Edward Argar

The hon. Gentleman is right. Although I spent two and a half years as a Minister in the Department of Health and Social Care, I was never the Minister for Primary Care, but I am very much aware, as I suspect Members across the House are, that that is an additional pressure on time for general practitioners. We in government sought to do what we could to reduce that, and to be fair to the new Government, I know the Secretary of State is actively looking at what can be done to further streamline administrative processes to allow general practitioners and their teams to spend more time with patients. Although my focus is on GP services in Melton Mowbray and Sileby, it is true that all GP surgeries in my area—whether that is the County practice and Jubilee medical practice in Syston, or practices in Thurmaston, Bottesford, Long Clawson and other nearby villages—continue to face huge pressures. It is important to say that these practices really do their best. Their staff—not just the GPs, but the whole teams—work incredibly hard, and I know they care deeply about the service they provide to their patients. In Melton Mowbray especially, they see acute pressure, particularly on appointments: we have just one GP practice for a growing town. Latham House medical practice has over 36,000 patients on its books, making it one of the largest in the country. Timely access to GP appointments is one of the largest regular issues to appear in my constituency inbox, with waits—according to the correspondence I receive—of at least six weeks, and it can be eight or 10 weeks before an appointment is available. Clearly, that is not right. It is important to say, to be fair to Latham House medical practice, that when my constituents get to see either a nurse, an allied health professional or a GP, they regularly cite in their emails the quality of the care and the kindness shown by the staff. Indeed, we recently saw a Cavell star award given to Debra Gilbert, one of the nurses at the practice, so the team there work hard and are passionate about what they do. In 2024, they saw an average of 6,900 appointments per 1,000 of the population on their list. That is higher than the national average, but I would urge a little caution because that is a crude statistic that does not necessarily comparatively reflect the different demographics of different areas, such as whether an older population or deprivation in an area lead to a higher need. It is important to put on the record that they are doing what they can to try to improve access, but clearly, an increase in provision is needed locally. Back in 2021, the then clinical commissioning group agreed that it recognised the need for increased provision of GP services in Melton Mowbray. In 2023, the integrated care board continued with that and agreed to explore a second GP practice, recognising the need for it. I believe that was a sensible decision by the ICB, but regrettably, just a few weeks ago in early October, it announced that it was pausing its work to develop such a plan until 2027. I have been around the Department of Health and Social Care and worked with the NHS long enough to know what a pause, sadly, all too often means. In Melton Mowbray, we have seen a pause of six months at the St Mary’s birth centre—a midwifery-led unit—to allow for staffing shortages to be addressed. Four months into that pause, we have yet to see any suggestion of how it might be brought to an end. When I hear the word “pause”, I fear that will run on into something more permanent. This issue, which is hugely important to my constituents, has been covered extensively and powerfully in the local media—in particular by the excellent local paper, the Melton Times. It is important to say that I am conscious that neither I, as a Member of Parliament, nor Melton borough council—which is equally keen for increased provision and with which I have spoken—or indeed the Minister himself have the power to simply overrule a decision taken by an integrated care board in a local matter such as this. I took through the 2022 Act, so I have a vague recollection of how that works. That remains a deeply disappointing decision, and, I believe, the wrong one. The value of access to general practice, and the impact that a lack of access has, is writ large. Earlier today, I had one of my regular catch-ups with Councillor Ronan Browne, the leader of the opposition on Melton borough council, who did a lot to get us to the point where we were hopeful of seeing a second GP practice. He set out his deep disappointment about this decision. There is a clear remaining need. The ICB, in its announcement on reaching its decision, stated that the section 106 payments on which it was aiming to base the provision of capital for the new building were now insufficient. It also stated that slow growth in new registrations, and slower population growth than had been anticipated, were relevant to its decision making. However, that does not help my constituents. I am conscious of the challenges of funding buildings. As the Minister and I have discussed, in a sense—ironic though it may sound—finding money for a building is sometimes easier than the second part of the equation, which is securing the staff, and managing the oncosts to fund that. I should say that I am grateful to the ICB for its engagement and to Toby Sanders, its chief executive, for his open engagement with me. As I say, he has emphasised that he believes that section 106 payments are not enough, and the ICB has said that it has no funds to backfill that or pay for anything from its own funds. It is important to remember that, as the Minister will be aware, general practitioners and general practices are, in many ways, private businesses contracted to provide services to the NHS, but they are not direct employees of the NHS, so they cannot be directly instructed by the Minister, by ICBs or by NHS England—it is important to put that context on the record. In respect of the argument by the ICB that there were insufficient increases in new registrations and new patients to justify a second GP practice at this time—noting the pause—I am afraid that that fails to reflect the importance of choice for patients in switching to a different service in their locality if they so wish, and, in so doing, potentially easing pressure on the existing practice’s list. Pausing without a clear alternative long-term plan is simply not good enough. Latham House surgery has recently announced that it has taken steps to help to address this in the short term. On 15 October, it announced that it was recruiting an extra five GPs and additional nursing staff, that its Asfordby satellite surgery would be opening full-time in the future, and that it was looking to create new provision in a small premises on Sherrard Street in the town. Those are welcome steps for which I am grateful, and I look forward to hearing more about those proposals from the practice, but they do not alter my view on the long-term needs of Melton Mowbray and the surrounding villages. The ICB needs to act and be supported in doing so by the Department of Health and Social Care. It is true to say as well that ICBs face real challenges, including the Government requiring them to force cuts in staff and to restructure, but without seemingly providing them with additional ringfenced funding for the costs of that restructuring, be they redundancies or otherwise. That means that regardless of whether the end is a good one—that is, a leaner ICB—ICBs will potentially have to cut from the frontline in the short to medium term to fund that restructuring. As I have alluded to, there are also the challenges of oncosts and funding GPs to staff a surgery. GPs have a choice as to where they choose to work, and I suspect the old Carr-Hill formula, which the Minister and I have spoken about in the past, does not aid that. It is a challenge that Governments of all complexions have faced and I hope that he, if he is willing, will take on the challenge of looking at the Carr-Hill formula. He will have my constructive support in doing so. Latham House practice has cited the challenges in securing and retaining staff so I recognise that, but again, those are challenges for the Government and the ICB to assist and support with and not ones that should be borne, as a consequence, by my constituents. I will briefly mention Sileby, another village in my constituency. It has two good GP practices, but it is a rapidly growing village, and larger premises are needed. Again, the ICB has indicated that it will not have funds to fund or support that and once again, section 106 moneys are likely to be insufficient. It is a real challenge faced by GP practices up and down the country as to how they take that step, often having to accept more patients as houses are built. Even when there is a section 106 payment, it is only triggered later in the process once they have already had to absorb an increase in patients. I hope that the Minister might look at that. Although I recognise and welcome Latham House’s actions and hard work and I hope that delivers results, I fear it simply is not enough to tackle the long-term needs. The Secretary of State’s new neighbourhood health centre programme may well help us in the longer term. For example, one of those could be allocated to Melton Mowbray, which already has Melton Mowbray hospital—in my view an underused and therefore perfect site, and the Minister can take that as a potential early bid for such a centre. That may help in the long term, but we still need action now for my constituents to improve access and to build for the long term. I am sure the Minister will know that Melton Mowbray and the surrounding villages and towns are fantastic places with a real sense of community, a proud history, a great present and huge future potential, just like the other parts of my constituency. Melton Mowbray’s residents are good, decent people who need, and frankly deserve, improved access to GP appointments and an increased focus on tackling this for their communities. Will the Minister set out what steps the Government are taking in partnership with ICBs to help address increased need for access to GP appointments, both nationally and locally? Is he willing to take on the challenge of looking at the Carr-Hill formula and how GPs are funded per patient for their activity? Will he reassure ICBs that all restructuring costs, over and above their current budgets, will be centrally funded to avoid them cutting frontline services? Will he work for better links between section 106 moneys and the needs of healthcare provision locally? Will he meet me, ideally in Melton Mowbray—he is very welcome—to discuss what can be done locally to improve GP provision? I genuinely hope that he shares my view that Melton Mowbray and the nearby villages not only need further enhancement to existing services, which Latham House is trying to put in place, but genuinely need that second GP practice to meet their future needs. I will continue to campaign on behalf of my constituents for that, but I will also, as I hope he has seen in the brief time we have known each other, be willing to work with the NHS and with any political party that helps facilitate that locally and nationally. Finally, will he agree to work with me and my constituents to deliver the improved premises and services needed to meet the current and future primary care needs of my fantastic constituents in Melton Mowbray and the surrounding villages?