Written questions by Evans.

What the underspend for the Additional Roles Reimbursement Scheme was in the most recent year for which data is available.

The following table shows the number of full-time equivalent direct patient care staff positions that have been recruited as of each December over the last four years, within general practice and primary care networks, (PCNs) and breaks this down by the role they were recruited to:RoleDecember 2021December 2022December 2023December 2024Total for all Additional Roles Reimbursement Scheme eligible roles15,36924,49935,80837,539Advanced Dietician Practitioners-111010Advanced Occupational Therapist Practitioners-201922Advanced Paramedic Practitioners-434594669Advanced Pharmacist Practitioners-679831916Advanced Physiotherapist Practitioners-113197219Advanced Podiatrist Practitioners-465Apprentice Physician Associates--2013Care Coordinators2,0824,1436,8227,062Dieticians67127176168General Practice Assistants--2,1482,670First Contact Physiotherapists1,0631,6202,0462,156Health and Wellbeing Coaches5161,0311,3411,294Mental Health Practitioners--1,0501,238Nursing Associates3346309851,242Paramedics1,2881,7052,2122,227Pharmacists5,1566,5347,9358,153Pharmacy Technicians1,1401,8912,5982,806Physician Associates1,0411,5412,0092,068Podiatrists30576060Social Prescribing Link Workers2,2293,1253,6643,543Therapists - Occupational Therapists111187224218Trainee Nursing Associates310647859781Source: the data is only available from September 2021, and is published quarterly by NHS England at the following link: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-workforce-quarterly-updateThis data does not distinguish between staff recruited through the Additional Roles Reimbursement Scheme or through other routes. The most recent complete year for which data is available on underspend for the Additional Roles Reimbursement Scheme is 2023/24. The maximum value of PCN level entitlements available under the Additional Roles Reimbursement Scheme in 2023/24 was £1,412 million. Total expenditure by PCNs in 2023/24 was £88 million, below the maximum entitlements.

How many positions were funded using the Additional Roles Reimbursement Scheme per year since 2019; and in what roles.

The following table shows the number of full-time equivalent direct patient care staff positions that have been recruited as of each December over the last four years, within general practice and primary care networks, (PCNs) and breaks this down by the role they were recruited to:RoleDecember 2021December 2022December 2023December 2024Total for all Additional Roles Reimbursement Scheme eligible roles15,36924,49935,80837,539Advanced Dietician Practitioners-111010Advanced Occupational Therapist Practitioners-201922Advanced Paramedic Practitioners-434594669Advanced Pharmacist Practitioners-679831916Advanced Physiotherapist Practitioners-113197219Advanced Podiatrist Practitioners-465Apprentice Physician Associates--2013Care Coordinators2,0824,1436,8227,062Dieticians67127176168General Practice Assistants--2,1482,670First Contact Physiotherapists1,0631,6202,0462,156Health and Wellbeing Coaches5161,0311,3411,294Mental Health Practitioners--1,0501,238Nursing Associates3346309851,242Paramedics1,2881,7052,2122,227Pharmacists5,1566,5347,9358,153Pharmacy Technicians1,1401,8912,5982,806Physician Associates1,0411,5412,0092,068Podiatrists30576060Social Prescribing Link Workers2,2293,1253,6643,543Therapists - Occupational Therapists111187224218Trainee Nursing Associates310647859781Source: the data is only available from September 2021, and is published quarterly by NHS England at the following link: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-workforce-quarterly-updateThis data does not distinguish between staff recruited through the Additional Roles Reimbursement Scheme or through other routes. The most recent complete year for which data is available on underspend for the Additional Roles Reimbursement Scheme is 2023/24. The maximum value of PCN level entitlements available under the Additional Roles Reimbursement Scheme in 2023/24 was £1,412 million. Total expenditure by PCNs in 2023/24 was £88 million, below the maximum entitlements.

With reference to his Department's report entitled Good for you, good for us, good for everybody, published in 2021, if he will take steps to expand structured medication reviews.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. Due to the multifaceted nature of overprescribing and the interventions used to address it, it is challenging to evaluate the effectiveness of individual policies and interventions. However, where an evaluation has been possible, there is evidence of reduced potential harms and more optimised use of medicines, for example prescribing volumes of unsafe and ineffective items, such as coproxamol and homeopathy, have reduced by 90% since policy interventions were implemented. Structured medication reviews remain a service requirement, as part of the 2025/2026 DES contract for primary care networks (PCNs). In addition to the primary care contract, medication reviews are outlined in NHS England’s Neighbourhood health guidelines 2025/26, as an essential part of the core components associated with the neighbourhood multidisciplinary team and an effective neighbourhood service. Further information on the DES contract for primary care networks and NHS England’s Neighbourhood health guidelines 2025/26 is available, respectively, at the following two links: https://www.england.nhs.uk/wp-content/uploads/2025/03/PRN01903-network-contract-des-contract-specification-2025-26-v1.1.pdf https://www.england.nhs.uk/long-read/neighbourhood-health-guidelines-2025-26/ NHS England is progressing a range of interventions to ensure that records can be safely shared and accessed across care settings by patients and health and care professionals, to support effective medicine optimisation. This includes progress in rolling out digital social care records (DSCRs). For example, this April, NHS England published a data standard for DSCRs that will ensure that core information is captured consistently across people, places, and providers. In the past 12 months, the following has been undertaken, which has raised awareness of overprescribing:the National Medicines Optimisation Opportunities for integrated care boards (ICBs) was updated in September 2024, and includes nine opportunities associated with overprescribing for ICBs to consider;NHS England commissioned the Health Innovation Network to deliver training, education, and masterclasses on a range of overprescribing related topics to support clinicians to better understand the data, and build skills and experience in deprescribing; andHealth Innovation Network guidance was published in early 2025 for ICBs and PCNs on overprescribing and problematic polypharmacy.

With reference to his Department's report entitled Good for you, good for us, good for everybody, published in 2021, whether he has had recent discussions with NHS England on improving awareness of overprescribing.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. Due to the multifaceted nature of overprescribing and the interventions used to address it, it is challenging to evaluate the effectiveness of individual policies and interventions. However, where an evaluation has been possible, there is evidence of reduced potential harms and more optimised use of medicines, for example prescribing volumes of unsafe and ineffective items, such as coproxamol and homeopathy, have reduced by 90% since policy interventions were implemented. Structured medication reviews remain a service requirement, as part of the 2025/2026 DES contract for primary care networks (PCNs). In addition to the primary care contract, medication reviews are outlined in NHS England’s Neighbourhood health guidelines 2025/26, as an essential part of the core components associated with the neighbourhood multidisciplinary team and an effective neighbourhood service. Further information on the DES contract for primary care networks and NHS England’s Neighbourhood health guidelines 2025/26 is available, respectively, at the following two links: https://www.england.nhs.uk/wp-content/uploads/2025/03/PRN01903-network-contract-des-contract-specification-2025-26-v1.1.pdf https://www.england.nhs.uk/long-read/neighbourhood-health-guidelines-2025-26/ NHS England is progressing a range of interventions to ensure that records can be safely shared and accessed across care settings by patients and health and care professionals, to support effective medicine optimisation. This includes progress in rolling out digital social care records (DSCRs). For example, this April, NHS England published a data standard for DSCRs that will ensure that core information is captured consistently across people, places, and providers. In the past 12 months, the following has been undertaken, which has raised awareness of overprescribing:the National Medicines Optimisation Opportunities for integrated care boards (ICBs) was updated in September 2024, and includes nine opportunities associated with overprescribing for ICBs to consider;NHS England commissioned the Health Innovation Network to deliver training, education, and masterclasses on a range of overprescribing related topics to support clinicians to better understand the data, and build skills and experience in deprescribing; andHealth Innovation Network guidance was published in early 2025 for ICBs and PCNs on overprescribing and problematic polypharmacy.

With reference to his Department's report entitled Good for you, good for us, good for everybody, published in 2021, what progress his Department has made on improving data sharing across care settings.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. Due to the multifaceted nature of overprescribing and the interventions used to address it, it is challenging to evaluate the effectiveness of individual policies and interventions. However, where an evaluation has been possible, there is evidence of reduced potential harms and more optimised use of medicines, for example prescribing volumes of unsafe and ineffective items, such as coproxamol and homeopathy, have reduced by 90% since policy interventions were implemented. Structured medication reviews remain a service requirement, as part of the 2025/2026 DES contract for primary care networks (PCNs). In addition to the primary care contract, medication reviews are outlined in NHS England’s Neighbourhood health guidelines 2025/26, as an essential part of the core components associated with the neighbourhood multidisciplinary team and an effective neighbourhood service. Further information on the DES contract for primary care networks and NHS England’s Neighbourhood health guidelines 2025/26 is available, respectively, at the following two links: https://www.england.nhs.uk/wp-content/uploads/2025/03/PRN01903-network-contract-des-contract-specification-2025-26-v1.1.pdf https://www.england.nhs.uk/long-read/neighbourhood-health-guidelines-2025-26/ NHS England is progressing a range of interventions to ensure that records can be safely shared and accessed across care settings by patients and health and care professionals, to support effective medicine optimisation. This includes progress in rolling out digital social care records (DSCRs). For example, this April, NHS England published a data standard for DSCRs that will ensure that core information is captured consistently across people, places, and providers. In the past 12 months, the following has been undertaken, which has raised awareness of overprescribing:the National Medicines Optimisation Opportunities for integrated care boards (ICBs) was updated in September 2024, and includes nine opportunities associated with overprescribing for ICBs to consider;NHS England commissioned the Health Innovation Network to deliver training, education, and masterclasses on a range of overprescribing related topics to support clinicians to better understand the data, and build skills and experience in deprescribing; andHealth Innovation Network guidance was published in early 2025 for ICBs and PCNs on overprescribing and problematic polypharmacy.

What assessment he has made of the effectiveness of his Department's policies on overprescribing.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. Due to the multifaceted nature of overprescribing and the interventions used to address it, it is challenging to evaluate the effectiveness of individual policies and interventions. However, where an evaluation has been possible, there is evidence of reduced potential harms and more optimised use of medicines, for example prescribing volumes of unsafe and ineffective items, such as coproxamol and homeopathy, have reduced by 90% since policy interventions were implemented. Structured medication reviews remain a service requirement, as part of the 2025/2026 DES contract for primary care networks (PCNs). In addition to the primary care contract, medication reviews are outlined in NHS England’s Neighbourhood health guidelines 2025/26, as an essential part of the core components associated with the neighbourhood multidisciplinary team and an effective neighbourhood service. Further information on the DES contract for primary care networks and NHS England’s Neighbourhood health guidelines 2025/26 is available, respectively, at the following two links: https://www.england.nhs.uk/wp-content/uploads/2025/03/PRN01903-network-contract-des-contract-specification-2025-26-v1.1.pdf https://www.england.nhs.uk/long-read/neighbourhood-health-guidelines-2025-26/ NHS England is progressing a range of interventions to ensure that records can be safely shared and accessed across care settings by patients and health and care professionals, to support effective medicine optimisation. This includes progress in rolling out digital social care records (DSCRs). For example, this April, NHS England published a data standard for DSCRs that will ensure that core information is captured consistently across people, places, and providers. In the past 12 months, the following has been undertaken, which has raised awareness of overprescribing:the National Medicines Optimisation Opportunities for integrated care boards (ICBs) was updated in September 2024, and includes nine opportunities associated with overprescribing for ICBs to consider;NHS England commissioned the Health Innovation Network to deliver training, education, and masterclasses on a range of overprescribing related topics to support clinicians to better understand the data, and build skills and experience in deprescribing; andHealth Innovation Network guidance was published in early 2025 for ICBs and PCNs on overprescribing and problematic polypharmacy.

With reference to the Local Government and Social Care Ombudsman’s Annual Review of Adult Social Care Complaints 2023-24, published in September 2024, if he will undertake a review of the proportion of complaints received from privately funded care.

We are aware of both the Annual Review and Triennial Review from the Local Government and Social Care Ombudsman (LGSCO) and support the work they do to ensure that those receiving care, whether self-funded or placed by their local authority, are aware of the options available to them if they wish to escalate their complaint. We are working across the Government on a response to the LGSCO’s recommendations, including on increasing awareness of the role of the LGSCO for those privately funding their care.

With reference to the Local Government and Social Care Ombudsman’s Annual Review of Adult Social Care Complaints 2023-24, published in September 2024, what assessment he has made of the potential merits of increasing levels of awareness of the Local Government and Social Care Ombudsman in privately funded and arranged care settings.

We are aware of both the Annual Review and Triennial Review from the Local Government and Social Care Ombudsman (LGSCO) and support the work they do to ensure that those receiving care, whether self-funded or placed by their local authority, are aware of the options available to them if they wish to escalate their complaint. We are working across the Government on a response to the LGSCO’s recommendations, including on increasing awareness of the role of the LGSCO for those privately funding their care.

What assessment he has made of the potential implications for his Department’s policies of the Local Government and Social Care Ombudsman’s Annual Review of Adult Social Care Complaints 2023-24, published in September 2024.

We are aware of both the Annual Review and Triennial Review from the Local Government and Social Care Ombudsman (LGSCO) and support the work they do to ensure that those receiving care, whether self-funded or placed by their local authority, are aware of the options available to them if they wish to escalate their complaint. We are working across the Government on a response to the LGSCO’s recommendations, including on increasing awareness of the role of the LGSCO for those privately funding their care.

With reference to FOI-02629, whether he has had recent discussions with (a) Capita and (b) the NHS Business Services Authority on GPs’ pensions records.

Every six weeks the Department meets with NHS England, the NHS Business Services Authority, Primary Care Support England, and the British Medical Association to review general practice (GP) pensions administration, discuss the current challenges and opportunities, track progress on key priorities, and ensure a co-ordinated approach to supporting GPs to submit records as required to ensure their pension records are up to date.

What assessment he has made of the potential implications for his Department’s policies of the findings of FOI 02629 on the (a) number and (b) percentage of GPs with up to date pension records.

The Department, NHS England, and NHS Pensions (NHSP) are working together to improve the processing of general practitioners’ (GPs) pensions and to identify solutions to resolve gaps in records. A total of 21,601 missing years have been resolved in the past year, as a result of the targeted work with GPs. NHS England has also recently written directly to affected NHS Pension Scheme members to make them aware of this, and to inform GPs of what they need to do.

If he will take steps to reduce overprescribing.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. There are currently no plans to undertake a further review. Progress has been made to implement the recommendations of that review, for example:- implementing the national medicines optimisation opportunities for integrated care boards (ICBs), or recommendations three and 13;- addressing problematic polypharmacy, when there is potential harm associated with taking multiple medicines, or recommendations eight and nine;- delivering structured medication reviews, or recommendation eight; and- publication of a repeat prescribing toolkit and oversupply dashboard to support general practices to identify oversupply and improve repeat prescribing processes, or recommendation seven. Offering treatments that are not medicines is also key to addressing overprescribing. Many other initiatives delivered across the NHS contribute towards this. These include delivery of personalised care and shared decision-making, NHS Talking Therapies for anxiety and depression, and social prescribing. We are continuing to address issues with the prescribing of medicines in line with the NHS’ 2025/26 priorities and operational planning guidance. It is not possible to quantify the overall cost of overprescribing.

What steps he has taken to implement the recommendations of his Department's report entitled Good for you, good for us, good for everybody, published on 22 September 2021.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. There are currently no plans to undertake a further review. Progress has been made to implement the recommendations of that review, for example:- implementing the national medicines optimisation opportunities for integrated care boards (ICBs), or recommendations three and 13;- addressing problematic polypharmacy, when there is potential harm associated with taking multiple medicines, or recommendations eight and nine;- delivering structured medication reviews, or recommendation eight; and- publication of a repeat prescribing toolkit and oversupply dashboard to support general practices to identify oversupply and improve repeat prescribing processes, or recommendation seven. Offering treatments that are not medicines is also key to addressing overprescribing. Many other initiatives delivered across the NHS contribute towards this. These include delivery of personalised care and shared decision-making, NHS Talking Therapies for anxiety and depression, and social prescribing. We are continuing to address issues with the prescribing of medicines in line with the NHS’ 2025/26 priorities and operational planning guidance. It is not possible to quantify the overall cost of overprescribing.

With reference to FOI 02629, if he will undertake a review into the difference in figures between GPs and General Dental Practitioners.

General practitioners (GPs) use Primary Care Support England to report earnings via a Type 1 GPs certificate, and are dependent on their tax return. Dentists use a system called Compass to report their earnings through the NHS Business Services Authority. Dentists’ pensionable earnings are not dependent on their tax return, and they also complete an annual reconciliation report via the Compass system.Since GPs and dentists report earnings in very different ways, a comparative review is not possible.

If he will undertake a review of overprescribing.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. There are currently no plans to undertake a further review. Progress has been made to implement the recommendations of that review, for example:- implementing the national medicines optimisation opportunities for integrated care boards (ICBs), or recommendations three and 13;- addressing problematic polypharmacy, when there is potential harm associated with taking multiple medicines, or recommendations eight and nine;- delivering structured medication reviews, or recommendation eight; and- publication of a repeat prescribing toolkit and oversupply dashboard to support general practices to identify oversupply and improve repeat prescribing processes, or recommendation seven. Offering treatments that are not medicines is also key to addressing overprescribing. Many other initiatives delivered across the NHS contribute towards this. These include delivery of personalised care and shared decision-making, NHS Talking Therapies for anxiety and depression, and social prescribing. We are continuing to address issues with the prescribing of medicines in line with the NHS’ 2025/26 priorities and operational planning guidance. It is not possible to quantify the overall cost of overprescribing.

What steps he plans to take to support integrated care boards through the closure of NHS England.

The Prime Minister announced that NHS England will be brought back into the Department. Integrated care boards (ICBs) are to act primarily as strategic commissioners of health and care services. Detailed guidance has been provided to ICBs, National Health Service trusts, and NHS foundation trusts on 1 April 2025, where ICBs were tasked with developing plans by the end of May setting out how they will manage their resources to deliver across their priorities. Further information is available at the following link:https://www.england.nhs.uk/long-read/working-together-in-2025-26-to-lay-the-foundations-for-reform/

Whether his Department plans to produce an impact assessment of the planned 50% reduction in integrated care board running costs.

NHS England has asked the integrated care boards (ICBs) to act primarily as strategic commissioners of health and care services and to reduce the duplication of responsibilities within their structure to achieve a 50% cost reduction in their running cost allowance. NHS England provided additional guidance to ICBs, National Health Service trusts, and NHS foundation trusts on 1 April 2025, where ICBs were tasked with developing plans by the end of May setting out how they will manage their resources to deliver across their priorities.NHS England will be working closely with the ICBs to support the development of these plans, ensuring that their implementation reduces duplication and supports patient care. Further details are available at the following link:https://www.england.nhs.uk/long-read/working-together-in-2025-26-to-lay-the-foundations-for-reform/In his letter to ICBs, Sir Jim Mackey committed to greater transparency and moving back to a fair shares allocation policy over time. The Department has not conducted an impact assessment of NHS decision to reduce ICB running costs.

If he will make an estimate of the cost to the public purse of overprescribing.

The National Health Service and its partner organisations are responding to the challenge of overprescribing, as set out in the Government’s review of overprescribing, Good for you, good for us, good for everybody, in September 2021. There are currently no plans to undertake a further review. Progress has been made to implement the recommendations of that review, for example:- implementing the national medicines optimisation opportunities for integrated care boards (ICBs), or recommendations three and 13;- addressing problematic polypharmacy, when there is potential harm associated with taking multiple medicines, or recommendations eight and nine;- delivering structured medication reviews, or recommendation eight; and- publication of a repeat prescribing toolkit and oversupply dashboard to support general practices to identify oversupply and improve repeat prescribing processes, or recommendation seven. Offering treatments that are not medicines is also key to addressing overprescribing. Many other initiatives delivered across the NHS contribute towards this. These include delivery of personalised care and shared decision-making, NHS Talking Therapies for anxiety and depression, and social prescribing. We are continuing to address issues with the prescribing of medicines in line with the NHS’ 2025/26 priorities and operational planning guidance. It is not possible to quantify the overall cost of overprescribing.

What estimate his Department has made of the adequate running cost of integrated care boards per head of population.

Sir Jim Mackey wrote to the National Health Service on 1 April 2025 setting out that in the future, integrated care boards (ICBs) should reduce their running costs by 50%.Analysis undertaken by NHS England shows the variation in the costs of commissioning in ICBs ranges from £51 to £26 per head of population. It is that variation that is being targeted, alongside the move to ICBs acting as strategic commissioners.A national target per head of weighted population of £18.76 has been set. There will be some flexibility to vary this for individual ICBs to reflect local circumstances, and NHS England will be providing further information on expectations of how the reduction should be delivered.

If he will take steps to increase the number of GPs with up-to-date pension records.

NHS England is working with NHS Pensions and Primary Care Support England (PCSE) to support general practitioners (GPs) to reduce the number of missing records. For the 2025/26 financial year, PCSE is maintaining a dedicated team to support GPs to resolve missing years. The Department and NHS England are also working with NHS Pensions and the British Medical Association to use their networks to encourage GPs to submit missing certificates.PCSE is reliant on GPs submitting the required forms to enable PCSE to update their pension record. NHS England will continue to work with PCSE to ensure they are undertaking their obligations upon receipt of the forms, and to support joint working with stakeholders to ensure pension record gaps are promptly resolved.PCSE is also working with those GPs who need to provide certificates to resolve missing years in their pension records, as GP’s pension records must be updated in sequential order, and if one year of data is missing all future years will also show as missing from the GPs annual pension statement issued by NHS Pensions. Any received information remains on the PCSE system until the missing year is received, at which point all information is then recorded on Pensions Online, which updates the NHS Pension record.PCSE has contacted GPs with missing certificates detailing the action they need to take to bring their pension record up to date. Webinars with supporting communications have been regularly organised by PCSE to ensure GPs are supported in how to access and resolve missing information and how to submit certificates at the end of each financial year.The NHS Pensions has also recently written directly to NHS Pension Scheme members affected by the public sector pensions remedy, McCloud, to highlight the need to ensure that PCSE records are up to date.