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Access to NHS Services

I share my hon. Friend’s distress about the matter. It is clear that, on the criterion of access to services, his constituency will be extremely badly served by decisions that have emanated from the Government and are contrary to all that was said in the Government White Paper in January 2006. Let me come to the points that I hope that the Secretary of State will have in mind. I understand that he has been in his post for only six days, but we need to get the immediate priorities up front. The following are among the things that he needs to do. He needs to start by working with primary care and especially family doctors. GP- bashing, which seems to have been the preoccupation of Ministers, has to stop—it is no good going down that path. Hamish Meldrum, the new chairman of the British Medical Association, has said: "““We are experiencing an unprecedented volume of misinformation, half-truths and politically- inspired doctor-bashing””." That does not mean that one should just let GPs do as they like, but we know that GPs will respond if they have the right framework and incentives. The clearly required principal incentive, which has not been present in the new contract, is empowerment, professional autonomy and the ability to take decisions as senior public service and clinical professionals about real budgets, real commissioning and real opportunities to shape services. Today, the NHS is not a primary care-led service but a centrally controlled service. The top-down initiatives are not working. Measures such as the 48-hour access target have been counter-productive, driving patients and practices into an absurd 8.30 am telephone scramble. Choose and book has been hopelessly mishandled and has compromised the freedom to refer that GPs always had. Out-of-hours services under the new contract have de-emphasised the role of general practitioners. The hon. Member for Grantham and Stamford will recall that we had to fight that one too, because GPs simply did not form part of the out-of-hours service in south Lincolnshire, and we had to persuade Ministers to involve them. I know that I have mentioned the hon. Gentleman, but I will not give way: we are just agreed about that issue, and we will settle it on that. Things can be changed. Let us take practice-based commissioning. Ministers, after a decade, have finally realised that the fundamentals of fundholding need to be brought back. GPs can take control of the commissioning of services, and that should include the commissioning of out-of-hours services. They can integrate those services more effectively with their own services. The Department has also failed to publish an urgent care strategy, despite the fact that, at the beginning of last year, the White Paper stated that one of the jobs for 2006 was to produce such a strategy. I do not know whether the Department has admitted it to the Secretary of State, but it should have been done last year and it has not been done yet, and we are in July. We need an urgent care strategy which says to patients, ““It is very straightforward how you access urgent care. If it is an emergency, you ring 999.”” Some of our concerns about accident and emergency services would be met by such a strategy. We understand, however, that if someone is in an ambulance with a paramedic, they may not necessarily go to the local A and E, but instead go to a specialist centre for trauma, stroke and heart attack. Apart from that, however, we need a much more integrated urgent care structure. If it is not a 999 call and an emergency, the call should be made to 0845 4647, which would offer access not just to NHS Direct but to the necessary core handling and triage that determines whether an emergency response by an ambulance, a doctor response through the out-of-hours service, or a nurse or emergency care practitioner response is appropriate, or whether the person should be advised to attend a walk-in centre or an A and E department, visit their general practice the following day or receive advice on the telephone.