Government developments
On 14 October, Prime Minister Liz Truss sacked Chancellor Kwasi Kwarteng and replaced him with former Health Secretary Jeremy Hunt.
In subsequent media and parliamentary statements, Mr Hunt stated that ‘all tax measures announced in the growth plan three weeks ago that have not started parliamentary legislation’ will be reversed. This does not include the repeal of the Health and Social Care levy on national insurance, which is set to take effect on 6 November.
Mr Hunt has also said that all government departments will be asked to make spending cuts.
Parliamentary statements
On 22 September, Therese Coffey, the Secretary of State for Health and Social Care made a statement to Parliament regarding her ‘Plan for Patients’.
Beginning the statement, Mrs Coffey highlighted that the Prime Minister, in her first speech from Downing Street, said that ‘the NHS’ and ‘patients being able to get a GP appointment’ was one of her 3 priorities.
Mrs Coffey asserted that ‘pension rules can currently be a disincentive for clinicians who want to stay in the profession or to return from retirement’. To improve this, pension rules will be corrected ‘relating to inflation’ and it is expected that ‘NHS trusts will offer pension recycling’. Measures that allow people to stay or return to the NHS will be extended until 2024.
Mrs Coffey stated that she is ‘determined to address one of the most frustrating problems faced by many patients: getting an appointment to see their doctor’.
Five steps are being taken to help make that happen:
- “Setting the expectation that everyone who needs a GP appointment can get one within two weeks.
- Opening up time for more than 1 million extra appointments, so that patients with urgent needs can be seen on the same day.
- Making it easier to book an appointment.
- Publishing performance by practice to help to inform patients.
- Requiring the local NHS to hold practices to account, providing support to those practices with the most acute access challenges to improve performance.”
To make more appointments available, the government ‘will ease pressures on GP practices by expanding the role of community pharmacies’, for example allowing pharmacists to prescribe certain medications. This and other measures ‘will free up 2 million appointments’. Funding rules will also change ‘to give freedoms to GPs to boost the number of staff to support their practice’. This measure could free up ‘1 million GP appointments’.
Patients will find it easier to contact their practice, both on the phone, with an ‘extra 31,000 phone lines available this winter’ and greater deployment of cloud-based telephony, and online and the NHS app.
Shadow Health Secretary and Ilford North MP Wes Streeting responded to the statement.
Mr Streeting pointed out that making GP appointments available within two weeks was ‘not a guarantee at all, but merely an expectation’. He also asked ‘what is the consequence if GPs do not meet this expectation?’.
Mr Streeting stated that ‘the super-massive black hole at the heart of the Secretary of State’s plan is the lack of a workforce strategy’, with the loss of ‘4,700 GPs over the past decade’ and ‘330 practices’ since 2019 making it difficult to see how extra appointments would be delivered.
In her response to Mr Streeting, Mrs Coffey noted that there is ‘record funding going into the NHS’ – ‘40% of the government’s day-to-day spending’.
She also said that the Department for Health and Social Care have ‘started getting data from NHS Digital about what is happening practice by practice’. Mrs Coffey intends to ‘use experts in the local NHS to prioritise helping those patients who are not getting the service that they should rightly expect, while giving freedom to those other GPs who are doing a fantastic job of supporting patients in their practice’.
Former Health Secretary and now Chair of the House of Commons Health Select Committee, Jeremy Hunt,asked the Secretary of State to ‘rethink’ the two-week target for GP appointments. Mr Hunt argued that GPs already work under 72 targets, and ‘adding a 73rd will not help them or their patients, because it is not more targets but more doctors that the NHS needs’.
In her answer, Mrs Coffey stated that the new Minister for primary care, Will Quince, ‘wants to try to make it easier for people to change general practices’.
The Liberal Democrat spokesperson for Health, Daisy Cooper said that ‘GPs are now seeing almost 12% more patients than they were just five years ago; the GP sector is facing a retirement timebomb; and one in five patients can only see a GP for less than five minutes’. She asked whether the government had given up on its target of 6000 more GPs by 2024.
Mrs Coffey replied ‘No.’
Health Select Committee member and Conservative MP Laura Trott proclaimed that ‘the majority of GPs—75%—now work part time’. This is ‘an understandable choice’ but impacts ‘the availability of appointments and the cost of training’.
Mrs Coffey answered that ‘it is a choice for GPs whether they work part time or full time.’ The action the government is taking ‘on pension flexibilities and diverting people to pharmacies’ should help.
Party conferences
In late September and early October, the Conservative and Labour parties held their annual conferences, a more extensive summary of health related news from these is available here.
Written Parliamentary Questions
Feryal Clark, Enfield North (Lab) – Shadow Minister for Primary Care
(7/9) A: Under the GP Contract, contraceptive services are an essential service which practices must provide or arrange for the provision of to their patients. Practices are paid for providing essential services via the global sum, which is a capitated payment based on practice patient list size, weighted to account for estimated patient workload and unavoidable costs. NHS England is currently piloting the management, review and supply of oral contraception from community pharmacy for people on a regime initiated in general practice or sexual health clinics, providing greater choice and access when considering continuing their current form of contraception.
The Government has provided more than £3.4 billion of ring-fenced funding to local authorities in England in 2022/23 to fund public health services, including contraceptive provision in specialist sexual and reproductive health (SRH) services. It is for individual local authorities to determine spending priorities based on an assessment of local need, including the need for SRH and contraceptive services taking account of statutory duties.
Andrew Rosindell, Romford (Con)
Missed appointments (6/9) Can an estimate be made of the number of missed GP and hospital appointments in England, Romford and the London Borough of Havering since 2016?
(27/9) A: From July 2020 to July 2022, the estimated number of missed GP appointments in England, excluding COVID-19 vaccinations, was 26.91 million and 1.15 million in North East London ICB.
The following table shows the number of ‘did not attends’ England and the London Borough of Havering in each year from 2015/16 to 2020/21, the most recent data available.
| Year | England | Havering |
| 2015/16 | 7,519,829 | 38,210 |
| 2016/17 | 7,938,009 | 40,125 |
| 2017/18 | 7,984,183 | 39,850 |
| 2018/19 | 7,919,660 | 37,910 |
| 2019/20 | 7,695,040 | 37,080 |
| 2020/21 | 5,640,749 | 22,750 |
Seema Malhotra, Feltham and Heston (Lab)
(22/9) A: In July 2022, excluding COVID-19 vaccinations, 44.3% of GP appointments in England took place on the same day as it was booked, with 72.3% within seven days. We are investing least £1.5 billion to create an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce.
Sam Tarry, Ilford South (Lab)
Access (2/9) What short and long term steps the Government is taking to increase the availability of GP appointments?
(21/9) A: Excluding COVID-19 vaccinations, there were an average of 1.24 million appointments per working day in July 2022, compared to 1.17 million in July 2019. We have also made £520 million available to improve access and expand general practice capacity during the pandemic. To reduce unnecessary bureaucracy for GPs and increase capacity for appointments, we have expanded the range of healthcare professionals who can sign fit notes and published seven principles to reduce unnecessary burdens on GPs.
We are investing at least £1.5 billion to create an additional 50 million general practice appointments by 2024 through increasing and diversifying the workforce. General practice teams include a range of other health professionals in addition to GPs, to respond to the needs of patients and we are on schedule to recruit an additional 26,000 primary care staff.
Workforce (2/9) What steps are being taken to help tackle the shortage of GPs and other healthcare staff?
(7/9) A: We are working with NHS England, HEE and the profession to increase the general practice workforce. This includes measures to increase recruitment, address the reasons why doctors leave the profession and encourage them to return to practice. The 2020 updated GP Contract Framework announced new retention schemes alongside continued support for existing schemes for the general practice workforce. We have also increased the number of GP training place to 4,000 from 2,671 in 2014.
To support the recruitment of other healthcare professionals in general practice, the ARRS provides funding for 26,000 additional roles to create bespoke multi-disciplinary teams. The Scheme is expanding to include more roles to reduce the shortages of non-clinical roles within primary care. While the Scheme initially included five roles, this has increased to 15 in the 2022/23 contract. As of June 2022, there were 30,824 FTE direct patient care staff working in primary care – an increase of 19,305 FTE compared to March 2019.
We have funded an additional 1,500 undergraduate medical school places each year for domestic students in England – a 25% increase over three years. This expansion was completed in September 2020 and has delivered five new medical schools in England.