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In the short time I have, I will restrict myself to just one issue, something very close to my heart, which has already been touched upon by a number of noble Lords today—continuity of care. As I said in my maiden speech not even a year ago, my very first...
In the short time I have, I will restrict myself to just one issue, something very close to my heart, which has already been touched upon by a number of noble Lords today—continuity of care. As I said in my maiden speech not even a year ago, my very first...
To ask His Majesty's Government what proportion of NHS expenditure has been allocated to (1) acute hospital services, (2) primary medical care, and (3) community health services in each financial year since 2015-16.
To ask His Majesty's Government what proportion of NHS expenditure has been allocated to (1) acute hospital services, (2) primary medical care, and (3) community health services in each financial year since 2015-16.
I refer the Noble Baroness to the answer provided on 20 July in response to Question HL1981, which, for ease of reference, is reproduced below.
The following table sets out the revenue spend categories for the specified services commissioned by NHS England and clinical commissioning groups, now integrated care boards, using audited figures between 2015/16 to 2024/25:
All spend figures are billions | 2015/16 | 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | 2024/25 |
Specialised services | £14.8 | £15.4 | £16.4 | £17.2 | £18.5 | £18.8 | £20.5 | £22.7 | £25 | £27.1 |
Primary medical care | £8.7 | £9.1 | £9.4 | £9.7 | £10.6 | £11.7 | £12.3 | £12.5 | £13.6 | £14.5 |
Community services | £7.1 | £7.3 | £7.4 | £7.5 | £8.1 | £10 | £11.2 | £12 | £12.8 | £13.8 |
Continuing care | £4.3 | £4.7 | £4.6 | £4.7 | £5 | £6.3 | £6.1 | £6.2 | £7.1 | £7.8 |
Acute | £38.2 | £40.1 | £41.4 | £42.9 | £45.9 | £50.7 | £60.7 | £62.4 | £68.1 | £74.7 |
Core mental health | £7.3 | £7.6 | £8.1 | £8.5 | £9.3 | £10.4 | £11.9 | £12.7 | £14.2 | £15.5 |
Other | £18.9 | £17.8 | £18.3 | £18.6 | £18.4 | £21 | £21 | £20 | £20.4 | £21.9 |
Total CCG/ICB and direct commissioning spend | £99.4 | £102 | £105.5 | £109.1 | £115.7 | £129 | £143.7 | £148.6 | £161.3 | £175.2 |
Notes:
- delegated specialised commissioning has been included within the specialised commissioning line as well as directly commissioned spec comm to remain consistent with previous years; and
- prescribing and delegated pharmacy/ophthalmology/primary and secondary dental all sit within the ‘other’ category.
Information for 2025/26 is unvalidated and not quality assured. In-year data is not routinely reported on with the breakdown of spend used for this answer and would be subject to material change between plan and outturn as a result.
75% of NHS England commissioned social services are within the community services line.
My Lords, since 1948, successive Governments have shifted care into the community without a simultaneous shift of people, estates or money. We have just heard that general practice now receives its lowest share of the NHS budget for a decade. Will the Minister agree to address this so that GPs can deliver continuity of care, which we know improves access, reduces demand, improves outcomes and fundamentally delivers better value for money?
My Lords, since 1948, successive Governments have shifted care into the community without a simultaneous shift of people, estates or money. We have just heard that general practice now receives its lowest share of the NHS budget for a decade. Will the Minister agree to address this so that GPs can deliver continuity of care, which we know improves access, reduces demand, improves outcomes and fundamentally delivers better value for money?
I say to the noble Baroness that that is what I feel the whole neighbourhood approach to the NHS is. As she is aware, it is about joining up around the person and bringing together teams, including GPs. It is important to acknowledge outcomes: we have delivered nearly 14 million additional appointments through GPs in the year to June 2026, and patient satisfaction is going up with GP access. We need to look at what the situation is as well as the concerns.
To ask His Majesty's Government what measures they are using to assess whether NHS resource allocations are reflecting their commitment to deliver more care closer to home.
To ask His Majesty's Government what measures they are using to assess whether NHS resource allocations are reflecting their commitment to deliver more care closer to home.
NHS England is responsible for determining allocations of financial resources to integrated care boards (ICBs). The allocation methodology takes account of population need, including community health needs and health inequalities, to ensure resources are distributed fairly across ICBs. This is being complemented by the development of neighbourhood health services and associated incentives to support the Government's ambition to shift more care from hospitals into community settings.
The Medium Term Planning Framework sets out the priority deliverables and the reform opportunities that ICBs and providers need to deliver for the next three years and the broader strategic aims that will need to be reflected in five-year plans developed by each organisation. This includes expectations on prevention, and on neighbourhood health, including primary and community care. Further guidance on neighbourhood health has also been set out in the subsequent Neighbourhood health framework.
To ask His Majesty's Government what guidance they have issued to integrated care boards on the allocation of resources towards prevention, primary care and community services.
To ask His Majesty's Government what guidance they have issued to integrated care boards on the allocation of resources towards prevention, primary care and community services.
NHS England is responsible for determining allocations of financial resources to integrated care boards (ICBs). The allocation methodology takes account of population need, including community health needs and health inequalities, to ensure resources are distributed fairly across ICBs. This is being complemented by the development of neighbourhood health services and associated incentives to support the Government's ambition to shift more care from hospitals into community settings.
The Medium Term Planning Framework sets out the priority deliverables and the reform opportunities that ICBs and providers need to deliver for the next three years and the broader strategic aims that will need to be reflected in five-year plans developed by each organisation. This includes expectations on prevention, and on neighbourhood health, including primary and community care. Further guidance on neighbourhood health has also been set out in the subsequent Neighbourhood health framework.
My Lords, I am grateful to the noble Lord, Lord Foster, for bringing this debate and for the unfailing, tireless work he does in this area. I declare my interest as medical director of the Primary Care Gambling Service, which treats patients experiencing gambling-related harms in services across England.
No matter...
My Lords, I am grateful to the noble Lord, Lord Foster, for bringing this debate and for the unfailing, tireless work he does in this area. I declare my interest as medical director of the Primary Care Gambling Service, which treats patients experiencing gambling-related harms in services across England.
No matter...
To ask His Majesty's Government what guidance they have issued to Integrated Care Boards on the allocation of resources towards prevention, primary care, and community services.
To ask His Majesty's Government what guidance they have issued to Integrated Care Boards on the allocation of resources towards prevention, primary care, and community services.
NHS England is responsible for determining allocations of financial resources to integrated care boards (ICBs). NHS England’s allocations policy aims to support equal opportunity of access for equal need, as well as NHS England’s duties to reduce health inequalities that are amenable to healthcare.
The Medium Term Planning Framework sets out the priority deliverables and the reform opportunities that ICBs and providers need to deliver for the next three years and the broader strategic aims that will need to be reflected in five year plans developed by each organisation. This includes expectations on prevention, and on neighbourhood health, including primary and community care. Further guidance on neighbourhood health has also been set out in the subsequent Neighbourhood health framework.
To ask His Majesty's Government what measures they use to assess whether NHS resource allocation reflects their longstanding commitment to deliver more care closer to home.
To ask His Majesty's Government what measures they use to assess whether NHS resource allocation reflects their longstanding commitment to deliver more care closer to home.
NHS England's allocation methodology takes account of population need, including community health needs and health inequalities, to ensure resources are distributed fairly across integrated care boards. This is being complemented by the development of neighbourhood health services and the associated incentives to support the Government's ambition to shift more care from hospitals into community settings.
To ask His Majesty's Government what proportion of NHS expenditure has been allocated to (1) acute hospital services, (2) primary medical care (general practice), and (3) community health services, in each financial year since 2015/16.
To ask His Majesty's Government what proportion of NHS expenditure has been allocated to (1) acute hospital services, (2) primary medical care (general practice), and (3) community health services, in each financial year since 2015/16.
The following table sets out the revenue spend categories for the specified services commissioned by NHS England and clinical commissioning groups, now integrated care boards, using audited figures between 2015/16 to 2024/25:
All spend figures are billions | 2015/16 | 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | 2024/25 |
|
| |||||||||||
| |||||||||||
Specialised services | £14.8 | £15.4 | £16.4 | £17.2 | £18.5 | £18.8 | £20.5 | £22.7 | £25 | £27.1 |
|
Primary medical care | £8.7 | £9.1 | £9.4 | £9.7 | £10.6 | £11.7 | £12.3 | £12.5 | £13.6 | £14.5 |
|
Community services | £7.1 | £7.3 | £7.4 | £7.5 | £8.1 | £10 | £11.2 | £12 | £12.8 | £13.8 |
|
Continuing care | £4.3 | £4.7 | £4.6 | £4.7 | £5 | £6.3 | £6.1 | £6.2 | £7.1 | £7.8 |
|
Acute | £38.2 | £40.1 | £41.4 | £42.9 | £45.9 | £50.7 | £60.7 | £62.4 | £68.1 | £74.7 |
|
Core mental health | £7.3 | £7.6 | £8.1 | £8.5 | £9.3 | £10.4 | £11.9 | £12.7 | £14.2 | £15.5 |
|
Other | £18.9 | £17.8 | £18.3 | £18.6 | £18.4 | £21 | £21 | £20 | £20.4 | £21.9 |
|
Total CCG/ICB and direct commissioning spend | £99.4 | £102 | £105.5 | £109.1 | £115.7 | £129 | £143.7 | £148.6 | £161.3 | £175.2 |
|
Notes:
- delegated specialised commissioning has been included within the specialised commissioning line as well as directly commissioned spec comm to remain consistent with previous years; and
- prescribing and delegated pharmacy/ophthalmology/primary and secondary dental all sit within the ‘other’ category.
Information for 2025/26 is unvalidated and not quality assured. In-year data is not routinely reported on with the breakdown of spend used for this answer and would be subject to material change between plan and outturn as a result.
75% of NHS England commissioned social services are within the community services line.
My Lords, would the Government consider requiring the HFEA to share data on these inappropriate and harmful add-ons with the General Medical Council so that fitness to practise concerns can be acted on?
My Lords, would the Government consider requiring the HFEA to share data on these inappropriate and harmful add-ons with the General Medical Council so that fitness to practise concerns can be acted on?
It is important that, where there are concerns, they are acted on. Perhaps the noble Baroness, with her experience, has a particular way in which that could be followed up, but certainly the GMC would be expected to take action if there was incorrect and unacceptable practice. I am not suggesting that in respect of add-ons to fertility treatment; I am focusing on the need for fair, equitable, NHS-funded fertility services and ensuring people know that there is not evidence that their chances of conceiving will be improved currently by any of these add-ons that are being offered, which is the worrying situation that we have.
My Lords, I am grateful to the noble Baroness, Lady Janke, for securing this debate and to the noble Baroness, Lady Walmsley, for saying many of the things around primary care and general practice that I want to say. I always feel that I am here defending my own profession.
The...
My Lords, I am grateful to the noble Baroness, Lady Janke, for securing this debate and to the noble Baroness, Lady Walmsley, for saying many of the things around primary care and general practice that I want to say. I always feel that I am here defending my own profession.
The...
Can the Minister comment on whether the mental health investment standard introduced in the Health and Care Act 2022, which requires the Secretary of State to report annually to Parliament on the share of NHS funding for mental health, will be replicated for primary care?
Can the Minister comment on whether the mental health investment standard introduced in the Health and Care Act 2022, which requires the Secretary of State to report annually to Parliament on the share of NHS funding for mental health, will be replicated for primary care?
I understand why the noble Baroness is asking that question. I cannot confirm that that is the case, but I will gladly raise that point with my colleague the Minister for Care.
To ask His Majesty's Government what assessment they have made of the clinical and patient safety implications of mandating general practitioners to use Advice and Guidance prior to referral to specialist care within the 2026–27 GP contract and in what clinical circumstances they intend such a mandate to apply; and...
To ask His Majesty's Government what assessment they have made of the clinical and patient safety implications of mandating general practitioners to use Advice and Guidance prior to referral to specialist care within the 2026–27 GP contract and in what clinical circumstances they intend such a mandate to apply; and...
The purpose of Advice and Guidance and an elective Single Point of Access is to ensure patients and practices receive rapid specialist assessment and a clear next step, using modern referral and triage approaches. It is important to emphasise that the clinical threshold for a referral remains unchanged.
Where there is clear clinical evidence, the intention is to avoid adding patients to outpatient waiting lists when they can receive timely diagnosis, advice, or management in a more appropriate setting. General practitioners (GPs) should continue to make a clinical decision to refer for specialist care where that is in the patient’s best interests, and to request specialist advice where that is needed. GPs retain responsibility for referral decisions, and this model supports and does not replace or override clinical judgement.
GPs, and other primary care referrers, remain professionally and legally accountable for their clinical decisions, including referring patients to specialist care where this is in the patient’s best interests. Requests for referral or specialist advice will receive a response from a named consultant with clear accountability and oversight.
The 2026/27 GP Contract embeds the previous Advice and Guidance enhanced service funding into core practice funding. Following near universal uptake of the Advice and Guidance Enhanced Service in 2025/26, the focus for 2026/27 is on stability and simplicity. Embedding the specialist advice model within the core contract recognises its role in routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways.
My Lords, I pay tribute to the noble Baroness, Lady Deech, for securing this important debate. Before I start, I will just clarify one issue: about 98% of abortion treatment is carried out in the not-for-profit sector, funded around 98% by the NHS. NHS hospitals do not make a profit...
My Lords, I pay tribute to the noble Baroness, Lady Deech, for securing this important debate. Before I start, I will just clarify one issue: about 98% of abortion treatment is carried out in the not-for-profit sector, funded around 98% by the NHS. NHS hospitals do not make a profit...
My Lords—
My Lords—
My Lords, I remind the House that Harold Shipman was a murderer convicted of 15 life sentences plus four years. He did not provide an assisted death. I would like that to be on the record.
I stand here as a general practitioner with over 40 years’ experience and, as I...
My Lords, I remind the House that Harold Shipman was a murderer convicted of 15 life sentences plus four years. He did not provide an assisted death. I would like that to be on the record.
I stand here as a general practitioner with over 40 years’ experience and, as I...
My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients...
My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients...
Can I give a clarification? I have just been in contact with most of the senior officers at the Royal College of General Practitioners. To put it on the record, to the best of my and their knowledge, the RCGP has not called for a register, a public one or...
Can I give a clarification? I have just been in contact with most of the senior officers at the Royal College of General Practitioners. To put it on the record, to the best of my and their knowledge, the RCGP has not called for a register, a public one or...
For goodness’ sake.
For goodness’ sake.
On a point of clarification, we have heard it said several times that the Royal College of GPs is in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of GPs is not in favour of a publicly available register....
On a point of clarification, we have heard it said several times that the Royal College of GPs is in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of GPs is not in favour of a publicly available register....