossible to get one. There is not a single practice taking on NHS patients right across the unitary authority of Wiltshire, despite its size.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

The number of dentists is obviously extremely important, but that is just part of what goes into the equation. In rural constituencies such as mine, access to healthcare services is heavily dependent on frequent, reliable services—in particular, bus services. Does the hon. Lady agree that if people are to access dental services, we need to ensure that those reliable, frequent public services are back in place?

[Sarah Gibson]

As I am sure the hon. Member will remember, I have already mentioned the serious issue of public transport in rural areas on several occasions. I could not agree with him more.

I thank the House once again for allowing me to make the case for improved NHS dental care, and I implore the Minister and his colleagues to do the right thing by my constituents and those of the Members who have intervened, in order to support dental care, specifically in rural areas.

Access to Primary Healthcare

Sarah Gibson Excerpts

Wednesday 16th October 2024 Commons Chamber

[Sarah Gibson (Chippenham) (LD)]

I will cut to the chase. The state of NHS primary healthcare in my constituency is depressing. I would like the Minister’s help with three local issues: first, with NHS dental care provision in the light of the Hathaway dental practice’s closing its doors to NHS patients on 1 November; secondly, the stalling of a proposed medical centre in Calne for more than four years due to delays by the ICB; and thirdly, the decision to refuse a licence for a new pharmacy in Corsham. However, given the shortage of time, I will concentrate on the urgent matter of the closure of a dentist’s surgery.

As everyone in the Chamber is aware, dental services are broken. People are pulling out their own teeth and then being rushed to the NHS to deal with a problem that is everywhere. However, integrated care boards across the country are underspending millions on dentistry. Chippenham comes under the Bath and North East Somerset, Swindon and Wiltshire ICB, and according to a freedom of information request to the British Dental Association, that ICB dental underspend amounts to £4.2 million. I mention that because there are several hon. Members here with the same ICB. My constituents are horrified. We are about to lose yet another NHS dental practice on 1 November, in part due to recruitment challenges but mostly because of the dental contract system.

In my first weeks as an elected Member for Chippenham, I attended a briefing on preventive healthcare with the Secretary of State and I felt reassured that the issue was being looked at. However, three months have passed and I have seen nothing concrete from the Government about a reform of the contracts or even a proposed consultation timeline. I implore Labour’s health team to urgently review the NHS dental contract system and stop dental healthcare being a privilege.

The ICB repeatedly says it will come back to me and the practice owner tells me they cannot get this to work. Truthfully, I am at a loss. The Government, along with the Care Quality Commission and my local ICB, say they are doing something, but nothing seems to happen. I implore the Government to work with Liberal Democrat Members, who want the best for our NHS. We agree that a more preventive approach is needed. So much is broken and we need to put it right together now, before it is too late.