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Family Doctor Services

This is an opportune time for us to discuss the Government's record and their plans for family doctors. The debate gives us Liberal Democrats an opportunity to reaffirm our opposition to central control of local health services. I was fascinated when the Secretary of State again tantalisingly indicated his recognition of the lack of accountability among primary care trusts to the communities that they serve, while the Conservatives rejected any change to the accountability of primary care trusts. May I commend to the Secretary of State the Liberal Democrats' proposals to democratise the commissioning of health care? Primary care trust boards should be elected, not appointed nationally. Ultimately, the Conservatives want to retain the central model of control of the NHS. The Secretary of State suggested that he recognised the case that we had made, but will he go the whole way and provide proper accountability to the communities that trusts serve? We wait to see what his announcement amounts to. I want to talk about the morale of general practice. It is important to recognise that the network of family doctors in this country is the bedrock of health care and the NHS. As others have said, that network is the envy of the world. We should not, however, be complacent or take the view that the service is never capable of improvement to meet modern needs. We should always be prepared to accept the case for evidence-based reform. The Government must recognise that they damage the service, which is so widely supported among the general public, at their peril, because it is such an important part of our health service. Whatever the Secretary of State says about how fortunate GPs are, given the way in which the Government have treated them, he must recognise that morale among GPs is very low. I am sure that he talks to GPs throughout the country, so I am sure that he recognises that they feel demoralised. Indeed, one Norfolk GP said to me recently, ““We're well paid—we recognise that—but we feel that some of our professionalism has been taken away from us, because we're dictated to so much from up above””—that is, from Whitehall. When GPs try to develop practice-based commissioning, those who make the decisions often do not listen. When they try to refer patients for services such as those for teenagers with mental health problems and discover that services are inadequate or simply non-existent in rural Norfolk, they cannot feel much pride in their job, despite the fact that they are being well paid. The Secretary of State should recognise the real concerns among general practitioners, who take pride in their work, which they undertake for the very best of motives. Their concerns should not simply be dismissed as unfair attacks on the Government. I have spoken to a number of GPs in the past fortnight. They raised several issues with me, the first of which was the GP contract, and I shall come back to that in a moment. The second issue was the state of practice-based commissioning and where it is going. The Conservative spokesman rightly referred to the fact that it appeared to have completely stalled, certainly in many parts of the country. The third issue is the central imposition of what we must now call health centres, rather than polyclinics. I shall return to that issue later as well. Are those concerns justified? Doctors feel that they are taking the blame for a contract that was ultimately the Government's contract. It was forced through three years ago, and GP leaders at the time warned the Government of the effect it would have. The National Audit Office reports that there has been a £1.76 billion overspend on the contract since its introduction. Remarkably, the contract frustrates GPs while failing to be consistent with some of the Government's key objectives, particularly in regard to preventive care, despite the potential of the quality and outcomes framework—QOF— system. I fully recognise that the introduction of that system could do much to incentivise preventive care. The contract also fails to be consistent with the Government's stated objectives on reducing inequalities.