You can say it for Wes Streeting: he doesn’t hang about. Reacting to the heavy loss of council seats in last week’s elections, he is proffering £102 million of money for extra GPs’ appointments – hopefully to end what has been termed the “8am scramble”: a kind of Hunger Games which NHS patients have to go through in order to be seen.
The Health Secretary has been pointed in trying to attribute this funding boost to the unpopular rise in employers’ national insurance contributions
The Health Secretary has been pointed in trying to attribute this funding boost to the very unpopular rise in employers’ national insurance contributions in last autumn’s Budget.
“None of this would be possible without the national insurance rise to fund the extra investment,” he says. “Other parties opposed the NICs rise, which would have meant more patients waiting for treatment, fewer GPs and no pay rises for staff.”
So there you go: you have to suffer so NHS workers can enjoy a pay rise, but it is all in a good cause because it means you might find it a little easier to get an appointment. But is it credible to claim that it is only thanks to NI that extra money is available for GPs’ surgeries, and that the extra money will make a noticeable appointment?
According to Streeting, the extra money announced today will fund an extra 8.3 million appointments a year. Given that NHS patients made 356 million appointments with GPs in 2023, this would be equivalent to a 2 per cent rise – useful but perhaps not transformational.
To put it another way, on average we each see the doctor about six times a year (although with huge variations between ‘frequent flyers’ and those who never see a doctor from year to year). Streeting’s claim of an extra 8.3 million appointments would mean being able to squeeze in an extra appointment about once every eight years. You might wonder whether a better rationalisation of GPs surgeries, or perhaps a modest charge to deter patients from making unnecessary appointments, would achieve better results.
But will the rise in NI really fund the extra appointments in any case? According to the Chancellor Rachel Reeves, the rise in NI (1.5 per cent on employers; contributions plus the lowering of the threshold at which they become payable from £9,000 to £5,000) is supposed to raise an extra £25 billion a year. The Institute for Fiscal Studies, however, believes the Treasury will be lucky to land an extra £16 billion, once the job-destroying effects of the rise have been taken into account. Even the latter figure would be a lot compared with Streeting’s extra £102 million. However, the extra predicted revenue from NI has already been accounted for, a large slice of it to the NHS – which has been promised £25.7 billion over two years. A hefty wadge of this will go in pay rises: according to the Nuffield Trust, the pay rises for junior doctors alone will consume £600 million a year when the cost of pensions is taken into account. In other words, the cost of the junior doctors’ pay rise along amounts to six times the extra money Streeting is promising for extra GPs appointments.
The rising benefits bill, too, dwarfs Streeting’s extra cash for GPs. At current trends the Office for Budget Responsibility expects the cost of benefits for working-age people to rise from £48.5 billion in 2023/24 to £75.7 billion in 2029/30. If you specifically want to source £100 million a year for GPs’ appointments, however, there is one obvious source of the money: not through NI revenues but simply by cancelling the deal with the Chagos Islands. The official cost of that has been out at £90 million for 99 years – although there have been rumours, denied by the government, that a renegotiation could double the cost.
Labour’s opponents might well point this out: by saying they could fund extra GPs appointments without inflicting an extra, growth-destroying tax burden on businesses but by cancelling a totally unnecessary handout to a foreign country which has no reasonable claim on the Chagos Islands in any case – and all to satisfy Keir Starmer’s wish to be seeing as nodding along to a dubious judgment by a UN court.
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