Karin Smyth
MP for Bristol South · Labour · United Kingdom
“Absolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House. I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines.”
“As the hon. and learned Gentleman knows—we have spent many long hours in this place discussing the arrangements with regard to our leaving the European Union—there are different regulations, as a result of Brexit, between Great Britain and Northern Ireland.”
“They provide a clearer legal framework for the Medicines and Healthcare products Regulatory Agency to share information with UK health systems, organisations and trusted international partners.”
“I thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients.”
“Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon.”
“I will carry on. As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care.”
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“Imposing fixed legislative limits on the age profile of equipment would reduce the flexibility required to manage that programme effectively. Additionally, the NHS is already under a clear statutory duty to fund NICE-recommended interventions, supported by national commissioning guidance. Additional minimum standards would duplicate those safeguards without improving outcomes. New clause 48 also suggests metrics to track radiotherapy performance. I assure the hon. Member for North Shropshire that high-quality and detailed data already helps us to understand emerging issues and to monitor performance. The National Disease Registration Service in NHS England collects diagnosis, treatment and outcome data on cancer patients in England.”
“Member for North Shropshire outlined. We are also aware of the serious variation between different parts of the country. We have at our disposal the Getting It Right First Time programme and national interventions to address those issues at a local level. The national cancer plan also tackles unwarranted variation through robust national data and oversight from the national cancer board, while ensuring that service configuration remains clinically led. We have committed to improving the productivity of radiotherapy services, including by using artificial intelligence to streamline treatment. We will make a £70 million investment in state-of-the-art radiotherapy machines by 2027 through a managed national replacement programme.”
“On new clauses 48 and 65, let me be clear that improving access to high-quality radiotherapy services is a priority for the Government, and one that we are already delivering. In May last year we announced the roll-out of new linear accelerator machines, we have committed to meeting all cancer waiting time targets by the end of this Parliament, and timely access to radiotherapy is central to the 31-day and 62-day treatment standards. We will go further by reviewing the targets, once they have been met, to consider whether they should be strengthened. That will include considering what data is needed to support improved performance. A separate statutory framework would duplicate the established performance regime. We are well aware that radiotherapy performance is below that of other treatment types, as the hon.”
“This is an important debate, as many of them are today. I understand that waiting for a cancer diagnosis, as I have had to do myself, is very stressful. The national cancer plan sets out how the Government will change that experience for patients and their families. Crucially, the plan is driven by evidence and shaped by the voices of more than 11,000 patients, charities and professionals who responded to our call for evidence. The plan covers the entirety of the pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention and research and innovation, and tackles the key issues raised in the new clauses. Delivery of the plan will be monitored by the national cancer board, with an independent co-chair reporting to the Department.”
“I am grateful to the hon. Member for bringing another important disease to the attention of the Committee. I agree that modern service frameworks are important tools for improving patient care. They sit at the heart of our 10-year health plan, enabling a step change in both service quality and delivery. That is why we are prioritising making rapid progress on them. The first two MSFs, on sepsis and cardiovascular disease, will be published shortly, and a further four are in development. Given the momentum, it is clear that primary legislation is not needed to drive the development of MSFs; instead, we have established a robust, expert-led process.”
“Like my hon. Friend’s constituency, my constituency of Bristol South has a large tobacco industry legacy, and it is crucial to address respiratory disease in a way that looks at the whole person.”
“The national quality board will assess all proposals for new MSFs against a clear set of criteria, ensuring that we prioritise those areas where an MSF will deliver the greatest impact for patients. Alongside developing the first wave of MSFs, we are further strengthening the process, including by setting out a clear and consistent approach for assessing future proposals. Embedding an MSF in respiratory health in primary legislation would risk limiting that flexibility, rather than strengthening our ability to improve care, as my hon. Friends the Members for Blaydon and Consett and for Bury St Edmunds and Stowmarket have outlined, by taking the action that is so necessary to help and support people with respiratory disease.”
“My hon. Friend tempts me to go down the path that we went down in another Committee. I recognise that the Tobacco and Vapes Bill took a long time to come through Parliament, despite having been started by the Conservatives under the right hon. Member for Richmond and Northallerton (Rishi Sunak). It faced a lot of opposition, but we are absolutely clear that that is the single most beneficial piece of work. The hon. Member for Sleaford and North Hykeham asked me about the future, in terms of vape shops and so on, and I have corresponded back to her on that issue. Instead of what is proposed in new clause 49, we have established a robust, expert-led process.”
“The new clause would inhibit that. Parliament does not usually have a role in overseeing delivery plans for specific elements of NHS technology. Adding in new reporting structures is unnecessary bureaucracy that would slow down delivery of the technologies and their impact on patients. In some areas, we already have arrangements in place to underpin delivery, via legislation approved by Parliament. The Health and Care Act 2022, the Data (Use and Access) Act 2025 and related legislation have established a framework for mandatory information standards, which can set the technical and data requirements to ensure interoperability. Along with our 10-year plan, our ambition to be the most artificial intelligence-enabled healthcare system in the world by 2035 and our commitment to an AI road map, that means that the new clause is unnecessary.”
“It is a pleasure to serve under your chairship, Ms Lewell. As the shadow Minister, the hon. Member for Sleaford and North Hykeham, said before the break, technology is a game changer. It is a key enabler of our 10-year health plan and a modern NHS. This new clause follows the plan’s five big bets, the transformative technologies key to NHS improvement: data to deliver impact; AI to drive patient power and productivity; genomics and predictive analytics for pre-emptive personalised care; wearables to make care real-time; and robotics to support precision. To require those diverse areas to be subject to a cohort of plans to be laid before Parliament, and to make them subject to perpetual monitoring by Parliament, would be to legislate for micromanagement. One of the priorities of tech delivery is that it needs to be agile.”
“May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.”
“I welcome the support of the hon. Member for Sleaford and North Hykeham for the broad programme of initiatives to professionalise and increase the accountability of managers and leaders in the NHS. Although we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which those measures will be delivered, officials in the Department of Health and Social Care and in NHS England are already working in partnership with organisations across the health sector and will set out more on the individual timelines in due course. For those reasons, I ask the hon. Member to withdraw her new clause.”
“We intend to do so as part of the planned secondary legislation to modernise the framework that governs the Health and Care Professions Council. Changes to this legislation are subject to a statutory three-month consultation period, in addition to which this legislation will be novel and complex. It will require extensive stakeholder engagement to ensure that we develop a barring system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation governing the work of NHS senior leaders. For those reasons, a 12-month timeline to bring forward the section 60 order is unfeasible. The new clause also sets out prescriptive duties on the content of the section 60 order; we would not wish to pre-empt the outcome of detailed policy development and consultation.”
“I thank my hon. Friend and the shadow Minister for their comments about NHS managers. I agree that they often get a bad press, and often from politicians as well. We cannot run the health service without both clinically and non-clinically trained managers, so we need to ensure that they have the right support to do their difficult job. My experience is that when the partnership with clinicians works well, it is really powerful. I have certainly learned a lot from working with some fantastic clinicians in my career. We are absolutely committed to introducing a statutory barring system. We will do that by introducing secondary legislation within this Parliament to enable the Health and Care Professions Council to operate that barring system.”
“Creating a new statutory duty to publish an implementation plan risks diverting attention and resources away from delivering the actions in the renewed strategy, which should now be our priority. It is for those reasons that I ask hon. Members not to press their new clauses.”
“This Government have already undertaken extensive engagement to inform the development of the strategy. We had nearly 100,000 responses to the 2022 women’s health strategy call for evidence, more than 400 submissions from individuals and organisations with expertise in women’s health, and analysis from the Change NHS engagement exercise, where roundtables brought together women with lived experience, clinicians, academics and expert organisations. I was part of some of those roundtables and it was very instructive. I thank them for the work they did to get us to this point. We will continue to engage and to listen to women through the new women’s voices partnership and through patient-reported experience and outcome measures, which will help to shape and improve services.”
“Some actions are already under way or funded for this year; others will be delivered over the next two to five years, and more fundamental reforms will be phased in over the next decade, aligned with the 10-year health plan. Progress in the renewed strategy will be judged against three overarching outcomes: reversing the decline in healthy life expectancy since the 2010s, raising healthy life expectancy in the poorest regions to at least 61 years, and reducing the time women spend in poor health, particularly where inequalities are greatest—something I see very starkly in my Bristol South constituency. We will also be transparent on progress through a new women’s health data dashboard, publishing neighbourhood-level data on performance, access, outcomes and experience.”
“By listening to women’s voices, improving performance where it matters most, and tackling the drivers of poor health and inequality, we will ensure that women and girls receive the care, respect and outcomes they deserve. As a result, we do not think that conducting an independent inquiry into women’s health provisions and outcomes in England at this time would add value. Instead, now is the time to deliver the change that we all know and agree is absolutely needed. I recognise the intention behind new clause 104, but I do not believe that it is necessary to publish an implementation plan. The action summary tables in the renewed women’s health strategy clearly highlight the responsible delivery organisation and the planned timeframe for all 117 actions.”
“We acknowledge that there have been longstanding failings in women’s health outcomes, experiences and access to care. That is why we published the renewed women’s health strategy, making it clear that women’s voices and choices are central in healthcare. We will transform NHS performance in the services that matter most to women, support all women to live healthy, prosperous lives, and create an approach to research and development that works for and empowers women. Reducing inequalities is hardwired throughout the strategy. Actions are targeted by deprivation, ethnicity and unmet need, with a focus on marginalised women, community-based services, neighbourhood health models, and transparent data. The renewed women’s health strategy marks a decisive shift from identifying problems to delivering change.”
“Patients will have the choice of getting the specialist care they need from home, and we will provide additional appointments to reduce waiting times. More broadly, we have committed to returning to the NHS constitutional standard by March 2029 so that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment across all patient groups and specialties. Delivering against this standard would also require the waiting times for a diagnostic test to improve significantly. We recognise that, which is why in the medium-term planning framework, the NHS target is to ensure that by March 2029 no more than 1% of patients are waiting more than six weeks for a diagnostic test. On new clause 58, we acknowledge that women’s health has been neglected and that women deserve better.”
“That is why we have implemented measures to improve gynaecology services and women’s access to care, including piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding, increasing the relative funding available to incentivise providers to take on more gynaecology procedures, and using surgical hubs to help endometriosis patients to get quicker treatment. Those measures have helped to improve 18-week referral-to-treatment times for gynaecology by 5.1 percentage points over the past year. We will go further over the course of this Parliament, including by launching NHS Online clinical services from 2027. That will initially prioritise nine conditions, including women’s health conditions such as severe menopause symptoms and menstrual problems that may be a sign of endometriosis or fibroids.”
“Member for Sleaford and North Hykeham, we wanted to go further and faster and acknowledge some things, as the former Secretary of State did, about medical misogyny, as well as the need to renew that strategy. I fully agree with new clause 57 that women should get equal access to high-quality elective care. We are committed to tackling the long waits for services primarily affecting women; I am acutely aware that women can wait disproportionately longer for a wide range of treatments, although none solely impacts women more than gynaecology services. The Government recognise that injustice.”
“Hon. Members have brought to the Committee a really important discussion about women’s health. I am very happy to have that discussion, because the Government are committed to prioritising women’s health. That is why I am so proud that we published a renewed women’s health strategy earlier this year. I say in response to the Liberal Democrat spokeswoman, the hon. Member for North Shropshire, that we renewed the strategy partly because—to be absolutely fair to the Conservative party—we agreed with much of what it put in place under its women’s health strategy. We did not see the need to start it from scratch, so to speak. There had not been a men’s health strategy, so they are very different propositions. Much of the direction had been covered, but the implementation had not. On the point made by the hon.”
“In line with the Cass review’s recommendation, a trial has been developed and has now secured updated study approvals from the MHRA and the Health Research Authority. This country has a well-deserved international reputation for academic and scientific excellence, with robust independent regulatory processes in place to properly scrutinise and assure the scientific rigour and ethics of publicly funded clinical trials. That helps to ensure that individuals receive evidence-based care, based on the highest quality research, regardless of their clinical diagnosis. I therefore disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, clinical trials for those types of medicines must be subject to the scrutiny and approval of both Houses.”
“Based on the available evidence, NHS England introduced a new clinical policy in March 2024 that means that puberty-suppressing hormones are no longer available routinely in the NHS for children and young people with gender incongruence. In December 2024, for non-NHS prescriptions, the Government introduced an indefinite ban on the sale and supply of puberty-suppressing hormones to children and young people for the purpose of gender dysphoria or incongruence. That followed independent advice from the Commission on Human Medicines. Clinical practice should be based on evidence. When evidence is lacking, clinical research takes place to improve the evidence base. That is why, to properly understand the impact of puberty-suppressing hormones to treat gender incongruence, the Cass review recommended a clinical trial.”
“Member for Bromsgrove when he was Secretary of State for Health—in 2022, he finally took action on that particular service and what went on there, commissioning Dr Hilary Cass’s review, which we supported on a cross-party basis, for the health, safety and wellbeing of children. Hilary Cass’s interim review in 2022—which bears reading, for those who have not read it recently—found the evidence for the service model and the clinical base to be woefully lacking. In the 2010s, that was allowed to continue for a long time, but fortunately started to be stopped in 2022. Ever since, we have had cross-party agreement in support of Dr Cass’s review. She found that the evidence on the use of puberty-supressing hormones for children and young people for treatment of gender incongruence is “remarkably weak”.”
“Usually, I say that I am grateful that a discussion has been brought before the Committee and that I am happy to have it, but it is unusual to have a discussion on a clinical trial in a political environment. I stand to be corrected, but I do not think that there has ever been a clinical trial subject to a parliamentary vote. There has been an Opposition day debate about this, in which many issues were rightly aired, so we will not spend much time discussing it this afternoon. The safety and wellbeing of children and young people is paramount. Children’s healthcare must always be led by evidence and expert scientific and clinical advice. We all know that that was not the case in some of the instances at the Tavistock over time, in the late 2010s. We pay tribute, as we have done several times, to the then right hon.”
“I think that was yet another addition to the hon. Lady’s speech. Initially, she asked whether I recognised the cancel culture in this area. I have already alluded to, absolutely, recognising that what occurred in the 2010s at the Tavistock and around was not acceptable. Under the stewardship of the Conservative party of the NHS and so on, it took until 2022 to start rectifying that situation in order to give good treatment to children and young people. She is herself a clinician, so I am somewhat surprised at her. Noting what I set out, I am surprised that she does not recognise that a clinical trial has never—I stand to be corrected—been subject to a vote in Parliament, whereby politicians who are not experts have a say; but we can come back to that.”
“I am going to move on. Noting what I have set out, having such a vote would set an uncomfortable precedent that would be likely to significantly compromise the value and reputation of UK research, as well as creating an inequity unique to individuals with gender incongruence or gender dysphoria. For those reasons, I ask the hon. Lady to withdraw the new clause.”
“As a first step, the package of reforms we introduced earlier this year will address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will help to prioritise those with the greatest need, supporting a shift away from clinically unnecessary check-ups. The Government are already making progress on improving access to NHS dentistry across England, including in Surrey and East Hampshire. I hope that hon. Members can see how legislating for one area in particular conflicts with the Secretary of State’s duties to promote a comprehensive health service for England as a whole, and risks creating health inequalities in other regions. For that reason, I ask that the hon. Member for North Shropshire withdraw the new clause.”
“As the Committee has discussed, that is why the Government have prioritised a number of improvements over the past two years. Last year, ICBs commissioned additional urgent dental care appointments, and there is now an urgent care safety net across the country. In April 2026, we introduced a requirement for NHS dental practices across England to deliver a set proportion of their contract as urgent care. Supported by increased payments for dentists delivering that care, that made it easier for patients to get prompt support through the NHS. We are committed to reforming the NHS dental contract by the end of this Parliament—something that could have been done at any point in the past 14 years.”
“Welcome to another rerun of the 2010s —happier times for the Opposition. Sometimes they do not remember what happened, and I have to remind them—and every now and then, they remind us. This is a really important issue, not only for the hon. Member for Guildford, who tabled new clause 72, and the hon. Member for North Shropshire, who moved it, but for all our constituencies. It has been a huge priority for this Government. The Secretary of State will continue to have a duty to promote a comprehensive health service in England. In addition, clause 4 provides for an amended duty for the Secretary of State to reduce inequalities in access to services across England. However, we also recognise that practical action is needed to secure access to urgent and routine NHS dentistry care.”
“A new statutory strategy focused solely on disinformation would risk narrowing our approach when a broader, evidence-led response is required. For those reasons, we do not consider the new clause to be the right approach. I recognise much of what the hon. Member says about access to information, but we want to maintain a wider approach. On that basis, I respectfully ask her to withdraw the new clause.”
“The hon. Member has brought up an important topic. The Government absolutely recognise that inaccurate information can undermine confidence in vaccines, which are so important. We are already taking a multi-pronged approach to addressing that through national communications, support for healthcare professionals and the ongoing monitoring of emerging narratives. The evidence is clear that, although it is a risk, misinformation is not a primary cause for people not to take up the offer of vaccinations. Rather, practical barriers such as access to services, socioeconomic factors and levels of awareness play a more significant role. We are already acting to reduce those barriers, with targeted action to improve access, strengthen communications and support frontline staff.”
“Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result. I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—”
“There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it. I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon.”
“Indeed. They wanted to work with resident doctors to talk through a way to make progress without resorting to strike action, because that is a sign of failure in any system. On new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. We want to create an industrial relations framework that is fit for a modern economy, and workplaces that work for everyone. That is why the Employment Rights Act 2025 repealed the Strikes (Minimum Service Level) Act 2023. The previous legislation created a hostile environment, which was not conducive to good partnership working with trade unions or to settling disputes. On new clause 82, although strikes are hugely disruptive, a ban on a doctor’s right to strike is not the answer.”
“I thank my hon. Friend for bringing his experience to bear on this matter. I absolutely agree. New clause 82 stems from that resident doctors dispute. One of the first things that we did was to agree the 10-point plan with regard to the management in trusts. I have said before how truly shocking the working conditions are in many trusts not just for resident doctors, but for other doctors and professionals. There is no ability to take a break, have a rest or get away. Some of the equipment that they are dealing with is also shocking, as are the levels of the estate. Those are some of the many things that have driven and continue to drive poor industrial relations, along with the fact that there is no one to speak up for them.”
“I think I said that it is a failure of representatives on both the management side and the union side to agree a solution. That is what I meant by a failure of the system. Ultimately, strike action, as my hon. Friend the Member for Lichfield would attest, is a sign of the failure of good, conducive relationships and partnership working. That is why we never want to see it.”
“It ensures that issues of discrimination, equality of opportunity and good relations between different groups of people are not overlooked during complex decision making. That is why it is important for publicly funded providers of health and social care to have due regard to the duty. The public sector equality duty should always be applied in a proportionate way. It should not create an administrative burden. If a provider of health and social care is taking a decision that has little or no consequence to equality outcomes, it needs only to note that. It is for that reason that I ask the hon. Member to withdraw her new clause.”
“With new clause 83, I think the hon. Member for Sleaford and North Hykeham would like to exempt organisations that receive public funding to provide health and social care services from the public sector equality duty. I do not agree with the intent of this measure. The duty under the Equality Act 2010 was designed to ensure that public authorities “have due regard to the need to…eliminate discrimination…advance equality of opportunity” and “foster good relations” in the exercise of their functions. That includes when designing and delivering services. It is not an unnecessary addition but part of good service design and delivery. The duty is not there to dictate a particular outcome or set of priorities for the decision maker; it is there to help decision makers understand and take account of the consequences of their choices.”
“Friend and the Prime Minister made clear during Tuesday night’s debate on the Hillsborough law, redress and patient trust are important aspects of rebuilding the confidence of the public and those who have been wronged in all parts of the state. We are committed to getting this out as soon as is credibly possible. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.”
“I responded to a Westminster Hall debate myself, and the Minister responsible for patient safety has previously responded to the commissioner and made public the work that the Government are doing. Due to the cross-Government nature of the work, we cannot give exact timelines. We have heard the calls for clarity, speed and decisive action, and we have committed to setting this out at the earliest opportunity. I have not had a chance to speak directly with my right hon. Friend the Member for Makerfield about this issue, but I am sure many conversations on many subjects will be coming our way soon. As both my right hon.”
“Where reviews or reports commissioned by the Secretary of State make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within the overall co-ordination retained by the Department. Our existing plans meet the intention behind new clause 85; in fact, they go further by prioritising national-level recommendations for the NHS in a proportionate way, without being bound to specific timescales. They will provide the greater clarity that the new clause seeks without the need for legislation. On the specific question, I am sorry to disappoint the many campaigners on this issue and Opposition Members by saying that we will not be announcing anything in the next two hours, but the point has been well made.”
“In line with the Dash review, work is progressing on a recommendations hub that will sit within the Department. The hub will include a repository to hold all national-level recommendations relevant to care quality, including safety, effectiveness and patient experience. It will provide an efficient system for co-ordinating, prioritising and overseeing recommendations made by the national quality board. The hub will record responsibility for implementing prioritised recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, which is something I think we all welcome. This new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes.”
“I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee again today. The safety recommendations are an important mechanism for improving services and securing better outcomes for patients. We support the aim of bringing greater clarity to the recommendations landscape, and we are already taking forward work in this area. The Dash review of patient safety across the health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost-benefit analysis, which is why the 10-year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the national quality board.”
“We are clear that GPs should continue to make a clinical decision to refer to specialist care where that is in the patient’s best interests. The model is intended to support decision making, not override it. To be clear to the hon. Member for Sleaford and North Hykeham, the intention was never to mandate. There is a difference, which I think was made clear in subsequent guidance on the system. The diversion rate, as she calls it, is an estimate of the potential of patients who are not referred to the right place in the first place. It is not compulsory. What the new clause proposes already exists and does not need to be set out in primary legislation. For those reasons, I ask her to withdraw it.”
“Trusts and integrated care boards must ensure that local GPs, GP leaders, local medical committees and interface groups are involved in the design and ongoing refinement of elective single point of access pathways. In my experience, that is important because we gain their expertise and there is more buy-in to making the pathways a routine part of their work. Advice and guidance is already a routine part of much GP practice. GPs continue to be able to make clinical decisions to refer for specialist care where that is in the patient’s best interests. Advice and guidance and the single point of access do not alter the clinical threshold for a referral, and a GP’s clinical decision to refer remains unchanged. All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight.”
“At the end of the day, the aim is to support patients getting the right clinical care in the right place as fast as possible. We want patients to have timely assessment of their care needs and clear next steps in the right settings. GP referrals and support for GPs in making those referrals is crucial. The advice and guidance model, which allows GPs to seek rapid specialist input into a patient’s care without an initial face-to-face appointment, and the single point of access model, which will be rolled out in October, support GPs and hospital specialists to work together and make the best treatment plans for patients while reducing unnecessary referrals and increasing waiting lists.”
“As someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion while everybody else watches us for the next hour and a half, but I am not going to do that. Some interesting points have been raised. To add my two pennies’ worth to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, the change in practice is partly due to increased specialism among consultants, which makes it harder to refer. When we set up a referral management service in Bristol, two issues were the pressure on general practice and the use of locums, who were perhaps working temporarily in the area and did not know the full range of available community services. That was some 12 years ago, so greater support on advice and guidance is long overdue as we roll this out.”