What will Labour mean for general practice?

Pulse looks at what a new government will mean for general practice

Unless you’ve been living underground for the past six weeks/14 years, yesterday’s result in the general election will not have come as a shock. Keir Starmer’s Labour Party cruised to an historic win, utterly humiliating the Conservatives all across the UK. We have a new Prime Minister and, despite a very close race in Ilford North, a new health secretary in Wes Streeting. 

One could argue that Labour did not have to campaign particularly hard; in fact all they had to do was rely on the self-imposed implosion of the Conservative Party. But what that does mean, is that very little has been said about details of actual policies for the new government. So now, with votes counted and seats filled, we ask: What will Labour do?

In theory it is a straightforward question. But, as pointed out in our manifesto deep dive last week, our burning question for Labour was: where are the details? They certainly weren’t in the manifesto. And none of the issues plaguing general practice were mentioned. In 1997, the last time that Labour came into power, the party delivered on their manifesto by abolishing GP Fundholding within a year of office – a scheme that critics lambasted for creating a two-tier health system.

In the 2024 Labour manifesto, the majority of general practice mentions lay under the heading ‘Healthcare closer to home.’ The closest we got to policy points were:

• Training ‘thousands more’ GPs
• Guaranteeing face-to-face appointments for all patients who want one
• A modern appointment booking system to end ‘8am scramble’
• Incentivising continuity of care to ‘bring back the family doctor’
• Taking pressure off GP surgeries by encouraging access to other treatment and service routes
• Expanding self-referral routes where appropriate

There was little detail on planning or funding on any of these. Furthermore, the ‘neighbourhood health service’ that the party has continually touted still remains vague. Despite questioning from Pulse, it is unclear how these hubs will greatly differ from the Darzi centres of the early 2010s, with the only detail provided so far being that GPs and other community health staff will work under one roof. 

But for GPs across the country, rather than looking at new implementations, it is the current problems they want addressed. Streeting has a chequered history with general practice. Last January, he said that he would ‘tear up’ the ‘murky, opaque’ GP contract, while considering abolishing the GP partnership model in favour of a salaried service. However, he later did soften his position, saying that he understood the value of the partnership model, and has since discussed primary care in various interviews and media circuits, stating that general practice would ‘do well’ under a Labour Government. The details themselves though remain unanswered. Here, we look at the core problems and try unravel what a Labour Government means for it all. 

Employment

The employment crisis is the ‘headline’ issue facing general practice at the moment. It is the result of a car crash of policies and underfunding. GPs across the board are unable to find work, and NHSE has admitted that the new batch of graduates in August will struggle, as the jobs for them are just not there. The ring-fenced Additional Roles Reimbursement Scheme has seen an aggressive attrition of the workforce, as practices and PCNs hire non-doctor staff over GPs, due to them being a cheaper hire. 

This has given way to the unmitigated rise of physician associates: both endangering patients, and threatening the existence of the GP workforce. GPs, and doctors in secondary care have been adamant and dogged in their protests to stop the influx of PAs. NHS England have so far been reluctant to add GPs to the scheme, saying that they are not ‘additional.’ Streeting has not gone so far as to say that he would halt the recruitment of PAs, but has said that GPs’ concerns must be addressed, and that under a Labour Government he would review ARRS.

In the manifesto, Labour promises to train thousands more GPs, they have told Pulse that this is per the long-term workforce plan; 28,000 more doctors (not GP-specific) in the NHS by 2029 than there were in 2023. As already stated, training in isolation is futile as we also need more jobs; not just more doctors. However, training is still an important component. To do this though, the new government will need to look at increasing the number of trainers and facilities to ensure we have the capacity to deliver the demand.

Funding

A year ago, Streeting said that he would shift more money towards primary care ‘over time’. Since then he added that that ‘any available funding’ would go to primary care and acute sectors over hospitals. However, it doesn’t look like there will be money immediately for general practice: incoming chancellor Rachel Reeves has consistently said that if elected, Labour would be the party of ‘economic stability.’ Compounding this with her commitment to not have an Autumn Budget, and to empower the Office of Budget Responsibility means that the party will not be able to increase their public spending upon entering office. Therefore, any increased spending for general practice will have to come from cuts to other departments. 

Given the sheer amount of practices that have had to hand back their contracts, or permanently shut doors in the past ten years, the lack of detail of amount and timeline will likely trouble many GPs. Andy Pow, a board member for the Association of Independent Specialist Medical Accountants (AISMA), recognising the finance constraints the new government commented that Streeting and his team ‘must explore how to reduce the possibility of more GP practices handing back their contracts. This means supporting funding going into the core contract in England and through the devolved budget in Scotland, Wales and Northern Ireland, which is what pays for GP premises, running costs, management, reception, nurse and GP staff at practice level.’

Industrial action

Another key issue for the new government, and perhaps the most time-pressing, is the threat of industrial action in general practice. Depending on the result of the BMA ballot of GP partners, collective action is set to take place on 1 August. Any action taken then will be part of a ‘first phase’ of action, with an escalation of to ‘phase two’ possible if the new Government doesn’t agree to make ‘contractual improvements’ to the 2024/25 imposed contract. Streeting has said that if elected, he will prioritise discussions with GPCE chair Dr Katie Bramall-Stainer in the hopes to convince them against taking action in the first place. Given the tight deadline for this, it remains to be seen whether Streeting will be able to do so much in such a short time. 

Many will welcome the demise of the Conservatives, but not fully embrace Labour, given its non-committal to new general practice policy and reform at this point. It remains to be seen if Streeting can save, or at the very least, offer a few lifeboats to the profession.

Coincidentally, it’s actually the NHS’s 76th birthday today. Let’s hope that Starmer, Streeting and the new government give it the best gift it can, by investing in general practice.