‘If you don’t reform the NHS I fear it will die’: Sir Keir Starmer pledges overhaul of GP services
Sir Keir Starmer has promised to overhaul GP services if he gets into power, saying the NHS will “die” without drastic change.
The Labour leader revealed his plans in the Sunday Telegraph, including making family doctors direct employees of the NHS and allowing patients to self refer to specialists.
Speaking to broadcasters later, he issued a stark warning about the service, saying: “Frankly, if you don’t reform the NHS then I fear it will die.”
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Dr Philip Banfield, chair of the British Medical Association, criticised the plans, saying GPs were “one of the most efficient and effective parts of the health service”.
Labour has already unveiled some of its proposals for the NHS if it took power at the next election, including funding more medical school places by scrapping the non-dom tax status and introducing a 10-year plan for reform.
Sir Keir gave more detail today, with a focus on primary care, saying: “When people can’t walk through that front door they inevitably end up going through another, more expensive one – the hospital.
“Quality care in the community provided by GPs is the difference between a diabetes patient living a happy, fulfilled life versus needing an emergency amputation. It is that stark.”
Writing in the newspaper, he said he would phase in a new system as existing GPs retire, replacing their contracts with direct NHS employment for new practitioners, allowing them to “focus on caring for patients rather than the admin that comes with effectively running a small business”.
He also said he would “be ruthless with the bureaucratic nonsense”, so, for example, people with back pain could refer themselves to a physio, or people needing tests could do them at home, rather than going through a GP.
Speaking later from central London, the party leader said: “I am a passionate defender of the NHS but in order to preserve the NHS going forward it has to change.
“And what we have seen is the worst NHS crisis under this government and every year it just gets worse. I think if we reform the NHS we can… make it fit for the 21st century and have it absolutely focused on patients.”
‘Managed decline’ under Tories
Sir Keir attacked the government’s handling of the service, accusing them of “just presiding over the managed decline – and that I will not accept for a Labour government”.
He also headed off his critics, pointing to his previous work running a public body.
“I have long believed in reform of public services,” he added. “When I ran the Crown Prosecution Service I could see the reform we needed.
“We will always have, whether it be the NHS or any other public service, people who say, ‘well don’t do it, it has always been done this way’. They are nearly always wrong.
“Of course there will be challenges whenever you reform something but frankly, if you don’t reform the NHS then I fear it will die.”
Dr Banfield is one of those against the changes, specifically the plan for self-referral.
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He also told Sky News about his wife’s experience spending 12 hours on an A&E trolley.
He told Sky News’ Sophy Ridge that he had met with Labour’s shadow health secretary Wes Streeting this week to discuss the proposals and “we had to agree to disagree”, with the chair claiming the MP “doesn’t understand general practice”.
“GPs are one of the most efficient and effective parts of the health service in the way that they manage risk, they are superb at it,” Dr Banfield added.
He also said Labour “have a lot of work to do between now and an election” to get his organisation onside.
“We have offered to help them with that and we’ll do business with anyone who has the right policies,” he said.
A crash between two oil tankers on a major shipping route near the UAE was likely caused by a navigational misjudgement by one of the vessels, officials have said.
The Adalynn and Front Eagle tankers collided and caught on fire on Tuesday near the Strait of Hormuz, a narrow channel which connects the Persian Gulf to the Gulf of Oman.
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In a statement issued today, the United Arab Emirates’ energy ministry did not draw any link between the crash and an upsurge in electronic interference amid the Israel-Iran conflict.
Interference has disrupted navigation systems near the strait since the two countries began firing missiles at each other last week.
The multinational US-led Combined Maritime Force’s Joint Maritime Information Centre said in an advisory this week that it had received reports of interference stemming from near Iran’s Port of Bandar Abbas and other areas in the Gulf region.
Tehran has not commented on the collision or reports of interference.
The UAE coastguard said it evacuated 24 people from the Adalynn, while personnel on Front Eagle were reported safe with no pollution visible after a fire on its deck.
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The Strait of Hormuz – which handles around a fifth of the world’s seaborne oil – links the Gulf to the northwest with the Gulf of Oman, the Arabian Sea beyond.
The Adalynn, owned by a company based in India, had no cargo and was sailing towards the Suez Canal in Egypt, according to monitoring service TankerTrackers.com.
The Front Eagle was on its way to Zhoushan in China – and loaded with two million barrels of Iraqi crude oil, the tracker said.
TankerTrackers.com said on X that the Front Eagle was moving southbound at a speed of 13.1 knots when it “executed a starboard [right] turn, resulting in a collision” with the Adalynn.
The exact cause of the collision, which resulted in no injuries or spills, is still unclear.
US President Donald Trump says he has yet to decide whether the US will join Israel militarily in its campaign against Iran.
Asked whether the US was getting closer to striking Iran’s nuclear facilities, Mr Trump said: “I may do it. I may not do it.”
Speaking outside the White House on Wednesday, he added: “Nobody knows what I’m going to do…Iran’s got a lot of trouble, and they want to negotiate.
“And I said, ‘why didn’t you negotiate with me before all this death and destruction?'”
Mr Trump said Iran had reached out to Washington, a claim Tehran denied, with Iran’s mission to the UN responding: “No Iranian official has ever asked to grovel at the gates of the White House.”
Iran’s supreme leader, Ayatollah Ali Khamenei said Iran would not surrender and warned “any US military intervention will undoubtedly cause irreparable damage” to US-Iranian relations.
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Strikes continue
Hundreds have reportedly died since Iran and Israel began exchanging strikes last Friday, when Israel launched an air assault after saying it had concluded Iran was on the verge of developing a nuclear weapon, a claim Tehran denies.
Israel launched three waves of aerial attacks on Iran in the last 24 hours, military spokesman Brigadier General Effie Defrin has said.
Israel deployed dozens of warplanes to strike over 60 targets in Tehran and western Iran, including missile launchers and missile-production sites, he said.
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“The aim of the operation is to eliminate the existential threat to the State of Israel, significantly damage Iran’s nuclear programme in all its components, and severely impact its missile array,” he said.
Early on Thursday Israel issued an evacuation warning to residents of the Iranian Arak region where Iran has heavy water reactor facilities. Heavy water is important in controlling chain reactions in the production of weapons grade plutonium.
Meanwhile Iran says it has arrested 18 people it describes as “enemy agents” who it says were building drones for the Israelis in the northern city of Mashhad.
Iran also launched small barrages of missiles at Israel on Wednesday with no reports of casualties. Israel has now eased some restrictions for its civilians.
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The US is working to evacuate its citizens from Israel by arranging flights and cruise ship departures, the US ambassador to the country has said.
In the UK, Sir Keir Starmer chaired a COBRA emergency meeting on the situation in the Middle East, with a Downing Street spokesperson saying: “Ministers were updated on efforts to support British nationals in region and protect regional security, as well as ongoing diplomatic efforts”.
The UK government’s top legal adviser has raised questions over whether Israel’s actions in Iran are lawful, according to a source familiar with discussions inside the government.
The source suggested to Sky News that Attorney General Richard Hermer’s thinking, which has not been published, complicates the UK’s potential involvement in the Iran-Israel conflict.
If the attorney general deems Israel’s actions in Iran to be unlawful then the UK is restricted in its ability to help to defend Israel or support the United States in any planned attacks on Iran.
Speaking on condition of anonymity, the source said that the attorney general’s concerns limit UK involvement in the conflict “unless our personnel are targeted”.
US President Donald Trump is currently weighing up his options for Iran and has repeatedly suggested the US could get involved militarily.
Members of the Israeli special forces check the remains of a suspected ballistic missile in northern Israel.
Pic: Reuters
This would likely involve the use of US B-2 bombers to drop bunker-busting bombs to destroy Iran’s nuclear facility built deep into the side of a mountain at Fordow.
These B-2 bombers could be flown from the UK base at Diego Garcia in the Indian Ocean, strategically close to Iran.
The US could also choose to fly them the far greater distance from the US mainland.
Under a long-standing convention, the UK grants permission to the US for the base to be used for military operations.
The US military could also request the use of the UK military base in Cyprus, for refuelling planes.
Any refusal by the British could complicate US military action and, diplomatically, put pressure on the trans-Atlantic relationship.
Israel’s justification
Israel has justified its war by claiming that Iran poses an “imminent” and “existential” threat to Israel.
Prime Minister Benjamin Netanyahu has cited his country’s own undisclosed intelligence claiming Iran was on the brink of obtaining a nuclear weapon.
The Israeli government also claimed, without publishing evidence, that Iran was planning an imminent attack on Israel.
They also cited the recent International Atomic Energy Agency (IAEA) report which concluded that Iran had been “less than satisfactory” in “a number of respects” on its international compliance over its nuclear activities.
It is not clear what aspect of Israel’s justification for military action the attorney general has concerns over.
The Attorney General’s Office has told Sky News: “By long-standing convention, reflected in the ministerial code, whether the law officers have been asked to provide legal advice and the content of any advice is not routinely disclosed.
“The convention provides the fullest guarantee that government business will be conducted at all times in light of thorough and candid legal advice.”
The UK armed forces have previously rallied to help defend Israel from Iranian missile and drone strikes when the two sides engaged in direct confrontation last year.
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In April 2024, RAF typhoon jets shot down drones fired from Iran.
The UK military was also involved in efforts to defend Israel from a ballistic missile attack in October 2024.
But the UK has not been involved in the current conflict, which began when Israel targeted Iranian nuclear facilities and scientists as well as more definitive military targets such as missile launchers and commanders.
The UN’s nuclear watchdog has previously raised concerns about any attack against nuclear facilities because of the inherent danger but also the legality.
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A number of resolutions passed by the IAEA’s general conference has said “any armed attack on and threat against nuclear facilities devoted to peaceful purposes constitutes a violation of the principles of the United Nations Charter, international law and the Statute of the Agency”.
Israel believes that Iran’s nuclear programme has a military use, which makes it a legitimate target.
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It believes the regime is aimed to enrich uranium to develop nuclear weapons.
Tehran, however, has always insisted its nuclear programme is for civilian use.
The site of an Iranian missile attack on Israel. Pic: Reuters
The International Commission of Jurists (ICJ) has also condemned Israel’s use of armed force against Iran as a violation of the United Nations (UN) Charter and international law.
Interpretations of International Law
Different countries adopt varying interpretations on the use of force in response to future attacks.
The first legal position is that nations can act preventatively to deflect threats.
The second is that they can act to deflect future armed attacks that are imminent.
The third is that states can only act to deflect attacks that have occurred.
An oil storage facility after it appeared to have been struck by an Israeli missile in Tehran. Pic: AP
That third position is generally considered to be too restrictive and the first as too broad.
The grey area lies with the second position, and it rests with the definition of “imminent”.
The concepts of “proportionality”, “necessity” and “imminence” are key considerations.
International law scholars have told Sky News that Israel may pass the “proportionality” test in its actions against Iran because its targets appear to have been military and nuclear.
But whether there was the “necessity” to attack Iran at this point is more questionable.
The attorney general would likely be considering the key legal test of the ‘imminence’ of the Iranian threat against Israel – and whether it is reasonable to conclude that an attack from Iran was “imminent” – as he weighs the legal advice issued to UK Prime Minister Sir Keir Starmer.
There is always nuance with legal advice, judgements rest on a variety of factors and advice can evolve.
In the run up to the 2003 Gulf War, the US and UK justified their action by arguing that Saddam Hussein possessed Weapons of Mass Destruction – a claim that turned out to be wrong.
The then-attorney general’s advice, which evolved, was central to Tony Blair’s decision to join President Bush in attacking Iraq.
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