Big questions special: What are the parties planning?

With six days to go until the general election, Pulse scrutinises the manifestos and asks what each party will do for general practice. 

Conservatives: How will you fix the crisis you created?

The Conservatives’ manifesto promises nothing that we haven’t heard before. It commits to modernise 150 surgeries and build 100 more. That’s all very nice and well – and not entirely unhelpful. But it seems they are ignoring an overwhelming stink under the carpet, and one that they caused over the past 14 years. Namely, who is going to be working in these surgeries? Because right now, it doesn’t seem as if it will be GPs.

The manifesto promises 28,000 more doctors in the NHS by 2029 than there were in 2023, but there is no specific mention made as to what percentage of those might be GPs. Maybe they learnt their lesson in not overpromising – the 2019 manifesto committed to 6,000 more doctors in general practice, but they have failed miserably on this pledge. The latest workforce figures show that there are 480 fewer fully qualified GPs than there were at the last election. So what will they do different this time?

In terms of retention, the Conservatives’ manifesto promises to ‘attract and maintain’ a high quality workforce in the NHS but is scant in detail. The NHS Long Term Workforce Plan published last year was also unclear on retention strategies. Pulse reached out to the party for clarification but did not receive a response. 

The manifesto also fails to lay out a clear plan for recruitment. The Workforce Plan does specifically mention GPs, pledging to increase the number of GP training places by 50% to 6,000 by 2031/32. But this simple mantra of ‘train more GPs!’ fails to address both the current shortage and the infrastructure needed to do so. A Pulse analysis revealed that in order to keep up with demand, we will need to double the training capacity by 2028, and treble it by 2033.  

The workforce plan’s targets were built on the premise of substituting doctors with other staff, leading us onto another issue entirely: the unemployment crisis in general practice. GPs across the board – locums and recently qualified doctors in particular – are unable to find work. This is due to a combination of the ARRS and general underfunding. GPs are not included in ARRS, meaning that many practices – already struggling financially due to the measly 1.9% uplift offered in the 2024/25 contract – will hire other staff (ANPs, HCAs, PAs etc) over GPs as they are more ‘cost-effective.’ While we don’t need to explain to readers the irreplaceable value that GPs provide, it seems as though the Conservatives still haven’t quite grasped it. 

The manifesto also states that a Conservative government would expand the Pharmacy First scheme, to include menopause, contraception and treatment for chest infections, as a means to free up 20 million GP appointments a year. In theory this is fine, but it ignores the reality of the Pharmacy First situation. Earlier this year, a number of GPs raised concerns that some pharmacies were reportedly directing patients back to general practice – therefore categorically not decreasing GP workload or appointments. 

Pulse also reached out to ask if the party would include GPs in the ARRS scheme, but did not receive a response. 

Labour: Where are the details?

Labour’s headline promise is to move the NHS towards a Neighbourhood Health Service (rather than a National Health Service that is) by trialling ‘neighbourhood health centres,’ with GPs and other community health staff all under one roof. Shadow health secretary Wes Streeting announced these plans late last year after a visit to Australia looking at the country’s health centre.

But the details on this initiative are scant. Streeting cited a practice he visited as a prime example of the innovation he hoped to achieve with these trials; a practice with a surgical suite on site that allowed more cost effective and ‘closer to home’ treatment for patients. With the current level – or lack thereof – of detail, these currently don’t seem all that different to the Darzi centres, which ultimately were deemed too costly with many shutting down.

Subsequently, the manifesto promises to guarantee face-to-face appointments for all who want one, and to ‘incentivise’ GPs to see the same patient, promoting the return of the family doctor. While patients will, understandably, be pleased by these pledges there isn’t much thought given to how this will be enacted by a Labour government beyond the training of ‘thousands more GPs.’ Pulse reached out to Labour to confirm whether this was as per the NSHE long-term workforce plan, to which they responded ‘yes’. In terms of promoting the family doctor and continuity of care, when asked, Labour responded by confirming that they would ‘introduce a new incentive so GPs are rewarded financially for offering this.’

As pointed out by the Health Foundation, high attrition rates have meant that – so far – increasing the number of GP trainees has not proved effective in boosting the overall GP workforce. Labour’s manifesto also has no mentions of any retention schemes for any healthcare workers, let alone GPs, so it is unclear how these face-to-face/same-doctor guarantees will be met. 

The manifesto makes no mention of overall NHS funding. Earlier this month, Streeting indicated that ‘over time’ more money should shift towards primary care, but again no specific numbers nor timeframe was given. Pulse reached out to the party to ask how GPs could be reassured that Labour would boost their funding, but received no answer to that particular question.

Not addressed explicitly in the manifesto, but mentioned both prior and post its release is the cutting of ‘red tape that ties up GPs’ time so they can spend more time with patients.’ Pulse reached out to ask what specific bureaucracy Labour would remove, and was told that the party would consult with GPs, and cited the introduction of a new well being QOF indicator as an example of bureaucracy that currently wastes GPs’ time. 

The party has pledged to review the ARRS scheme if elected, recognising the ‘perverse set of handcuffs’ tying practices hands from recruiting GPs. Streeting also said that if elected, he will make discussions with GPCE chair Dr Katie Bramall-Stainer a priority regarding the planned industrial action with a hope to convince GPs against taking action.

Liberal Democrats: How will you enact ambitious workforce expansion goals?

The priority for the Liberal Democrats is access; they will give everyone the right to see a GP within seven days, or 24 hours if needed. This is a measure they first announced in 2022, declaring it would be a legal right done by enshrining the policy into law in the NHS constitution. Again, to any patient this is a welcome proposal, but the reality of getting to that point is another ball game altogether. In 2023 Daisy Cooper, the Liberal Democrat spokesperson for health, wellbeing and social care said in Parliament that the party would achieve this goal by getting 8,000 more GPs in the system within five years, through campaigns of recruitment and retention. The current manifesto has retained that figure but has removed the timeframe, which is probably for the best.

The manifesto also says the Liberal Democrats will:

• Give everyone 70+ and everyone with long-term health conditions access to a named GP
  • Given that over a quarter of the population have a long-term health condition, and we have an ageing population in the UK, this seems like an incredibly ambitious goal to achieve.
• Remove top-down bureaucracy to let practices hire the staff they need
  • Pulse reached out to ask if this means that they would push for ARRS to include GPs, or potentially scrap the scheme altogether, but did not receive a response. 

Green Party: When will extra funding be available to general practice?

The Green Party’s manifesto is one of the only ones to declare specific figures for funding towards primary care, indicating they are aware that a good part of the current crisis is due to underfunding. Elected MPs will push for: ‘an increase in allocation of funding to primary care with additional annual spending to reach £1.5 billion by 2030; and a £2 billion investment in primary care over the next five years.’

The manifesto also says the Green Party will guarantee rapid access to a GP and same day access in case of urgent need. Some GPs will point out that same-day urgent access is already available.

Reform UK: Is using private healthcare as a crutch the best you can do?

Reform UK’s manifesto seems to refer to private healthcare as a mechanism to support the NHS. The manifesto’s headline proposal is to ‘put patients in charge’ by giving them a voucher for private treatment if they cannot see a GP within three days. The party would also provide a 20% tax relief on all private healthcare to ‘improve care for all by relieving pressure on the NHS’. It feels as though this policy hasn’t quite been thought through.

The manifesto also says Reform UK will:

• Cut A&E waiting times with a campaign called ‘Pharmacy First, GP Second, A&E Last.’ 
  • Pulse asked if this slogan means that they would look to build upon the current Pharmacy First scheme but received no response. 
•  Give tax breaks for doctors and nurses to tackle the staffing crisis.   
  • The recognition of ‘crisis’ is fair, but what a tax break will do to combat it is uncertain. Is it meant to entice more people into the profession? If so, then it doesn’t address what the party would do to increase training capacity or create more jobs for GPs. Or how they would pay for their training, what with all the tax take going down.