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Family Doctor Services

I am talking about contracts between GPs as commissioners and the whole range of health care providers. Overwhelmingly, the contracts will be with NHS providers, although they will include private sector providers. I see absolutely no reason why there should not be an ““any willing provider”” policy in respect of both community provision and secondary provision. The hon. Member for St. Ives makes an important point; in the midst of what he was asking was the question of what the consequence of the shift to large polyclinics will be. In the past couple of days, we have seen on the Department's website evidence of how it is guiding primary care trusts to go about not only developing polyclinics but reconfiguring the whole of general practitioner services. It is clear that it wants to do that on the basis of a small number of contracts with large providers. That is true not only for this first polyclinic, but pretty much across the board. For a long time, the Department has wanted to get rid of the independent contractor status of GPs and turn them into salaried employees; Ministers seem now to have embraced that absurdity. Presumably, the Department is thinking that it can save a third of the cost of a GP, because a salaried GP costs only two thirds of what a principal in general practice costs. That is a dangerous route, because if practitioners lose their independent contractor status, they will find it impossible to take the position of GP budget holders or practice-based commissioners. In November 2004, we had a debate on family doctor services in the Opposition's time. The Government's response then was to say, ““Look how useful practice-based commissioning will be for the future.”” Now we have another debate, and what is the Government's response? It is, ““Look how useful polyclinics will be in future.”” Practice-based commissioning has disappeared. It has stalled across the country; more than half of primary care trusts are not giving it management support and the information to support it is not available to general practices. The proposed measure is a weak substitute for fundholding in the sense that it does not give real budgets or real incentives to save and reinvest for patients and it does not give the opportunity to innovate in contracts with health care providers. The Government's approach is a shameful abdication of the Government's existing policy, which two years ago Tony Blair said was absolutely central to health care reforms. He said that there should be practice-based commissioning, but that has disappeared and is off the lexicon; instead, the Government are reverting to type and going towards a centralised, top-down, one-size-fits-all approach.