Written questions by Wilkinson.

What assessment has his Department made of the potential impact of ICB mergers on continuity and access in rural and semi-rural areas.

Across larger integrated care board (ICB) footprints there will be a renewed focus on the local level as part of our commitment to delivering care closer to home, and this includes rural and semi rural areas. As outlined in our 10-Year Health Plan, neighbourhood health plans will be created and will be brought together as part of the ICBs’ plans to improve population health locally.

What steps he is taking to help ensure that smaller systems, such as Gloucestershire, do not lose visibility or influence within larger merged ICBs which include urban centres.

Across larger integrated care board (ICB) footprints there will be a renewed focus on the local level as part of our commitment to deliver care closer to home. As outlined in our 10-Year Health Plan, neighbourhood health plans will be created, including for Gloucestershire, and will be brought together as part of the ICBs’ plans to improve population health locally.

What steps are his department taking to ensure the that upcoming GP Connect requirements support confidentiality and data integrity.

GP Connect helps clinicians to gain access to general practice (GP) patient records during interactions away from a patient’s registered practice and makes their medical information available to appropriate health and social care professionals when and where they need it, to support the patient’s direct care. From a privacy, confidentiality, and data protection perspective, GP Connect provides a method of secure information transfer and reduces the need to use less secure or less efficient methods of transferring information, such as email or telephone. Access to GP Connect is governed by role-based access and organisational controls, and only people who need to see the GP patient record for a patient’s direct care should be able to see it. Data integrity is ensured by the GP Connect Application Programming Interface sharing an accurate, consistent, and real time complete copy of specific data held in the source GP record. All systems that allow the use of GP Connect must undergo a robust compliance process. All organisations applying to use GP Connect must comply with the National Data Sharing Arrangement (NDSA) and end-user agreement that sets out their responsibilities and confidentiality obligations. Further information is available at the following link:https://digital.nhs.uk/services/gp-connect/national-data-sharing-arrangement-for-gp-connectThe NDSA and its terms and conditions stipulate that any information received or accessed about a patient for direct care purposes must remain confidential.NHS England has published a Privacy Notice and a Data Protection Impact Assessment for GP Connect, which can be found, respectively, at the following two links:https://digital.nhs.uk/services/gp-connect/gp-connect-in-your-organisation/gp-connect-privacy-notice/impact-assessmenthttps://digital.nhs.uk/services/gp-connect/gp-connect-in-your-organisation/gp-connect-privacy-notice

What mechanisms will ensure accountability for primary care outcomes within merged ICBs, particularly where decision-making is centralised elsewhere.

The NHS Oversight Framework will continue to provide the approach to assessing integrated care boards, including in relation to primary care.

What assessment has his department made of the potential impact of funding levels for primary care on levels of demand for secondary and urgent care.

We are investing an additional £1.1 billion in general practice (GP) to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.4 billion in 2025/26, which 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. Over 10 million more GP appointments have been delivered in the 12-months to September 2025 compared to the same period last year, building capacity and improving access so that patients can be seen when they need to be in primary care.As part of GP Contract funding, since 1 October, GPs must allow patients to contact them via an online form at any time during core hours to request an appointment or to raise a query, in addition to telephone and in-person requests. By expanding ease of contact via online access, we will reduce pressure on accident and emergency, as we know that many patients seek medical care in accident and emergency if they fail to make contact with their GP. We are also funding the expansion of Advice and Guidance to improve two-way communication between GPs and hospital specialists and to ensure care is delivered in the right setting. We expect this to increase the usage of Advice and Guidance and to help patients receive the care they need in primary and community settings where appropriate, reducing referrals to secondary care.

How will GPs be supported with increases in workload demand for ADHD, gender medicine and weight-management prescribing.

We are investing an additional £1.1 billion in general practice (GP) to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.4 billion in 2025/26, which 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.Since October 2024, we have funded primary care networks with an additional £160 million to recruit recently qualified GPs through the Additional Roles Reimbursement Scheme. Over 2,600 individual GPs have now been recruited, preventing them from graduating into unemployment. We have committed to training thousands more GPs across the country which will increase capacity and take the pressure off those currently working in the system.The Government is committed to ensuring the GP workforce is sustainable, supported, and valued for the work they do. Good staff experience is crucial in ensuring the NHS is able to recruit and retain staff and its importance is recognised and illustrated in the recently published 10-Year Health Plan. Later this year we will publish a 10 Year Workforce Plan which will ensure that staff will be better treated, have better training, more fulfilling roles, and hope for the future, so they can achieve more.The National Institute for Health and Care Excellence produces evidence-based guidance for health and care practitioners on best practice for a variety of conditions including attention deficit hyperactivity disorder and obesity. NHS England has also published service specifications that describe how clinical and medical care is offered to people with gender dysphoria.GPs have access to a range of support from their integrated care boards and NHS England has developed a suite of implementation materials, delivery guidance and protocols, and has provided access to training resources to help GPs with weight management prescribing.

Whether his Department has considered guarantees on specialist care provision for Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) and very severe ME.

The commissioning of myalgic encephalomyelitis, also known as chronic fatigue syndrome (ME/CFS), services is the responsibility of local integrated care boards, based on the needs of their local population.The final delivery plan on ME/CFS, which we published in July, includes an action for the Department and NHS England to explore whether a specialised service should be prescribed by my Rt Hon. Friend, the Secretary of State for Health and Social Care, for very severe ME/CFS. Officials from the Department have commenced discussions with NHS England on how best to take forward this action.

Which department is responsible for making decisions and research into Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) as part of the Final Delivery Plan.

The Department of Health and Social Care is responsible for the overall delivery of the final delivery plan on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The Department funds research through the National Institute for Health and Care Research (NIHR).To address the breadth of the ME/CFS research challenge, the NIHR and the Medical Research Council (MRC), part of UK Research and Innovation, play complementary roles in the United Kingdom landscape by funding research across the research system, with MRC funding aetiological and early-stage translational science and NIHR funding later stage translational and applied clinical work.The NIHR and MRC are working together to deliver the research actions outlined in the ME/CFS final delivery plan that we published in July.

Whether access metrics will be reviewed to ensure they support relationship-based care.

This Government values continuity in general practice (GP) and there is an incentive to identify those who would benefit from continuity in the GP contract, but this isn't inconsistent with efforts to improve access, such as via the 24 hour access target where urgent treatment is required.We are investing an additional £1.1 billion in general practice to reinforce the front door of the National Health Service, 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.Over ten million more GP appointments have been delivered in the 12 months to September 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.In the 2025/26 GP contract, a new domain was introduced into the Capacity and Access Improvement Payment which incentivises primary care networks to risk stratify their patients in accordance with need including to identify those that would benefit most from continuity of care.

What assessment has his department made of the potential impact of access targets on continuity of care.

The Government values continuity in general practice, but this is not inconsistent with efforts to improve access, such as via the 24-hour access target where urgent treatment is required.In the 2025/26 contract, one of the domains of the Capacity and Access Improvement Payment, worth £29.2 million, incentivises primary care networks to risk stratify their patients in accordance with need for continuity. This allows general practitioners (GPs) to deliver care to meet the specific needs of their patients.We are investing an additional £1.1 billion in GPs to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.4 billion in 2025/26, which 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 National Health Service budget as a whole.Over ten million more GP appointments have been delivered in the 12 months to September 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. Patient satisfaction with access has improved significantly, rising from 61% in July 2024 to 74% in July 2025, marking a 13-percentage-point increase over the last year.

If he will consider reviewing the geographical areas within which resident doctors are expected to relocate during specialty training.

We recognise the importance of location stability for doctors in training and the impact that frequent relocations can have on wellbeing, retention, and workforce planning.A review into postgraduate medical training is already underway. The first phase of the review has now concluded, with further information available at the following link:https://www.england.nhs.uk/publication/the-medical-training-review-phase-1-diagnostic-report/The next phase of the review will involve working with a wide range of stakeholders across the system to design a package of reform.Alongside this review, a review of rotational training is currently in progress and is being led by the Department, along with NHS England and the British Medical Association.NHS England’s 10 Point Plan to improve resident doctors’ working lives, published on 29 August, contains a commitment to reduce the impact of rotations upon resident doctors’ lives while maintaining service delivery. Further information can be found at the following link:https://www.england.nhs.uk/long-read/10-point-plan-to-improve-resident-doctors-working-lives/

What assessment his Department has made of the capacity of GP services in Gloucestershire to meet patient demand.

We are expanding capacity in general practice, enabling more appointments for patients both nationally and in Gloucestershire.Gloucestershire Integrated Care Board has achieved a 6.4% increase in appointments delivered in general practice since 2024, with 398,000 appointments provided in September 2025 compared to 374,000 in September 2024.In October 2024, we invested £82 million into the Additional Roles Reimbursement Scheme to support the recruitment of an additional 2,500 GPs into Primary Care Networks across England. This has helped to increase appointment availability and improve care for thousands of patients. We have invested an additional £1.1 billion in general practice to reinforce the front door of the National Health Service which was the biggest increase in over a decade. Additionally, we have invested £102 million into the Primary Care Utilisation and Modernisation Fund which will create additional clinical space within over 1,000 GP practices across England and will help deliver more appointments each year.

What assessment his Department made of the potential impact of unlimited online consultations, introduced in the new GP contract, on the ability of GPs to meet patient demand.

In February 2025 the GPCE agreed to make it a contractual obligation for all GP practices to offer access to online services throughout core hours (8:00am - 18:30pm), bringing online access in line with walk-in and phone access. To support practices in preparing for this transition and to ensure they had sufficient time to make the necessary adjustments, the start date was deferred to 1 October 2025.This change aims to improve patient access, reduce long phone queues, and help general practitioners manage demand more effectively. Experience suggests that extending online access offers significant benefits to both patients and practices. With more patients using online options, phone lines will be less busy and will open up availability for those who need additional help or more urgent care.We understand that practices require additional resource to deliver services to their patients. That is why we have invested £1.1 billion into general practice: £160 million of this to expand the GP workforce (adding 2,000 more GPs since October 2024), and £102 million to create more clinical space which will enable the delivery of 8.3 million extra appointments.

What assessment his Department has made of the potential impact of offering free flu vaccines to (a) charity and (b) voluntary workers on the health of vulnerable people.

Eligibility for a free National Health Service flu vaccine is guided, each year, by advice and recommendations from the independent Joint Committee on Vaccination and Immunisation (JCVI) and is kept under regular review. The aim of the flu vaccination programme is to protect those most at risk from serious illness and hospitalisation.Those eligible to receive a free flu vaccine on the NHS this autumn are:pregnant womenall children aged 2 or 3 years on 31 August 2025children with certain long-term health conditions (aged 6 months to less than 18 years)primary school aged children (from reception to Year 6)secondary school aged children (from Year 7 to Year 11)all children in clinical risk groups aged from 6 months to under 18 yearseveryone aged 65 years and overindividuals aged 18 to under 65 with certain long-term health conditionscare home residentscarers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled personthose living with people who are immunocompromisedfrontline health and social care workersThe NHS website contains further information on eligibility, which is available at the following link:https://www.nhs.uk/vaccinations/flu-vaccine/Anyone who feels unsure about their eligibility (including those who work with vulnerable people in a voluntary capacity) can consult their general practitioner, practice nurse, or pharmacist. Pregnant women can also consult their midwife.

Whether his Department plans to reopen the Aveta Birth Centre at Cheltenham General Hospital.

The national review and the local needs assessment processes will help in setting out ideas on how services could be developed. The trust and the integrated care board (ICB) are keen that any proposals for future service development are co-designed through meaningful engagement.The maternity health needs assessment at the Gloucestershire Hospitals NHS Foundation Trust is under way, led by the NHS Gloucestershire ICB. The needs assessment involves a review of nationally available data and trends, and the evidence base for what works in terms of quality and safety. NHS England is aligning its maternity needs assessment with national priorities to improve outcomes and experiences, particularly by tackling health inequalities.As part of the maternity needs assessment, NHS England is gathering insights from women and staff, asking about their experiences and their ideas for how services could be developed in the future.NHS England is in the process of agreeing a timeline for approval of the needs assessment, with final publication expected in Spring 2026.No plan to reopen the Aveta Birth Centre will be made until the outcome of the Government's Independent National Maternity Investigation, and the local Health Needs Assessment, led by the NHS Gloucestershire ICB and exploring the needs and changes in maternity care for Gloucestershire, are published. These are both due to report in Spring 2026.

What Gloucestershire Hospitals NHS Foundation Trust's planned timetable is for the (a) commencement and (b) publication of its health needs review.

The national review and the local needs assessment processes will help in setting out ideas on how services could be developed. The trust and the integrated care board (ICB) are keen that any proposals for future service development are co-designed through meaningful engagement.The maternity health needs assessment at the Gloucestershire Hospitals NHS Foundation Trust is under way, led by the NHS Gloucestershire ICB. The needs assessment involves a review of nationally available data and trends, and the evidence base for what works in terms of quality and safety. NHS England is aligning its maternity needs assessment with national priorities to improve outcomes and experiences, particularly by tackling health inequalities.As part of the maternity needs assessment, NHS England is gathering insights from women and staff, asking about their experiences and their ideas for how services could be developed in the future.NHS England is in the process of agreeing a timeline for approval of the needs assessment, with final publication expected in Spring 2026.No plan to reopen the Aveta Birth Centre will be made until the outcome of the Government's Independent National Maternity Investigation, and the local Health Needs Assessment, led by the NHS Gloucestershire ICB and exploring the needs and changes in maternity care for Gloucestershire, are published. These are both due to report in Spring 2026.

What steps his Department has taken to ensure that the third-party data entry of NHS patient data is processed securely.

IT systems in the National Health Service operate to the highest standards of security, and all organisations have governance arrangements in place to ensure the safe, legal management of data. Third party organisations operate under the instruction of the NHS when processing data, with safeguards in place to keep people’s confidential information secure as per contractual requirements. All organisations that have access to NHS patient data and systems must use the Data Security and Protection Toolkit (DSPT) to provide assurance on an annual basis that they are practising good data security and that personal information is handled correctly. Over 61,500 organisations completed a DSPT assessment for 2024/25.The privacy and confidentiality of health and care data is championed by the National Data Guardian who provides independent advice on the use of such data and holds the Caldicott Principles, which provide a framework for the safe and respectful use of data.

What assessment his Department has made of the adequacy of the capacity of GP services to meet demand in Gloucestershire.

We are expanding capacity in general practice, which will help to deliver more appointments to patients across the country, including in Gloucestershire. In October 2024, we invested £160 million into the Additional Roles Reimbursement Scheme to support the recruitment of an additional 2,000 general practitioners into primary care networks across England, helping to increase appointment availability and improve care for thousands of patients. We have invested an additional £1.1 billion in general practices to reinforce the front door of the National Health Service. This is the biggest increase in over a decade. Additionally, the new £102 million Primary Care Utilisation and Modernisation Fund will create additional clinical space within over 1,000 general practices across England to deliver 8.3 million more appointments each year. In the 12 months to August 2025, 4.74 million appointments were delivered in the Gloucestershire Integrated Care Board, which is a 3.2% increase from the previous year.

What assessment his Department has made of the potential impact of unlimited online consultations on the ability of GPs to meet patient demand.

From 1 October, we extended access to general practice (GP) online services throughout core hours, which are from 8:00am to 18:30pm. According to the Office for National Statistics, for the first time ever, more patients are contacting their GP online rather than by phone, at 42.3% and 41.3% respectively. For GPs already offer online services, we are asking them to extend this service throughout core hours to bring online access in line with walk-in and phone access. GPs already using online systems have seen big improvements. One London GP surgery reduced waits from 14 days to just three, with 95% of patients seen within a week. The National Health Service continues to support those practices needing assistance with implementing these changes.We understand that practices require additional resource to deliver services to their patients. That’s why we have invested £1.1 billion into GPs, with £160 million of this to expand the GP workforce, which has added 2,000 more GPs since October 2024, and £102 million to create more clinical space which will enable the delivery of 8.3 million extra appointments.

What assessment his Department has made of the potential impact of NICE's decision to restrict secondary breast cancer patient's access to Enhertu on the grounds of patient wellbeing.

The National Institute for Health and Care Excellence (NICE) makes independent, evidence-based recommendations for the National Health Service in England on whether new licensed medicines should be routinely funded for eligible patients based on an evaluation of clinical and cost effectiveness.NICE has recommended Enhertu, also known as trastuzumab deruxtecan, for use in the Cancer Drugs Fund for the treatment of women with HER2-positive secondary breast cancer and it is now available for the treatment of eligible patients while further data on its effectiveness is being collected that will inform a NICE decision on routine funding.NICE published guidance in July 2024 on the use of Enhertu for the treatment of HER-2 low metastatic and unresectable breast cancer and was unfortunately unable to recommend it for routine NHS funding. I understand that NICE and NHS England have sought to apply as much flexibility as they can in their considerations of Enhertu for HER2-low breast cancer and have made it clear to the companies that their pricing of the drug remains the only obstacle to access.Ministers met with the manufacturers of Enhertu, AstraZeneca and Daiichi Sankyo in November 2024, to encourage them to re-engage in commercial discussions with NHS England. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. NICE’s guidance published in July 2024 will therefore remain unchanged. NICE has reassured me that the door remains open for the companies to enter into a new NICE appraisal if they are willing to offer Enhertu at a cost-effective price.Since January 2022, NICE has recommended all but one of the treatments for breast cancer that it has assessed. These treatments are now available to eligible National Health Service patients.