Written questions by Moon.

Whether he has made an assessment of the extent of geographical variation in access to NHS ear syringing and ear wax removal services; and what plans he has to support Integrated Care Boards to ensure consistent provision of these services.

The Department has not made a specific assessment. Integrated care boards have a statutory responsibility to commission cost-effective healthcare to meet the needs of their local populations. Guidance for patients on ear wax build-up, including when to seek advice from a pharmacist or general practitioner, is available at the following link:https://www.nhs.uk/conditions/earwax-build-up/

Whether his Department has made a comparative assessment of the clinical and administrative workload required to deliver QOF indicators in (a) practices serving highly deprived populations and (b) other practices.

The Department consults with the profession to ensure that the Quality and Outcomes Framework’s (QOF) proposals are reasonable and deliverable for practices in England, using the relevant available performance data to inform the setting of achievement thresholds.There are high achievement rates in the majority of practices, for instance in the 2024/25 contract year, 83.2% of practices achieved over 90% of the available QOF points.

What assessment his Department has made of the potential impact of higher rates of missed GP appointments in deprived areas on practices’ ability to deliver QOF requirements.

In the 2024 to 2025 contract year, 83.2% of practices achieved over 90% of the available Quality and Outcomes Framework (QOF) points. General practices (GPs) servicing populations in areas of higher deprivation face greater levels of unmet need and barriers to patient engagement, which can affect delivery against contractual frameworks, such as QOF.The indicators and thresholds included in the QOF are developed in accordance with National Institute for Health and Care Excellence guidelines and are underpinned by a robust evidence base. Thresholds are designed to be attainable, reflecting the potential challenges involved with delivering the intended outcomes for certain interventions or care practices, while encouraging and incentivising practices to provide the best possible care. Thresholds are aspirational rather than a contractual obligation.We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. This is why we are currently reviewing the way GP funding is allocated across England (the Carr-Hill formula). The review will look at how health needs are reflected in the distribution of funding through the GP Contract.To ensure that patients are not digitally excluded, the GP Contract is clear that patients should always have the option of telephoning or visiting their practice in person, and all online tools must always be provided in addition to, rather than as a replacement for, other channels for accessing a GP. Practice receptions should be open so that patients without access to telephone or online services are in no way disadvantaged.In 2025, NHS England published an improvement framework for community language, translation, and interpreting services to support the provision of consistent, high-quality community language translation and interpreting services by the National Health Service to people with limited English proficiency. In primary care, the framework supplements the existing guidance for commissioners on interpreting and translation services.NHS England’s statement on information on health inequalities sets out details on the recording of housing status. This can enable a better understanding of how social risk factors such as insecure housing or homelessness affects health outcomes and health inequalities. The statement is available at the following link:https://www.england.nhs.uk/publication/nhs-englands-statement-on-information-on-health-inequalities/

What steps his Department is taking to support general practices serving populations with higher levels of multimorbidity and patient complexity to meet QOF indicators.

In the Quality and Outcomes Framework (QOF), clinical indicators all have a target population. Patients with co-morbidities are included in all relevant target populations and registers where they meet the defined criteria. These patients are eligible for the interventions outlined in all relevant disease areas and as such, practices are reimbursed for these interventions.The indicators and thresholds included in the QOF are developed in accordance with National Institute for Health and Care Excellence guidelines, underpinned by a robust evidence base.We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. This is why we are currently reviewing the way general practice funding is allocated across England (the Carr-Hill formula). The review will look at how health needs are reflected in the distribution of funding through the GP Contract.Over the past 16 months, the Government has invested an extra £1.1 billion into primary care, prevented over 3,000 GPs from graduating into unemployment, and have halved the number of targets GPs are held to so GPs spend more time caring for patients. Over 6.5 million more GP appointments have been delivered in the 12 months to November 2025 compared to the same period last year, building capacity for continuity of care and improving access so that patients can be seen when they need to be in primary care.

What research his Department has commissioned on the drivers of lower QOF attainment in deprived areas.

In the 2024 to 2025 contract year, 83.2% of practices achieved over 90% of the available Quality and Outcomes Framework (QOF) points. General practices (GPs) servicing populations in areas of higher deprivation face greater levels of unmet need and barriers to patient engagement, which can affect delivery against contractual frameworks, such as QOF.The indicators and thresholds included in the QOF are developed in accordance with National Institute for Health and Care Excellence guidelines and are underpinned by a robust evidence base. Thresholds are designed to be attainable, reflecting the potential challenges involved with delivering the intended outcomes for certain interventions or care practices, while encouraging and incentivising practices to provide the best possible care. Thresholds are aspirational rather than a contractual obligation.We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. This is why we are currently reviewing the way GP funding is allocated across England (the Carr-Hill formula). The review will look at how health needs are reflected in the distribution of funding through the GP Contract.To ensure that patients are not digitally excluded, the GP Contract is clear that patients should always have the option of telephoning or visiting their practice in person, and all online tools must always be provided in addition to, rather than as a replacement for, other channels for accessing a GP. Practice receptions should be open so that patients without access to telephone or online services are in no way disadvantaged.In 2025, NHS England published an improvement framework for community language, translation, and interpreting services to support the provision of consistent, high-quality community language translation and interpreting services by the National Health Service to people with limited English proficiency. In primary care, the framework supplements the existing guidance for commissioners on interpreting and translation services.NHS England’s statement on information on health inequalities sets out details on the recording of housing status. This can enable a better understanding of how social risk factors such as insecure housing or homelessness affects health outcomes and health inequalities. The statement is available at the following link:https://www.england.nhs.uk/publication/nhs-englands-statement-on-information-on-health-inequalities/

Whether his Department has made an assessment of the potential impact of transport, housing instability, language barriers and digital exclusion on patient engagement with QOF requirements in high-deprivation areas.

In the 2024 to 2025 contract year, 83.2% of practices achieved over 90% of the available Quality and Outcomes Framework (QOF) points. General practices (GPs) servicing populations in areas of higher deprivation face greater levels of unmet need and barriers to patient engagement, which can affect delivery against contractual frameworks, such as QOF.The indicators and thresholds included in the QOF are developed in accordance with National Institute for Health and Care Excellence guidelines and are underpinned by a robust evidence base. Thresholds are designed to be attainable, reflecting the potential challenges involved with delivering the intended outcomes for certain interventions or care practices, while encouraging and incentivising practices to provide the best possible care. Thresholds are aspirational rather than a contractual obligation.We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. This is why we are currently reviewing the way GP funding is allocated across England (the Carr-Hill formula). The review will look at how health needs are reflected in the distribution of funding through the GP Contract.To ensure that patients are not digitally excluded, the GP Contract is clear that patients should always have the option of telephoning or visiting their practice in person, and all online tools must always be provided in addition to, rather than as a replacement for, other channels for accessing a GP. Practice receptions should be open so that patients without access to telephone or online services are in no way disadvantaged.In 2025, NHS England published an improvement framework for community language, translation, and interpreting services to support the provision of consistent, high-quality community language translation and interpreting services by the National Health Service to people with limited English proficiency. In primary care, the framework supplements the existing guidance for commissioners on interpreting and translation services.NHS England’s statement on information on health inequalities sets out details on the recording of housing status. This can enable a better understanding of how social risk factors such as insecure housing or homelessness affects health outcomes and health inequalities. The statement is available at the following link:https://www.england.nhs.uk/publication/nhs-englands-statement-on-information-on-health-inequalities/

What steps his Department is taking to help improve outcomes for people with pulmonary fibrosis.

NHS England has established 13 respiratory clinical networks across the country. These have been vital in providing clinical leadership for respiratory services and supporting services in primary care, including restoring spirometry, which is one of the tests used to diagnose pulmonary fibrosis.NHS Interstitial Lung Disease (ILD) clinics offer expert care from specialist respiratory doctors and nurses for pulmonary fibrosis and other ILDs, often with access to additional services like lung function testing and research facilities.The National Health Service also provides pulmonary rehabilitation, which plays an important role in the management of patients with pulmonary fibrosis and which should be made available to all patients who would benefit from this intervention.

What steps NHS England is taking to ensure equitable geographic access to hyperbaric treatment for decompression illness following changes to the national contract.

The contract for hyperbaric oxygen therapy (HBOT) services was reviewed in 2024, as existing contract terms expired. This included an update of the service specification using the published full methods process, and a public consultation on the proposal to reduce the number of commissioned providers in England from eight to six centres. Further information on the service specification, the published full methods process, and the consultation is available, respectively, at the following three links:https://www.england.nhs.uk/wp-content/uploads/2018/11/Hyperbaric-oxygen-therapy-services-all-ages-Service-specification-January-2025.pdfhttps://www.england.nhs.uk/publication/methods-national-service-specifications/https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background,Background,Manual%20of%20Prescribed%20Specialised%20ServicesThe updates to the specification seek to ensure timely access to treatment for the most acutely unwell patients, with the specification requiring:the delivery of care that is integrated with other services, including the emergency department, critical care, and other healthcare professionals as required; andfacilities should be capable of receiving patients in any diagnostic category who may require advanced life support either immediately or during HBOT.The geographical scope of the six services will ensure that there are no more than four hours travelling time by road from coastal locations, from the furthest borders, or between neighbouring commissioned HBOT centres, which is in line with good practice guidelines.

What steps his Department is taking to improve service provision for people with sarcoma in Cornwall.

NHS England has published a national service specification, covering both bone and soft tissue sarcomas. The specification requires close working between sarcoma services and other National Health Service partners, co-ordinated by Sarcoma Advisory Groups, to improve care pathways.Work is underway across both bone and soft tissue sarcoma provision to ensure that cancer care providers meet national service standards and improve care to patients across the country, including in Cornwall.The Government welcomes the recent publication of Sarcoma UK’s sarcoma state of the nation report as it highlights the importance of early diagnosis, care co-ordination across complex pathways, research into new treatments, and survivorship. Our forthcoming National Cancer Plan will set out how we will improve outcomes for all cancers, including sarcoma.

What steps his Department is taking to improve outcomes for patients with peripheral arterial disease in Camborne and Redruth constituency.

To improve outcomes for patients with coronary heart disease, including those in the Camborne and Redruth constituency, the Government will publish a cardiovascular disease modern service framework. This will identify and set standards for the best evidenced interventions, drive innovation in cardiovascular disease prevention and management, and reduce unwarranted variation in healthcare.

What steps his Department is taking to improve outcomes for patients with (a) strokes and (b) transient ischaemic attacks in Camborne and Redruth constituency.

The National Health Service operates an Integrated Community Stroke Service at Camborne Redruth Community Hospital. This service provides specialist therapy, advice, and support for people, their families, and carers following stroke and transient ischaemic attack or mini stroke. To improve outcomes for patients with stroke and transient ischaemic attacks, the Government will publish a cardiovascular disease modern service framework. This will identify and set standards for the best evidenced interventions, drive innovation in stroke prevention and management, and reduce unwarranted variation in healthcare.

Whether his Department is taking steps to help support pharmacies to increase their productivity.

The Department has recently implemented several reforms to help pharmacy contractors to improve dispensing efficiencies and productivity. Since January 2025, pharmacies have been allowed to dispense medicines in the original manufacturers package if the quantity in the package is 10% higher or lower than the quantity ordered on prescription. This removes the need to open and split the package in a pharmacy and increases the number of orders that can be processed through automated dispensing facilities. From 1 October 2025, pharmacies can make arrangements with a pharmacy owned by a different legal entity to undertake routine assembly of medicines on their behalf. This is known as hub and spoke arrangements and enables smaller pharmacies to utilise automated dispensing hubs to free up time for the pharmacist in the spoke pharmacy to focus on patient facing tasks.On 17 July, draft regulations were laid with the aim to modernise the rules concerning who must supervise the dispensing of medicines in pharmacies. The Government is working to make the National Patient Prescription Tracking Service available in each pharmacy to help patients track their prescriptions online through the NHS App. This will reduce the burden on busy general practitioners and pharmacy teams and will avoid patients queuing at a pharmacy only to find that their prescription is not ready. The Government has also launched a public consultation on giving pharmacists increased flexibilities to supply an alternative product against a prescription, if the prescribed item is not available.

What steps his Department is taking to improve outcomes for patients with coronary heart disease in Camborne and Redruth constituency.

To improve outcomes for patients with coronary heart disease, including those in the Camborne and Redruth constituency, the Government will publish a cardiovascular disease modern service framework. This will identify and set standards for the best evidenced interventions, drive innovation in cardiovascular disease prevention and management, and reduce unwarranted variation in healthcare.

What steps his Department is taking to increase the numbers of walk-in consultation services at pharmacies.

Community pharmacies already provide a range of walk-in consultation services, including blood pressure checks, contraception consultations, and Pharmacy First. They also provide health advice and sell over the counter medicines for minor illnesses.The Government is committed to expanding the role of pharmacies and better utilising the skills of pharmacists and pharmacy technicians. For example, on 29 October the Pharmacy Contraception Service was expanded so that pharmacies can supply emergency contraception free of charge, to ensure women have access to a consistent offer across England.

What steps his Department is taking to ensure that pay awards for NHS staff are reflected in general practice settings.

The Government looks to the independent pay review bodies for a pay recommendation for NHS staff, including both contractor and salaried general practitioners (GPs). They consider a range of evidence from organisations, including the Government, the National Health Service and trade unions to reach their recommendations.The independent review body on Doctors’ and Dentists’ Remuneration (DDRB) has recommended an uplift of 4% to the pay ranges for salaried GPs, and to GP contractor pay. As with last year, we accepted the DDRB’s pay recommendation. We have provided an increase to core funding for practices to allow this 4% pay uplift, on top of the provisional 2.8% uplift already provided, to be passed on to salaried and contractor GPs. The additional funding will also allow for pay uplifts for other salaried general practice staff. Information on the funding increase was communicated to practices on 31 July 2025. Further information is available at the following link:https://www.england.nhs.uk/long-read/implementing-the-2025-26-gp-contract/The Government has written to GP Committee England to set out its expectations regarding the extra funding being used to fund uplifts for all staff and a letter to ICBs was published on 31 July, available at the following link:https://www.england.nhs.uk/long-read/financial-implications-and-actions-for-integrated-care-boards-icbs-following-the-mid-year-updates-to-the-2025-26-gp-contract/We expect GP contractors to implement pay rises to other practice staff in line with the uplift in funding they have received. As self-employed contractors to the NHS, it is up to general practices how they distribute pay and benefits to their staff.

What steps his Department is taking to improve managerial support for GPs.

Regarding the oversight of general practices (GPs), GPs are independent businesses, providing primary care services based on a National Health Service GP Contract to their local populations. Most commonly, GPs are run by GP partners who, alongside other GPs and healthcare staff, are responsible for running their own practice.NHS England has delegated its responsibilities for the direct commissioning of primary care services, for instance primary medical, dental, ophthalmic, and community pharmacy services, to integrated care boards (ICBs).The responsibilities delegated are set out in the standard delegation agreement between NHS England and each ICB. This includes contractual management and supporting the improvement and transformation of services. Further information on the delegation agreement is available at the following link:https://www.england.nhs.uk/commissioning/publication/delegation-of-primary-medical-dental-ophthalmic-and-pharmaceutical-functions/#heading-1We are investing an additional £1.1 billion in general practice to reinforce the front door of the NHS, bringing total spend on the GP Contract to £13.4 billion in 2025/26. This is the biggest cash increase in over a decade. The 8.9% boost to the GP contract in 2025/26 is greater than the 5.8% growth to the NHS budget as a whole and reflects this government’s commitment to improve support for general practice and ease pressure on general practitioners.

Whether he plans to bring forward legislative proposals to allow pharmacies to independently proscribe medication.

There are no legislative barriers for pharmacists who are appropriately trained to independently prescribe. The 10-Year Health Plan set out how we will transition community pharmacy from being focused largely on dispensing medicines to becoming integral to the Neighbourhood Health Service, which will include making prescribing part of the National Health Services delivered by community pharmacists.Earlier this year, we laid legislation to modernise legislation governing the supervision of activities by a pharmacist in a pharmacy. This legislation, which will come into effect following a transition period, is intended to make greater use of the wider pharmacy workforce, such as registered pharmacy technicians, in dispensing therefore freeing up pharmacists to deliver more clinical services.

What steps his Department is taking to improve outcomes for patients with atrial fibrillation in Camborne and Redruth constituency.

The National Health Service in Cornwall has a comprehensive cardiovascular training programme in place for primary care staff. This is a key initiative to increase awareness of prevention, cause and management of stroke, atrial fibrillation, acute coronary syndromes and heart failure.The NHS locally report over nine in ten patients with atrial fibrillation in Camborne and Redruth are treated with anti-coagulants, with treatment rates having increased across Cornwall over the last three years with biggest increases in areas with highest deprivation.The NHS in Cornwall is also working to prevent, identify and treat linked conditions such as diabetes, alcohol dependency and high blood pressure and to support lifestyle changes that can improve atrial fibrillation symptoms, coronary heart disease, strokes and transient ischemic attacks as well as other cardiovascular conditions such as peripheral arterial disease.

Whether he plans to increase the number of defibrillators at (a) care homes, (b) sheltered housing and (c) warden controlled properties.

The provision of defibrillators is a matter for local communities, working in partnership with local organisations and charities.Decisions as to whether automated external defibrillators should be fitted is a matter for the owners of those properties, with regard to any legal requirements on the operation of those premises.

What steps his Department is taking to regulate advertising by direct cremation companies to ensure transparency about the handling and care of the deceased.

The Digital Markets, Competition and Consumers Act 2024 prohibits unfair commercial practices. These include misleading actions and omissions, that are likely to impact the average consumer’s transactional decisions. Traders who engage in commercial practices that are misleading omissions, or misleading actions, may be committing a criminal offence.In July 2025, the final report of the independent inquiry into the issues raised by the David Fuller case recommended the introduction of a statutory regulatory regime for those caring for the deceased. The Department will publish an interim update on progress in winter 2025 and a final response by summer 2026. This will include updates on the recommendations for the funeral sector which set out that direct cremation businesses should also be considered in this context, and mandatory standards to protect the security and dignity of the deceased should be applied to these businesses and to any emerging new models of delivery of care for the deceased.