Recovering Access to Primary Care

– in the House of Commons at 4:25 pm on 9 May 2023.

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Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care 4:25, 9 May 2023

With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend Neil O’Brien, for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments. NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months. In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology. Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day. Instead, they will get their appointment booked on the same day or be signposted to other services.

The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.

Photo of Wes Streeting Wes Streeting Shadow Secretary of State for Health and Social Care 4:36, 9 May 2023

I thank the Secretary of State for advance sight of his statement. This announcement was meant to be the Prime Minister’s relaunch after he received a drubbing in the local elections. Unfortunately for Conservative Members, it seems that the Prime Minister is bouncing back in true Alan Partridge-style.

Having read that Downing Street had drawn up plans for a health-focused mini relaunch, I eagerly tuned into the radio this morning to hear the Health Minister, Neil O’Brien. What was the Conservatives’ message to the public this morning, following their worst defeat since 1997? They are breaking their manifesto commitment to recruit 6,000 new GPs. Once again, the Conservatives have over-promised and under-delivered.

I think the Secretary of State just admitted to missing his target to eliminate 18-month waits by April. Is that the second broken promise of the day? It is hard to keep up. Millions of patients are waiting a month to see a GP, if they can get an appointment at all, in pain and discomfort, unable to go about their normal lives. That is the price patients are paying every day for 13 years of Conservative failure. The Prime Minister has no idea what it is like to be most people in this country. He is completely out of touch with what NHS patients are going through, and that is why he cannot offer the change the country is desperately crying out for.

The Health Secretary has called this announcement the GP access recovery plan. What is this a plan to recover from, if not his party’s appalling record of under-investment and failure to reform? Does he now regret the 2,000 GPs cut since 2015, the 350 GP practices that have closed in the same time, and the 670 community pharmacies that have shut up shop on their watch? Is expecting the Conservatives to fix the NHS after they broke it not just like expecting an arsonist to put out the fire that they started? It is just not going to happen.

It is not just the voters who are turning to the Labour party for answers; the Government are, too. In January, we set out our plans for the future of primary care, including allowing pharmacies to prescribe for common conditions, opening up self-referral routes into things such as physiotherapy, and ending the 8 am scramble. Sound familiar? The problem is, that is where the similarities end, because what the Conservatives offer today is a pale imitation of Labour’s reform agenda. Where is the plan to give patients real choice? There is nothing on enabling patients to see the same doctor at each appointment, when doctors themselves tell us that continuity of care is important. There is nothing on allowing patients to choose whether they are seen face-to-face or over the phone, merely the promise of better hold music and the “invention” of things such as call-back, which has existed for many years. In fact, where is the plan for better mental health support, more care in the community and in people’s homes and more health visitors to give children a healthy start in life, or have all those issues been dumped into a box marked “Too difficult”?

The Secretary of State says that patients will get an appointment within two weeks as if it is some kind of triumph. When we were in government, we delivered GP appointments within two days. When will this pitiful promise be delivered? There is no date or deadline. By when can patients expect the 8 am scramble to end? There is no date or deadline. When will patients with urgent needs be seen on the same day? There is no date or deadline. In fact, I wrote to the Minister and asked him how many patients are currently not seen on the same day. He said he did not know and that the Department does not hold that information. What is the point of these pledges if Ministers do not know whether they are being met? The document says that the NHS and the Department have “retargeted over £1 billion” to pay for the announcements, but not where that money has come from. Where has the Secretary of State cut NHS services to pay for these announcements?

The Secretary of State’s plans for patients to refer themselves to physios for back pain, bypassing GPs, could lead to 5,000 cancer patients missing their diagnosis. That, as perhaps he remembers, was according to—that is right—the Conservative party back in February. Three months later it is the Government’s policy, so perhaps the Secretary of State can clarify: was the Conservative party telling porkies back in February, or does he simply not know what on earth he is doing? Given that this is meant to be a primary care recovery plan, where is dentistry? NHS dentists are in even shorter supply than Conservative council leaders.

Finally, let me turn to the super-massive black hole at the heart of today’s announcement: where is the plan to train the doctors and nurses the NHS is so desperately short of? Labour has set out our plan to train 7,500 more doctors and 10,000 more nurses each year, paid for by abolishing the non-dom tax status. When will the Secretary of State finally admit he does not have any ideas of his own, and adopt Labour’s plan? After 13 years, the Conservatives have no plan to give the NHS the staff it needs, they have broken their promise to recruit 6,000 new GPs and they have missed a golden opportunity to give patients real choice. Only Labour has a plan to rebuild and renew the NHS, and that is why people across the country are coming home to Labour.

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is

“the most significant investment in community pharmacy in well over a decade”.

The Boots chief executive says that this is

“great news that they’ll be able use their clinical expertise more widely”.

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients. I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be

“a real game-changer for patients”, and that is what our focus has been.

The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer. Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House.

The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day. It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care.

The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon. Friend Mrs May was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support.

The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news. On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use. That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.

Photo of Steve Brine Steve Brine Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

I welcome the plan, which I note the Government have released at the first possible moment after the local election purdah period. Members of the Health and Social Care Committee and I will study it carefully, and I know the primary care Minister has already agreed to come before us so that we can give it a good going over. My question is about timing. How quickly can investment in the 8 am scramble part of the policy make a difference to those practices that do not have it? The Secretary of State said that they were already negotiating with the Pharmaceutical Services Negotiating Committee, so how quickly can that very welcome new investment get to the frontline of community pharmacy?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

The short answer is this year, but the Chair of the Health and Social Care Committee is right to focus, as with all recovery plans, on deliverability. I hope he will take comfort from the fact that around half of GP practices already have cloud telephony, which is why we are so confident that it is the right approach. It is one that is already working. We are seeing from patients’ positive feedback that they hugely value online booking and call-back systems, but they also allow primary care to better triage calls to specialists and therefore to use the additional roles we have recruited in an optimum way. That will be rolled out this year, but it is already up and running and we can see that it is working.

Photo of Margaret Hodge Margaret Hodge Labour, Barking

I would like to take the Secretary of State out of the bubble of Westminster and the green Benches and into the reality of what is happening on the ground in my constituency. We have the second highest number of A&E attendances for minor injuries—people who should be going to their GP. We are the most under-doctored and second most under-nursed area in north-east London and, last year, just under 9% of patients could see their GP within 14 days of requesting an appointment. So for me, the recovery plan announced today is deeply underwhelming. I hope that the Secretary of State can answer these three questions. When will he, not plan, but deliver the 6,000 extra GPs promised? What work is he doing to move GPs from working part time to putting in more hours at the frontline with their patients? Where is the commitment to deliver face-to-face appointments for those who want them in my constituency? Only when I have answers to those questions will I feel confident that there really is a plan for GP services in Barking and Dagenham.

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I know the right hon. Lady well, having served with her for four years on the Public Accounts Committee, so I hope that she will not mind me being slightly surprised about being told, as someone who lives in the Fens and not in London, that I am in the bubble. On her points, obviously, we have 37,000 more doctors than when the Government came to power. Directly, the changes to pensions lift about 9,000 GPs out of the tax changes. It is also about training more—4,000, compared with 2,600 in 2014—so being on track in terms of the number we are training. It is also about the additional roles that we are funding, the 25,000 and the manifesto commitment of 26,000. Also, the pharmacy announcement is all about freeing up GP capacity for face-to-face appointments for those who want come in. By enabling pharmacy capability for those who want to get oral contraception, have a blood pressure test or access services for the seven common conditions—including urinary tract infections and ear infections, for which prescriptions can then be given—we will free up GP time for face-to-face appointments. If we look at last year’s patients survey, we see that about two fifths of patients hugely valued continuity of care and face-to-face, which means about three fifths preferred to prioritise speed of access, rather than seeing the same GP or seeing someone face to face. So it is about tailoring the offer to what the patient wants, and patients do not always want the same thing. Some want speed and pharmacies can deliver that.

Photo of Jackie Doyle-Price Jackie Doyle-Price Conservative, Thurrock

I congratulate my right hon. Friend on his announcement on pharmacy, for which I have been calling for a number of years. We ought to be making more use of this massively skilled body of medical professionals, particularly to free up GPs. For many people, they are the front door to the NHS more than the GP surgery is. Could he confirm that, for the additional work that they will be doing to support our NHS, they will get some reward?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

First, I commend my hon. Friend because this is an issue that she has championed and she has been right to do so. These are degree-qualified clinical roles, so it is sensible that we make far better use of the skills that they offer. We saw during covid just how much value they offer to their communities. I confirm that they will be paid for these roles; that is what the additional funding is all about. She has been right over the years to highlight the importance of pharmacies and what they can offer, and that is what this announcement is all about.

Photo of Clive Betts Clive Betts Chair, Levelling Up, Housing and Communities Committee, Chair, Levelling Up, Housing and Communities Committee, Chairman of the House of Commons Members' Fund

First, I thank the GPs in my constituency and their staff for the job that they are doing for my constituents under the most enormous pressure. I want to include in particular GPs’ receptionists in that for the up-front service they give; there is particular pressure on them. GPs—often in their 50s—are saying to me that they want to leave and give up not because of pensions but because of the overbearing workload they have, and the incredible centralisation and red tape coming from NHS England at national level. They look for new GPs coming through and see so many trainees and qualified doctors now going off to Canada, New Zealand and Australia because the terms and conditions of work are better there. When will we see from the Secretary of State the workforce plan that has been promised over and over again—it was supported by the Chancellor when he was Chair of the Health and Social Care Committee—to deliver the amount of training we need and the efforts to retain the GPs we already have?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I agree and thank the hon. Member, who is absolutely right to recognise the huge amount of work done by GPs and their staff, including receptionists. That is why the recovery plan is very much targeted at recognising the workload. I flagged in my statement the additional volume of patients that a typical GP surgery is seeing and that reflects the huge amount of work that is done. I think pensions were a factor, certainly in the feedback from the profession. The issue was raised. The changes the Chancellor announced take 9,000 GPs out of the tax changes, but the hon. Gentleman is right—that was not the only factor; the workload was another. The recovery plan looks to cut bureaucracy and, as I say, reduces the targets to five. It also looks at areas where there are appointments that we do not feel are necessary—so it looks at how secondary care can do fit notes, for example, rather than someone needing to go to the GP to get one. There are areas where we can streamline GPs’ workload and that is what the recovery plan does. On the workforce plan, we have said on a number of occasions that, post purdah, we would set that out very shortly. We will have more to say on that in due course.

Photo of Bernard Jenkin Bernard Jenkin Chair, Liaison Committee (Commons), Chair, Liaison Committee Sub-Committee on National Policy Statements, Chair, Liaison Committee Sub-Committee on National Policy Statements

I join Mr Betts in inviting the Secretary of State to thank all our GPs for their incredible work. I very much welcome his statement. Will the Pharmacy First plan enable places such as Harwich and Dovercourt in my constituency to increase the out-of-hours cover that pharmacies provide? Otherwise people will have to travel miles just to get a prescription. Also, where are all these new GP staff going to be put? Most GPs have very cramped premises. West Mersea surgery in my constituency has been trying to develop new premises for a long time, unsuccessfully because the GPs’ partners will not take the risk. At the Mayflower surgery in Harwich, there is empty space in the building rented by the NHS from a failed Labour private finance initiative project, but the GPs cannot afford to pay the rent, so the space sits empty, although it is still paid for by the taxpayer. What are we going to do about that?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

First, I join my hon. Friend in paying tribute to the work that GPs do in his constituency, as they do elsewhere. On pharmacies, part of the reason for the investment is to support pharmacy, including in rural settings. The more funding going in, the more they can prescribe. The more things they are able to do, the better the business model. There are more pharmacists and more pharmacy shops than there were in 2010, but it is important we make the business model more viable and that is what the announcement does. On estates planning, that is an issue for each integrated care board to consider. He mentions a specific issue locally with a former PFI and how it is being used. That is not a new issue. I sat on the Public Accounts Committee when it was chaired by Dame Margaret Hodge and I remember looking at many a Labour PFI. The regional fire control centres were a case in point; the estate could no longer be afforded and the space was empty. If there is an issue like that, I will be happy to look at it in due course.

Photo of Taiwo Owatemi Taiwo Owatemi Labour, Coventry North West

As chair of the all-party parliamentary pharmacy group and as a pharmacist myself, this is a step in the right direction. However, I have spoken to many pharmacists and many in the sector, and we believe that, for the policy to unleash the full potential of pharmacy, there needs to be proper investment in the workforce plan. What we are seeing is pharmacists who can prescribe leaving community pharmacies and going into other sectors. It is great that they have the ability to prescribe, but if the pharmacies are not there the full potential cannot be unleashed. Secondly, we have a funding crisis, with many pharmacies closing, so the plan needs to be accompanied by further funding and steps to address the medicines supply chain.

Will the Minister clarify a few points? Will pharmacists be paid competitively for their prescribing skills? In previous Government announcements, that has not been the case. Pharmacists would like to feel valued from this announcement. Will the announcement be followed by actual support for premises as well? I am sure the Minister is aware of pharmacists who have challenges, for example, in accessing a patient’s record, and who do not have the workforce needed to take time out to go out to speak to patients. Will he meet me and the APPG to discuss those issues further?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

First, I thank the hon. Member for recognising, constructively, that this is a step in the right direction. As the quotes from the sector show, many working within pharmacy welcome it. As I said a moment ago, there are 20,000 more pharmacists than in 2010. The additional funding, including—directly to her question—for prescribing, will make the business model more viable and therefore support the workforce within the pharmacy sector.

We are working on IT as part of the recovery plan. There is a big read-across into the NHS app and how we better empower patients both to access their own medical records and to find the right services, including by being directed from the NHS app to pharmacies.

Photo of Maggie Throup Maggie Throup Conservative, Erewash

I welcome today’s announcement, which will undoubtedly widen access to primary care services. However, will my right hon. Friend consider investing in point-of-care diagnostic testing in pharmacies and GP surgeries, to speed up the diagnostic pathway and help to reduce NHS waiting times?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.

Photo of Daisy Cooper Daisy Cooper Liberal Democrat Spokesperson (Health and Social Care), Deputy Leader, Liberal Democrats

Liberal Democrats and many others in this House have called for a pharmacy first approach for a long time, but there appear to be two major problems with today’s announcement. The first is that the Government’s own plan says that the money will be re-targeted; I would be grateful to know from the Secretary of State which other service will miss out.

In my constituency two pharmacies have already closed, and across England 16% of pharmacies have said that they do not think they will survive another year. How does the Secretary of State expect people to access a pharmacy first if their pharmacies continue to close?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.

Photo of Bob Seely Bob Seely Conservative, Isle of Wight

I welcome the statement. I notice the difference in opinion on the Opposition Benches between the people who know what they are talking about and the people who do not.

Pharmacy First is a brilliant idea, and I thank the Secretary of State. I very much hope it will be welcomed by pharmacies in my patch. I want to reiterate some of the points that have been made. First, some of my pharmacies have been under a lot of financial pressure recently. Will the financial package be able to support them and make them feel valued, considering what extraordinarily good value for money they are? Related to that, will any financial support or grants be made available to pharmacies—especially the smaller ones in some of my rural areas and small towns—so that they can have a room to see patients and take advantage of this great Pharmacy First scheme?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I welcome my hon. Friend’s comments. There is £645 million of funding over the next two years to support the expansion of this work through Pharmacy First. As I said a moment ago, the estates programme is more an issue for the integrated care boards. We should not try to determine all the decisions on estates from Westminster; it is right that we let the 42 ICBs have more discretion over what is the right estate strategy in their area. I am sure that his local ICB will hear his representations.

Photo of Chris Bryant Chris Bryant Chair, Committee on Standards, Chair, Committee on Standards

I completely support the idea of pharmacists being able to do more. For instance, it makes more sense that someone with shingles can go to a pharmacist today to get antivirals prescribed. My fear is that what has been announced today does not fully understand the crisis in primary healthcare. According to the numbers given by the Government’s own Ministers, in September 2015 we had 29,364 fully qualified GPs in England, but last September we had 27,556. By the Government’s own numbers, that is 2,000 fewer. Community pharmacies have gone from 11,949 in 2015 to 11,026—a nearly 10% fall. Do we need to do more to enthuse people to work in our NHS across the whole of primary healthcare? Would it be a good idea to change the model for GPs, so that we have more salaried GPs?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.

Photo of Dr Caroline Johnson Dr Caroline Johnson Conservative, Sleaford and North Hykeham

I am pleased that the Government are looking at how they can best support GPs and improve access to primary care, but how will these plans protect and enhance the role of GPs who dispense in their own practices? How will my right hon. Friend deal with concerns about antibiotic resistance, and how will he solve the root cause of the problem, which is the fact that there are not enough GPs?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.

Photo of Seema Malhotra Seema Malhotra Shadow Minister (Business, Energy and Industrial Strategy)

The steps proposed in the statement reflect what Labour has been calling for, and are well overdue. I am glad that at least some steps are being taken, but they fall well short of the scale of the challenge that we face. Pharmacists need to work in a strong primary care environment. We need to see more GPs, an increase in primary care services, and more tests, diagnoses and minor procedures carried out in the community, speeding up primary care and taking the pressure off secondary care.

Three years ago, I met Ministers and officials in the Department to seek advice on and support for the rebuilding of the rundown Heston health centre in my constituency. What is the Government’s strategy on the rebuilding of rundown primary care facilities, not only to assist the recruitment and retention of GPs but to better facilitate the work taking place between GPs, pharmacies and other community healthcare services?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

There seems to be a slightly confused response from the Opposition. They challenge this announcement on the grounds that they are not happy with it, and in the same breath claim that it is part of Labour’s plan or a step in the right direction. They need to make up their mind.

As I said in response to two earlier questions, it is for the integrated care boards to adopt estate strategies in their areas. Not all decisions about estates should be made centrally. However, one of the changes that we are setting centrally involves embracing more modern methods of construction and a more modular approach. The unit cost of that approach is much lower, and when the level of confidence is higher, the contingency cost is much lower as well. So we are changing the way in which we build our estate, but the estate strategy is an issue for the ICBs.

Photo of Michael Fabricant Michael Fabricant Conservative, Lichfield

As Taiwo Owatemi will know, it takes five years to obtain a master of pharmacy degree and to become fully qualified. Training continues as pharmacists continue in their work, so they are a valuable resource, and I welcome the statement. As my right hon. Friend the Secretary of State will know, in France, for instance, where it costs €26.50 to see a GP, most people would choose to see a pharmacist first, but is he sure that by taking pressure off general practices, he will not overwhelm pharmacists such as mine in Lichfield and Burntwood?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend is right to draw attention to the practice in other countries, and the fact that patients are very happy to visit pharmacists when that is more appropriate for the treatment that they are using. That is what the Pharmacy First strategy and the learning of lessons are all about, although we must also think about how to mitigate some of the risks connected with antimicrobial resistance. In the context of the impact on pharmacy, I refer my hon. Friend to what has been said by those in the sector. This is a move that they have called for and have now welcomed, and it responds very much to our discussions with pharmacists who have said that they can do more and are keen to do more, but need the funding to enable them to do so—which is what Pharmacy First delivers.

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central

The impact of today’s announcement will be miniscule compared with the scale of the challenge facing primary care right now. In York, our GPs are innovative and ambitious—far more ambitious than the Secretary of State—and want to bring real change to the way pathways operate. In light of that, will additional money be available for innovation in primary care, so that GPs can meet the challenge and lead the change that is needed?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.

Photo of Paul Bristow Paul Bristow Conservative, Peterborough

I am pleased to inform the House that my mother has moved in with my wife and me, from the Secretary of State’s constituency. One of the joys of living with my mother is helping her with Tesco orders and Amazon deliveries and with surfing what she calls the interweb, and I am looking forward to helping her with the new NHS app. Does my right hon. Friend agree with me that enabling many more people to use the NHS app, including Mrs Bristow, and having many more services available on the NHS app is more convenient for patients and will free up GP time, so that GPs can do what they should be doing?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I am happy to recognise the scope for Mrs Bristow and many others to make more use of the NHS app. That app is all about empowering the patient and enabling them to get the right care, in the right place, at the right time, whether from a pharmacist, one of the additional primary care roles we are creating or a GP where applicable. The NHS app can free primary care practices from many of the tasks that are currently placed on them, such as people phoning for their records or repeat prescriptions. It is a key part of streamlining such tasks.

Photo of John Cryer John Cryer Labour, Leyton and Wanstead

In my constituency, we have lost GPs and surgeries. There are increasing numbers of people on fewer and fewer lists. Community pharmacies are under pressure and some have closed, so people then go to the local hospital, Whipps Cross University Hospital, which is struggling, with 100% bed occupancy rates. The Secretary of State has been ducking making an announcement about funding for the new Whipps since he took on the job, but that hospital is struggling every day. My question is twofold: when will the Secretary of State announce the workforce plan for primary care, and when will he finally get around to making an announcement for Whipps Cross University Hospital?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

Far from ducking Whipps Cross, I have actually been and visited in person, so I am very familiar with the issue and I recognise the importance of the new hospital programme. I hope to make an announcement about that programme and about the workforce plan shortly, just as I am doing today about the primary care recovery plan.

In today’s plan, the hon. Gentleman may want see at the proposals to look at the contribution to pressures on primary care from new housing developments, and at what changes might be made to ensure that where such developments take place, funding from them goes not only to new schools, as it frequently does, but into primary care, and particularly GPs.

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner, The Second Church Estates Commissioner

I warmly praise all those who work in primary care in my constituency, including Dr John Henderson and Dr Stephen Price, who are the leaders of my two primary care networks.

It is great to see another 25,000 staff in primary care. They now need somewhere to work, including somewhere in the middle of Leighton Buzzard before we get the extra health facilities next year. When we build tens of thousands of extra houses, my experience, over decades, is that no Government, comprised of any party, have made sure that extra primary care facilities come on stream with as much certainty as a new primary school. If we could crack that, we would do a huge service to the whole nation. Please could the Secretary of State make it his personal mission to do that?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

We plan to change planning guidance this year to address that specific issue. I have visited my hon. Friend’s constituency, and we resolved one of the issues in relation to the estate, which was extremely constructive. I know he has been discussing a further issue with the Department, but I hope he can take some comfort that his representations have been heard. The Under-Secretary of State for Health and Social Care, my hon. Friend Neil O’Brien, is planning to make changes to the guidance to better ensure that, where there is new housing, a contribution is made to primary care.

Photo of Emma Hardy Emma Hardy Labour, Kingston upon Hull West and Hessle

The problem in primary care is that we do not have enough GPs to meet the demand for appointments. The problem is not with the telephone system. The area I represent has one of the lowest ratios of GPs to population in the whole country. Will the Secretary of State support our campaign to train more doctors at Hull York Medical School, and for Hull York Medical School to set up a training facility for pharmacists and dentists?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

As I said in my statement, we have 4,000 doctors training in primary care, compared with 2,600 in 2014. We are also looking at how we can better retain the GPs we have. That is why we made the pension changes, which will affect around 9,000 GPs. It is also why we are looking at additional roles to take pressure off GPs, and at how we can reduce some of the burden of bureaucracy, too. We are training more doctors, and we are looking at retention and bureaucracy. No one is suggesting that this is solely an issue of telephony or online booking, as the hon. Lady suggests, but all of this will help to relieve pressure on extremely busy primary care.

Photo of Luke Evans Luke Evans Conservative, Bosworth

I am pleased to be talking about primary care, for obvious reasons. It is important that the Government made the pension changes, which will make a difference to retention, but I am also pleased with the next part of the plan. When I was a clinician, 15% of my workload was chasing letters and administration, which is borne out by the evidence we have heard on the Health and Social Care Committee. Will the Secretary of State comment further on the bureaucracy he is cutting? Will he ensure that this is the first step in pushing down on that bureaucracy, as that will improve the welfare of both our workforce and our patients?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

I reinforce what colleagues have said. This is a step in the right direction, but it fails to grapple with the grave situation in which there has been a threefold increase in waiting lists since 2010, including a twofold increase since 2019, before the pandemic. In Oldham we have fewer GPs and more patients with increased acuity, so when will we get our fair share of the promised 6,000 GPs?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I have recognised throughout that demand has increased. Primary care is treating 10% more patients than before the pandemic, with around 1 million appointments a day. There is more demand, not just because of the pandemic but, as I said in my opening remarks, because we have a third more people over the age of 70, and they are five times more likely than younger people to go to their GP. That demographic change, the impact of the pandemic and a change in public expectations of advances in medicine are all creating additional pressure, which is why it is right that we use the full range of additional roles and that we invest in technology, in addition to the 2,000 more doctors in general practice.

Photo of Siobhan Baillie Siobhan Baillie Conservative, Stroud

GPs, pharmacists and primary care teams do an incredible job for local people in the Stroud district, and I look forward to the funding flowing to our pharmacists, as many of them have made a constructive case for it. A local GP told me that he believes a national education campaign is needed to advise patients of when to access general practice and when to access other services, such as pharmacies. I think this is a good idea, given today’s announcement. Will the Government take it up?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend is absolutely right on this and we plan to have a communications campaign. The front door to the NHS can often be confusing for people—whether they should go to primary care, a pharmacy, accident and emergency or elsewhere. We will have a campaign, not just linked to the opportunity to access care through Pharmacy First, but looking at the technology innovations we are bringing on stream, particularly on the NHS app. We are also making changes to 111. So there will be a communications campaign, on exactly the lines she references.

Photo of Kim Johnson Kim Johnson Labour, Liverpool, Riverside

I wish to thank all the primary care workers in my constituency. Despite the Minister’s assurances, 600 pharmacies have closed since 2015, which is having a significant impact on our most disadvantaged communities. Does he agree that more funding is needed to prevent more pharmacies from closing and to fix the broken NHS? Will he join me in condemning the Rowlands Pharmacy on Lodge Lane, which is pulling out of the community and preventing another pharmacy from taking its place?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

I join the hon. Lady—as I did the other colleagues from across the House who have done this—in paying tribute to the primary care staff in her constituency for the work they do. We have touched a number of times on the fact that there are both more pharmacies and more pharmacists than there were in 2010, so there is more capacity. However, we also recognise the scope to better use the expertise within pharmacy, which is why an additional £645 million of investment—new funding—is going into pharmacies over the next two years.

Photo of Matt Warman Matt Warman Conservative, Boston and Skegness

I am married to a trainee GP, so I have read all 46 pages of this excellent plan—reading it makes me different from those on the Opposition Front Bench. Importantly, the plan is littered with examples of brilliant practice up and down the country, with case studies that should be adopted more widely. Almost all of them come back to the use of technology. Will the Secretary of State say that he will target the help needed to adopt that technology at the practices that need it most, which are so often those in coastal constituencies such as mine?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend is right about the opportunity that tech offers to deliver changes at scale and the fact that this is proven technology that is working and already up and running in many primary care settings. So often within the NHS the challenge is not the initial innovation—we get pockets of wonderful innovation—but how we industrialise it across the wider NHS. This recovery plan focuses on that, looking at how we scale the case studies to which he refers. About half of primary care does have digital telephony. The opportunity here is to target that funding at the other half; that is often the smaller GP practices, as well as those in coastal communities, because they find the transition to tech more difficult. That is why a key part of this recovery plan is about the investment in not just the tech, but in locums, to provide cover so that staff can make the transition to that new way of working.

Photo of Diana R. Johnson Diana R. Johnson Chair, Home Affairs Committee, Chair, Home Affairs Committee

The NHS workforce plan has been promised for years. Meanwhile, as my hon. Friend Emma Hardy says, we are short of GPs, pharmacists and dentists in Hull. Will the Secretary of State answer the question she put to him: can we please build on the excellent work of the Hull York Medical School to set up a dental training school there, and a school of pharmacy and one for ophthalmologists? That would help in the longer term, but we need a proper workforce plan and the Government need to get on with it.

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

As I have said several times, we will publish a workforce plan shortly. We are committed to that and the Chancellor set that out in the autumn statement. Of course, when he was doing this job and when I was previously in the Department, we expanded medical undergraduate places by a fifth, so there was an increase then. I have said that we will also set out a dental recovery plan in due course.

Photo of Jack Brereton Jack Brereton Conservative, Stoke-on-Trent South

I very much welcome these plans to improve access to primary care, particularly around the 8 am scrum, which is beneficial neither for patients nor for NHS staff. In North Staffordshire we have some very good GP practices, but also some very poor ones, which we need to see improve. Will my right hon. Friend confirm that, with these new measures, the archaic practices that we see in some of those GP surgeries will be outlawed, and that we will put in place the new services as soon as possible?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend touches on an extremely important point. The measures will provide, for all Members of the House, much greater transparency on the variation between primary care settings. I am keen that we should publish much more information showing, within constituencies, the differences in the services offered by different primary care settings. We already see that between those that have digital telephony and online booking and those that do not, but we also see that in other indicators, and I am keen that he and other Members of the House get visibility of that.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the Secretary of State for his statement. The primary care recovery plan is very welcome, and it will be wonderful for NHS England when the goals are achieved. However, I have a very specific question about Northern Ireland. My constituents are struggling to get hold of their medical records over the phone for personal independence payment assessments and appeals. He referred in his statement to improvements in the app system. What discussions will he have with the Department of Health in Northern Ireland about introducing a similar system to enable patients in Northern Ireland to access their medical records via an NHS app?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

The hon. Member is right to recognise the importance of access to medical records. It is a key part of the functionality that we are delivering through the NHS app. He is correct that that is focused on England and not on Northern Ireland, but I am very happy for us to have discussions with him and his colleagues in Northern Ireland on any shared practice.

Photo of Simon Jupp Simon Jupp Conservative, East Devon

Today’s welcome announcement will help patients get prescriptions directly from hard-working, resilient but sometimes overstretched pharmacies, freeing up GP appointments. Will my right hon. Friend outline how pharmacies in my constituency of East Devon will be able to access funding and support to deliver this?

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

The funding will include for prescriptions for the seven common conditions, which form part of Pharmacy First. That will be part of a new NHS service that will be offered, as set out in this plan. That is what the £645 million over the two years is targeted at, and obviously we will have further discussions with the sector on the roll-out.

Photo of Greg Smith Greg Smith Conservative, Buckingham

I very much welcome this recovery plan. It is the right thing to do and will make a big difference. Does my right hon. Friend agree that it is also critical for rural communities to have local and convenient access to GPs? With that in mind, will he redouble his Department’s efforts, alongside the Buckinghamshire, Oxfordshire and Berkshire West ICB, to find a way to fund the construction of Long Crendon’s innovative model to replace the old village surgery, which sadly had to close under covid. This will not only deliver first-rate primary care to the village of Long Crendon and surrounding villages, but relieve the pressure on Brill surgery, where patients find themselves displaced to.

Photo of Steve Barclay Steve Barclay Secretary of State for Health and Social Care

My hon. Friend has raised this issue previously, and he is quite right to champion it—I know that it is hugely important to his constituents. I hope the ICB will take heed of the issue he raises, particularly in relation to the level of visibility on the estate plan. Based on our conversations, I think that more can be done to share that with him. I urge the ICB to engage closely with him to make sure that the estate plan addresses the very real needs that his constituents have identified.