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Family Doctor Services

No, if my hon. Friend will forgive me, because I need to make this clear. The purpose of this debate is not only to criticise polyclinics and how the Government are going about this but to make it clear that the House should express its support for the family doctor service and for the future of general practice, which needs to develop in future. We need to have GP commissioning; GPs must be responsible for real budgets. There is clearly an opportunity for GPs to manage care on behalf of their patients so that the relationships and continuity that they already have can be turned into something that delivers integrated care for patients and so that where services are provided they are in the best interests of patients. GPs should not be immune from competition. There should be a role for alternative providers and different models of care, but it should not be a one-size, top-down kind of care. We need patient choice of the kind that I described. Patients should be able to exercise not only choice in secondary care but choice in who is their primary care provider. We should ensure that the remuneration of GPs not only incentivises them to be in socially and economically deprived areas looking after the patients who are most in need of their primary care services but is geared towards quality and outcomes, including patient-reported outcomes, not just the process measures that are in the QOF at the moment. We know that primary care is highly effective—the international evidence shows that—and primary care in this country is in many respects the envy of many other countries. Primary care is instrumental to the delivery not only of high-quality care but of cost-controlled care. We can see, in this country and in others, what happens when the people making clinical decisions are not also responsible for the resource consequences. GPs can be those people. They will be well rewarded, as they are and should be, but they should have the responsibility that goes with it. They should not be treated, as the Government have treated them, as production line drones who behave only as the Government direct. We need a future for general practice that responds to the needs of patients and to GPs' own clinical evidence about what is in the best interests of the patients and the service. The Government use the excuse of patients wanting longer opening hours, although only 4 per cent. of patients expressed a desire for longer weekday openings. Most GPs to whom I have spoken would be happy to respond to that and would have no difficulty in doing so. Earlier this week, I spoke to a GP in Camden who said that when she went to the primary care trust and said that she wanted to open at 7 o'clock in the morning because all the patients who wanted extended hours wanted them at that time, she was told, ““No, that is not good enough because the Government have told us that you've got to open until 8 o'clock in the evening.”” She does not have any patients who want to go there at 8 o'clock in the evening—they want to arrive at 7 o'clock in the morning—but the PCT is now in such a top-down system that it will not even listen to GPs and patients.