Written questions by Naish.

What steps he is taking to support healthcare providers to ensure (a) uninterrupted access to essential patient care and (b) maintain the stability of primary care services.

It is vital that patients can access primary care services when they need it.In October 2024, we provided an £82 million boost to the Additional Roles Reimbursement Scheme, enabling the recruitment of 1,000 newly qualified general practitioners (GPs) across England. This will take pressure off the existing workforce, secure the future supply of GPs and increase the number of appointments delivered in general practice. We have uplifted a monthly payment to practices by 7.4% to fund a 6% increase in pay to the general practice workforce. We have also announced a proposed £889 million uplift to the GP contract for 2025/26, the largest uplift in years, with a rising share of total National Health Service resources going to general practice. We are currently consulting the profession on key proposals to improve access, continuity of care and GP recruitment.We are working to ensure patients can start to access 700,000 additional urgent NHS dental appointments as soon as possible, targeting areas that need them most. To rebuild NHS dentistry in the long term, we will reform the dental contract with a shift to focus on prevention and the retention of NHS dentists. We are committed to stabilising the pharmacy sector and building a service fit for the future, making full use of the skills of pharmacists and pharmacy technicians. That includes making prescribing part of the services delivered by community pharmacists as we shift care from hospital to the community.

How many people have been fined for accessing prescriptions without a valid Maternity Exception Certificate.

There are no plans to revise the application process for maternity exemption certificates that provide entitlement to free National Health Service prescriptions. The NHS Business Services Authority has advised that in 2024, 48,063 Penalty Charge Notices were issued to those who indicated they held a valid maternity exemption certificate that could not be validated.

If he will make an assessment of the potential merits of increasing non-academic routes for people to train as nurses.

We have a complete apprentice pathway for nursing, from entry level to postgraduate advanced clinical practice. NHS England is expanding routes into healthcare professions through apprenticeships. Our 10-Year Health Plan to reform the National Health Service will establish how to train and provide the staff the NHS needs, including nurses, through all training routes, to care for patients across our communities. A refreshed NHS Long Term Workforce Plan due for publication in summer 2025 will deliver the transformed health service we will build over the next decade, ensuring the NHS has the right people, in the right places, with the right skills to give the care patients need when they need it.

If he will simplify the process for obtaining Maternity Exception Certificates.

There are no plans to revise the application process for maternity exemption certificates that provide entitlement to free National Health Service prescriptions. The NHS Business Services Authority has advised that in 2024, 48,063 Penalty Charge Notices were issued to those who indicated they held a valid maternity exemption certificate that could not be validated.

What steps his Department is taking to increase the number of (a) supervisor and (b) designated prescribing practitioners.

NHS England is investing in training for independent prescribers, as well as initiatives to support the development and safe practice of designated prescribing practitioners (DPPs) and educational supervisors. This will ensure the National Health Service is ready to support and mentor foundation trainee pharmacists from 2025, alongside training for currently registered pharmacists that are learning to be independent prescribers.Reforms to pharmacist education and training will allow for development of prescriber pharmacists from the point of registration from 2026. This will enable a career-long focus on prescriber services and an associated expansion of the DPP workforce, to support multi-professional teams and the expansion of cross-sector prescribing services.

Whether he has made an assessment of the potential merits of introducing a weekly cap on domiciliary care costs.

We announced on 3 January 2025 that we are launching an independent commission into adult social care as part of our critical first steps towards delivering a National Care Service. Chaired by Baroness Louise Casey and reporting to the Prime Minister, the Commission will work with people who draw on care and their families, staff, politicians, and the public, private and third sector to make clear recommendations for how to rebuild the adult social care system to meet the current and future needs of the population. The Commission will be comprehensive and will build on the expert proposals of other reviews, including that of Sir Andrew Dilnot into care funding and support. It will be broader and wider than ever before, asking essential questions about the shape and future of the social care sector, including what long-term and sustainable funding solutions should look like.

If he will take steps to encourage (a) pharmacists and (b) independent prescribers to work in the community.

The Government is committed to expanding the role of pharmacies and to better using the skills of pharmacists and pharmacy technicians. That includes embedding services such as Pharmacy First and making prescribing part of the services delivered by community pharmacists.The current seven conditions covered by Pharmacy First clinical pathways were informed by guidance from the National Institute for Health and Care Excellence and were designed with input from an expert panel of clinicians. NHS England will keep the clinical scope of this service under review.The community pharmacy independent prescribing Pathfinder programme is currently piloting clinical models to inform a commissioning framework that can be used to deliver national and local National Health Service clinical services with a prescribing element.NHS England is funding up to 3,000 existing pharmacists each year to become independent prescribers and upskill the existing workforce to play a greater role in multidisciplinary clinical teams. This ensures we have more independent prescribers working in the community than ever before and is expected to lead to more diverse and rewarding careers in the community providing direct care for patients.To ensure adequate supervision during training, NHS England is also providing national funding of supervisors and Designated Prescribing Practitioners. This will ensure the NHS is ready to support and mentor the trainee pharmacists from 2025/26 alongside currently registered pharmacists learning to be independent prescribers.

How (a) pharmacies and (b) GPs will be able to contribute to defining the best services to include in the planned expanded Pharmacy First scheme; and when he plans that the consultation will begin.

The Government is committed to expanding the role of pharmacies and to better using the skills of pharmacists and pharmacy technicians. That includes embedding services such as Pharmacy First and making prescribing part of the services delivered by community pharmacists.The current seven conditions covered by Pharmacy First clinical pathways were informed by guidance from the National Institute for Health and Care Excellence and were designed with input from an expert panel of clinicians. NHS England will keep the clinical scope of this service under review.The community pharmacy independent prescribing Pathfinder programme is currently piloting clinical models to inform a commissioning framework that can be used to deliver national and local National Health Service clinical services with a prescribing element.NHS England is funding up to 3,000 existing pharmacists each year to become independent prescribers and upskill the existing workforce to play a greater role in multidisciplinary clinical teams. This ensures we have more independent prescribers working in the community than ever before and is expected to lead to more diverse and rewarding careers in the community providing direct care for patients.To ensure adequate supervision during training, NHS England is also providing national funding of supervisors and Designated Prescribing Practitioners. This will ensure the NHS is ready to support and mentor the trainee pharmacists from 2025/26 alongside currently registered pharmacists learning to be independent prescribers.

What steps his Department is taking to help upskill existing pharmacists to enable them to become independent prescribers, in the context that, from 2026, all newly qualified pharmacists will become prescribers from the point of registration.

The Government is committed to expanding the role of pharmacies and to better using the skills of pharmacists and pharmacy technicians. That includes embedding services such as Pharmacy First and making prescribing part of the services delivered by community pharmacists.The current seven conditions covered by Pharmacy First clinical pathways were informed by guidance from the National Institute for Health and Care Excellence and were designed with input from an expert panel of clinicians. NHS England will keep the clinical scope of this service under review.The community pharmacy independent prescribing Pathfinder programme is currently piloting clinical models to inform a commissioning framework that can be used to deliver national and local National Health Service clinical services with a prescribing element.NHS England is funding up to 3,000 existing pharmacists each year to become independent prescribers and upskill the existing workforce to play a greater role in multidisciplinary clinical teams. This ensures we have more independent prescribers working in the community than ever before and is expected to lead to more diverse and rewarding careers in the community providing direct care for patients.To ensure adequate supervision during training, NHS England is also providing national funding of supervisors and Designated Prescribing Practitioners. This will ensure the NHS is ready to support and mentor the trainee pharmacists from 2025/26 alongside currently registered pharmacists learning to be independent prescribers.

For what reason Gonadotrophin-Releasing Hormone Analogues are permitted for treatment of precocious puberty but not gender incongruence.

Gonadotrophin-releasing hormone analogues, puberty suppressing hormones, have been licenced by the Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of precocious puberty and certain types of cancer. In granting a licence for these purposes, the MHRA has made a robust assessment of safety and efficacy data for use in these specific indications.The MHRA has not licenced these medications for use in gender incongruence. There is not enough evidence about the long-term effects of using puberty suppressing hormones to treat gender incongruence to know whether they are safe or beneficial.This is why the Government is supporting NHS England to set up a study into the potential benefits and harms of puberty suppressing hormones as a treatment option for children and young people with gender incongruence. The trial aims to begin recruiting participants in spring 2025.

What steps he is taking to ensure that domiciliary care is sustainably funded.

The Government is committed to reforming adult social care and improving the quality of care for people in need. That’s why we are taking steps to ensure all adult social care is sustainably funded, including domiciliary care. In 2025/26, the Government is providing at least £600 million in new grant funding for social care, as part of a broader estimated real terms increase in local government spending power of approximately 3.2%.

What steps he plans to take to include a focus on respiratory conditions in the NHS Long Term Plan.

The Ten Year Health Plan will consider the change needed to meet the three health mission goals: a fairer system where everyone lives well for longer; a National Health service that is there when people need it and fewer lives lost to the biggest killers. We will carefully be considering policies with input from patients, public, health staff and our stakeholders as we develop the plan, including on respiratory conditions.

If he will make an estimate of the potential cost to the public purse of respiratory conditions in (a) 2023-24 and (b) 2034.

Chronic respiratory diseases are the third biggest contributor to Years of Life Lost in England. The annual economic burden of asthma and chronic obstructive pulmonary disease on the National Health Service in the United Kingdom is estimated as £3 billion and £1.9 billion, respectively. In total, all lung conditions, including lung cancer, directly cost the NHS in the UK £11 billion annually. Further information is available at the following link:https://www.england.nhs.uk/ourwork/prevention/secondary-prevention/respiratory-high-impact-interventions/NHS England is working alongside a range of organisations with an interest in respiratory data, including Asthma and Lung UK, Health Data Research UK, and the British Thoracic Society, and have developed a collective vision for the future of high-quality respiratory data. The vision is due to be finalised in October 2024 and is supported by a working group of key stakeholders to take forward.

What steps he plans to take to improve the (a) availability and (b) quality of data on respiratory health.

Chronic respiratory diseases are the third biggest contributor to Years of Life Lost in England. The annual economic burden of asthma and chronic obstructive pulmonary disease on the National Health Service in the United Kingdom is estimated as £3 billion and £1.9 billion, respectively. In total, all lung conditions, including lung cancer, directly cost the NHS in the UK £11 billion annually. Further information is available at the following link:https://www.england.nhs.uk/ourwork/prevention/secondary-prevention/respiratory-high-impact-interventions/NHS England is working alongside a range of organisations with an interest in respiratory data, including Asthma and Lung UK, Health Data Research UK, and the British Thoracic Society, and have developed a collective vision for the future of high-quality respiratory data. The vision is due to be finalised in October 2024 and is supported by a working group of key stakeholders to take forward.

What steps he plans to take to ensure that only appropriately accredited psychologists are able to (a) diagnose and (b) treat illnesses and psychological disorders.

The British Psychological Society accredits undergraduate and postgraduate psychology programmes. Accreditation is an important hallmark of quality that is extensively acknowledged by employers in the field, and an essential stepping-stone for students who are looking to progress to become a Chartered Psychologist after graduation.The Health and Care Professions Council (HCPC), which is independent of the Government, is the statutory regulator of practitioner psychologists in the United Kingdom, meaning that only those who are registered with the HCPC and meet its standards can practise as practitioner psychologists.In addition, the Professional Standards Authority for Health and Social Care holds a list of accredited voluntary registers, which they have independently assessed against nine standards. In relation to psychological professions, accredited registers include: the British Psychoanalytic Council (a professional association of the psychoanalytic psychotherapy profession)’ s Register of practitioners; and the British Psychological Society’s Wider Psychological Workforce register of Wellbeing Practitioners and Associate Psychologists.Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver appropriate treatment for patients.

Whether he has made an assessment of the potential merits of expanding existing water fluoridation arrangements in Nottinghamshire to cover the whole of (a) Nottingham and (b) Nottinghamshire.

No such assessment has been made. Public consultation is required on proposals for new, or the expansion of existing, community water fluoridation schemes. The Water Fluoridation (Consultation) (England) Regulations 2022 set out the requirements, and is available at the following link:https://www.legislation.gov.uk/uksi/2022/1163/contents/made

What steps his Department is taking to support (a) experienced GPs not covered by the Additional Roles Reimbursement Scheme and (b) other GPs to find employment.

We remain committed to growing the number of doctors in general practice (GP) and we are working to increase the GP workforce in England.NHS England is working to address training bottlenecks so the health service has enough staff for the future, and we will provide £82 million to fund the recruitment of over 1,000 newly qualified GPs, via the Additional Roles Reimbursement Scheme, so patients can get the care they need. GPs are self-employed contractors to the National Health Service, and it is largely up to employers to determine how best to staff their Primary Care Network or GP to best meet the needs of their population.

If he will take steps to encourage practices to create salaried GP roles instead of using physician associates.

We have committed to training thousands more GPs across the country which will increase capacity in the system and take the pressure off those currently working in the system. NHS England is working to address training bottlenecks so the health service has enough staff for the future and we are providing £82 million to fund the recruitment of over 1,000 newly qualified GPs, via the additional roles reimbursement scheme, so patients can get the care they need.Physician associates (PAs) can make a valuable contribution to patient care providing appointments and performing clinical and administrative tasks as part of the wider General Practice multi-disciplinary team with appropriate supervision. But they must not substitute the role of the GP within general practice.GP practices are self-employed contractors to the NHS and it is largely up to employers to determine how best to staff their primary care network (PCN) or GP practice to best meet the needs of their population.

What steps he is taking to address regional disparities in cancer treatment.

Reducing inequalities and variation in cancer treatment is a priority for the Government, as is increasing early cancer diagnosis, as both are key contributors to reducing cancer health inequalities.To improve diagnosis and outcomes, NHS England is delivering a range of interventions including implementing non-specific symptom pathways for patients who have symptoms, such as unexplained weight-loss and fatigue, that do not align to a single tumour type, as is often the case with pancreatic cancer. 115 pathways are now in place across the country, providing almost full population coverage.We are also rolling out the Targeted Lung Health Checks Programme, which aims to improve early detection of lunch cancer. People living in deprived areas are four times more likely to smoke, and smoking causes 72% of lung cancers. Therefore, introducing this programme will disproportionately benefit those in deprived areas.