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Family Doctor Services

Last October, we published our document, ““The patient will see you now doctor””, which the hon. Lady has probably read. In that document, we made it clear that there must be a mechanism by which, beyond the boundary of the primary medical services contract, GPs can commission services from connected providers or providers that they control only in circumstances in which there has been a tendering process controlled by the PCT, which would prevent them from handing business to themselves. That is one of the problems with GP fundholding that needed to be sorted out. The Government have not sorted it out because the same problem is occurring in places where there has been any progress on practice-based commissioning. The hon. Lady also raised the issue of a voice for patients. We have repeatedly made it clear in this House that we need a strong voice for patients. We need ““health watch”” locally and nationally to make that happen, but where general practitioners are concerned, we also need the exercise of patient choice. Again, it is interesting to quote Martin Roland from Manchester:"““The NHS goal of providing patient choice in primary care is not realised in many parts of the country where patients have little real choice of practice. Increased patient choice requires more high quality practices, not the small number of large practices that some polyclinic models suggest. We know that patients in small practices rate their care more highly in terms of both access and continuity. Indeed, although small practices show more variation in quality, on average, they achieved slightly higher levels of clinical quality than larger practices in the quality and outcomes framework.””" So having more high-quality practices, which include many smaller practices, is the route down which to go. Our patient choice proposals are similar to some that the Government made in the community White Paper of 2006. They are about making sure that when patients move from one practice to another, proper capitation follows them and to ensure that practices with open lists cannot be declared full when there is no justification for that. Those proposals are precisely the mechanisms to make sure that general practice, although integral to service delivery and commissioning, is none the less increasingly accountable to patients. At the moment, the Government seem to be moving to a world in which the only customer to matter is the primary care trust. To whom is the primary care trust accountable? The experience of everybody—including, I suspect, most of my hon. Friends across the country—is that primary care trusts are accountable only to the Department of Health and Ministers, who are the only people they ever listen to. At the moment, patients get no look in at all.