---

Family Doctor Services

The common problem among those on the Conservative Benches is that they do not understand the difference between extended hours and out-of-hours services, to which I shall come in a second. The Opposition offer a return to the bad old days, when GPs were effectively responsible for their patients 24 hours a day, 365 days a year. The Royal College of Physicians is among the many organisations that have pointed to the international evidence of the risk to patient safety that long hours pose. How could we ever have supported a system in which tired GPs called out in the middle of the night had to attend patients the next morning, and it was common to wait weeks instead of days for an appointment that would often be little more than cursory, because of the pressures that GPs faced? The new arrangements for extended hours will mean that the average-sized practice, run by three to four GPs, will open for an extra three hours a week. Those arrangements offer a fair deal for both doctor and patient, and I am pleased that the British Medical Association has given its agreement, following a ballot of its members in which 92 per cent. voted in favour. The Opposition claim that they support the traditional family practice, but what does this mean—restricted opening hours, problems getting appointments, tired GPs and under-doctored areas? Yes, small family practices can work well and are popular with many patients; but we should not support this fixed model of primary care any more than we should support any other fixed model, particularly at the expense of improving access to primary care in areas of most acute need. Patients should be able to see a GP or a practice nurse at a time and location that is convenient to them. That should be a defining feature of a world-class primary care system, but it will not be for politicians to determine nationally what will work best locally. The next stage review, led by the noble Lord Darzi of Denham, is a bottom-up process, with 2,000 clinicians engaged with the public, unions and patient groups in determining how clinical care can be improved in every part of the country. That will be another stage in the exciting journey that commenced with the NHS plan and that has seen greater investment, improved resources, new hospitals and better clinical outcomes—a journey to an NHS that is world class in all aspects, instead of world class in just some.