GP Funding: South-west England

Vikki Slade Excerpts

Wednesday 25th June 2025 Westminster Hall

[Vikki Slade (Mid Dorset and North Poole) (LD)]

It is a pleasure to serve under your chairship, Dame Siobhain.

GPs epitomise the NHS for us all. They support us from cradle to grave like no other part of the NHS. Although they represent 90% of the patient’s experience of the NHS, they get less than 10% of the budget. To better understand these issues, I have spent recent months meeting doctors and practice managers, but I have also spent a morning shadowing a GP at Walford Mill medical centre in Wimborne to see the reality of their life at first hand.

I thank Dr Wright and every patient who kindly allowed me to observe often deeply personal and distressing consultations. I witnessed high-quality, compassionate care. Despite a busy schedule, the GP took time to liaise with hospitals, arrange tests, write referrals and fully support his patients. Almost every patient was supported with more than they arrived to discuss. He sensitively raised worrying comorbidities with them and encouraged them to come back and think about their wider life. I could not fault the care that he gave.

That brings me to appointment times. The British Medical Association recommends 15-minute appointments for GPs. Most surgeries allow only 10 minutes, but they typically try to get away with five minutes. There is no way a GP can look after a person in that time, particularly given the emotional connection that they have with their patients. One minute they are telling a patient that they have cancer; the next, they are comforting a new mum who is worried about the health of her baby. How does a doctor download their own emotions in between, particularly when they are dealing with financial pressures and their own home lives too?

GP surgeries are also struggling with having to do things that they were not designed to do and not being reimbursed properly. One of the issues I witnessed was the reimbursement of blood tests. That practice recently negotiated a contract with NHS Dorset, which not only did not agree with the amount that the GP said they needed, but cut it dramatically. The GPs are being reimbursed at 25% of the actual cost to them, so they personally subsidise every blood test that they undertake, in a drive to push blood tests to hospitals where patients do not want to be and that they cannot get to. It is quite distressing for them. It is in the patients’ best interests for blood tests to be taken locally.

On the flipside, NHS Dorset’s pathway for cancer means that the follow-up investigations, including some very personal examinations, have to take place at a surgery with a GP who does not know the patient. The patient does not start their cancer journey by going to the hospital and seeing people who actually know about cancer. I found that quite worrying and distressing.

The other issue I experienced was the discrepancy between the electronic systems used by GPs and the paper systems used by doctors in hospitals, where letters were still being sent by post, causing delays and additional administration in surgeries. Bizarrely, paper prescriptions were still being issued by hospitals, meaning that patients were not able to leave to get their prescription elsewhere, and people rushing to get their family member home were having to get a new prescription, creating more delay and unnecessary work for GPs.

I have some examples with which the Government can perhaps help. I am grateful to the Minister for replying to one of these cases, so it may be familiar to him. The GPs at Wareham surgery are all partners, and they are working out of a building that was part of a hospital and ambulance station, but the building is falling down. The hospital was going to be rebuilt, but that was shelved long ago, and the surgery has finally found a new building. Unfortunately, the building comes with a 25-year lease, which extends beyond even the most youthful of partners, and there is no break clause. It also has a requirement that there be at least three GP partners, and if there are not, retiring GPs will remain personally liable until there are.

However, what we are finding in both Wimborne and Wareham is that people can no longer afford to be a partner in these surgeries. Bethan, my niece, is a GP in her early 30s, and she has probably accrued more than £100,000-worth of debt to get there. She probably has a £250,000 mortgage, because she lives on the south coast. How on earth can she, as a young woman, be expected to take unlimited personal liability on top of that? More people are therefore becoming salaried GPs. They are working their socks off in clinical terms, but they do not have any of the burden of running their surgery, taking that responsibility and subsidising patients.

The GP surgeries I mentioned are struggling to find people willing to be a partner, so that they can take up that lease. I did not hear from the Minister any real reassurance or understanding of the fact that the nature of being a GP is changing. What are the Government doing? Are we expecting the GP partner model to be phased out, and if so, what will replace it? How do we make sure that these organisations can remain?

I was most bothered when the chief executive of NHS Dorset said that GPs are independent contractors and are responsible for sorting out their own businesses. I find it absolutely appalling that we treat our GPs as if they are the local carpenter. GPs are the heart of our communities, and we need to start talking about them as an integral part of the NHS, not as an independent business that needs to make money. These people are not making money; they are saving our lives and keeping us well, and we need to treat them much better.

The population of Wimborne has doubled, and people are worried because the town has lost a GP surgery. They are constantly writing, “We need another surgery.” The surgery in Wimborne, like most surgeries, wants to expand, but one of the problems with the funding model that GPs can access—I would be grateful if this could be looked at—is the requirement to bid, design, obtain planning permission and build within a financial year. With the best will in the world and the most efficient planning system, there may be a tiny district that can do that, but I do not know anywhere that can complete the whole process in a year. We need to find a way for GP surgeries to access funding over multiple years, so that communities know they have an NHS fit for the future.

I look forward to the Minister’s comments.

--- Later in debate ---

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

It is a pleasure to serve under your leadership, Dame Siobhain, and to be here. I pay tribute to the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate on a topic that I am all too familiar with, having spent time as a GP. This place may not be so familiar with the inner workings of GP practices, so it is fantastic to have the chance to discuss it. I declare an interest: many of my immediate and wider family are GPs, and it is important to put that on the record.

This debate has allowed us to discuss a huge variety of things, including the Carr-Hill formula and the QOF. We did not touch on DES and LES—directed enhanced services and local enhanced services. Rural dispensing practices are a really important funding stream. We have talked about the partnership model, retention, joining up services, ICBs and their toolkits, the interaction with the planning department and rurality, which has a particular impact on services in my area.

I want to pick up on the comments made by the hon. Member for Mid Dorset and North Poole (Vikki Slade). Fair play to her for going out and shadowing a GP to see what their life is all about. At the heart of what she said was the good care that goes on. If we were to believe the Daily Mail, every GP is on the golf course and only cares about the money. The money is important, but GPs care far more about the patients and the quality of care they give. That is what drives them and gets them out of bed each day. We in this house must not forget that when we discuss healthcare, because it is important. We will get far better healthcare than ever before in the last few decades, and we must not lose sight of that.

I am grateful to the hon. Member for Newton Abbot for giving me my first chance as a shadow Health Minister to debate general practice and ask the Minister some questions. Without further ado, I will turn to those questions. First, what is the Government’s current position on primary care and its models? In an interview in The Times in January 2023, the current Secretary of State for Health and Social Care said:

“I’m minded to phase out the whole system of GP partners altogether and look at salaried GPs working in modern practices alongside a range of other professionals.”

He went on to speak at events held by the King’s Fund and the Institute for Public Policy Research, where he acknowledged that he has

“observed a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs”

and that the

“status quo is not an option”.

Then 18 months ago, just six months before the election, the Secretary of State stated,

“What we were minded to do is to sort of phase it out over time. I’m still not sure whether or not the GP partnership can survive in the longer term. But I haven’t reached a sort of firm conclusion that says that it shouldn’t.”

In the light of that, and given the importance of the partnership model, could the Government clarify their position with regard to the partnership model and any other models that are being considered?

[Vikki Slade]

I thank the hon. Member for his comments about my visit to the GP, because it was an absolutely wonderful experience. If the proposal is to phase out the partnership model and move to a salaried model, how would that work, given the severe cuts that ICBs are facing? With 50% cuts to most of the ICB funding, somebody will have to pick up the costs of running these organisations, rather than the clinical side of it.

[Dr Evans]

The hon. Lady is spot on. I posed my question to the Government because we know that primary care is one of the most efficient parts of the NHS. Why? Because the people running those businesses—they are businesses, and we have to be open and honest about that—pay attention to where the money comes in and goes out. They take full pride in it, first, because they care, and secondly, because their salaries are paid from the profit that comes out of that. Again, “profit” is a dirty word that people do not like to use, but it is the reality of what we are dealing with when it comes to how we break down the funding.

The Government have proposed to get rid of NHS England, and it is still unclear not only how much that will cost, but how much it will save and where the administrative burden will fall. On top of that, we do not know what will replace the partnership model if we lose it, and this is the question to be asked. Given that it was only six months before the election that the Secretary of State stated his intent, I too am keen to find out the answer.

I have a second question to pose to the Government. There are concerning reports this month in the Health Service Journal, which has had sight of a leaked version of the Government’s 10-year plan to improve the NHS. It says that the plan will push back the Government’s ambition to increase the share of NHS spending on primary and community care to 2035, rather than 2029 as originally promised. Can the Minister confirm or deny those reports?

When it comes to funding, the Government raised taxes directly on GPs as part of the national insurance increase. Has the Department made any assessment of how much of the £886 million uplift that has been allocated to GP practices will be needed to meet the increase in employer’s national insurance contributions?

I turn to the figures for the ARR scheme. The Government announced in April that they thought they had reached 1,500 new GPs, but as the RCGP pointed out at the time, although having

“more GPs employed in the workforce is encouraging, when considering full time equivalent GPs—which gives the most accurate picture of the GP workforce and the care and services GPs are able to deliver for patients—the numbers published today are lower, at 851 GPs”.

The increase is encouraging, but when we dig into the data, it appears that we are simply seeing more locum doctors coming back into the scheme. I would be grateful to understand exactly how the numbers are made up, and where the inference of 1,500 GPs comes from.

More importantly, where is the scheme going in the future? Is it time-limited? Will it continue? Will it be expanded and, if so, what does that look like? Although it is an important part of addressing provision, we also need to understand exactly what is going on. Initial reviews of the data suggest that appointments have not kept up with the pace of the introduction of GPs, so I am interested to understand from the Minister why, despite the supposedly new GPs coming in, the number of appointments has not increased proportionately. I would be grateful for any comment on that.

Finally, I turn to recruitment. Training new GPs has understandably been seen as the priority when it comes to solving the long-term workforce problems in England. As Pulse magazine puts it:

“This is probably one of the areas of workforce planning that could be considered a success. Health Education England, which has been incorporated into NHS England, has been able to meet its target of over 4,000 new GP trainees a year.”

The NHS workforce report, launched under the previous Government in 2023, made commitments to increase that. It set goals to increase the number of GP specialist training places to 6,000 by 2031, ensure that all foundation-year doctors do a rotation in general practice, and require GP registrars to spend the full three years in general practice.

There has been progress, but along with progress come new problems. The British Medical Association has warned that up to 1,000 GP registrars could face difficulty when qualifying in summer 2025 without funding for GP practices to recruit newly qualified, unemployed or underemployed GPs. What active steps are the Government taking to avoid that, and what support will they be offering newly qualified GPs?

--- Later in debate ---

[Stephen Kinnock]

We recognise that the partnership model has many strengths. It is a very important part of the system, and it helps to drive efficiency, innovation and a kind of go-getting approach to general practice. That is what we want to see—innovative approaches.

We are committed to substantive GP contract reform. We see the partnership model as a really important part of that, but we also recognise that fewer GPs are interested in going into partnership. The partnership model is not the only model delivering general practice; GP practices can and do choose to organise themselves in different ways. Many practices cite evidence of good outcomes on staff engagement and patient experience through the partnership model. I do not think it is right to say that there are any specific plans to change the partnership model, but we recognise that there are a number of other ways, and we will always keep the way in which the contract is delivered under review.

[Vikki Slade]

For some leasehold properties, there is a requirement that practices have partners. How is the Minister ensuring that such practices can be taken on, either by the ICB or the DHSC? Somebody has to take responsibility for those practices, and if we are moving to a model of having more salaried people, who will do that?

[Stephen Kinnock]

In debates about how we deliver health and care in our country, the question often comes up about the balance between the role of the DHSC at the centre, the role of ICBs and the role of those who are at the coalface delivering services. I do not think there is a single answer to that question. What is important is that we commit to devolution and to empowering those who are closest to their communities, because they are in the best position to make the decisions that work for their communities.

It is vital that we at the centre agree on and set desired outcomes for health, access and quality that the entire system is expected to meet. We have to set a framework, and it is then up to those at the coalface to decide how best to deliver it. It would not be right for me to say, on specific leasehold cases for example, that case A should go this way and case B should go that way; to try to dictate that from the centre would be a recipe for disaster. We do need to hold the system to account, however, and the system needs to hold us to account. That is the way to deliver true political and strategic leadership.