---

Family Doctor Services

My hon. Friend is absolutely right to highlight that. We should acknowledge, however, that measures of productivity can sometimes be misleading. If GPs are spending more time with their patients, that could be a good thing. This is certainly an issue that has been highlighted by the NAO, however. I want to deal specifically with the QOF system—the system that encourages GPs to do all sorts of things with preventive care. When the QOF system is reviewed, there is an evidence-gathering process to determine what should be incentivised in the reviewed system. On this occasion, a lot of work was done to develop ideas for addressing osteoporosis, including testing those who are most at risk, especially after the first fracture. A lot of work was also done on peripheral arterial disease and on heart failure. But what happened then? The thing that particularly frustrated GPs and many others is that the entire objective evidence-gathering process came to nothing because, at the last minute, the Government decided that the political imperative was to force through a one-size-fits-all extension of hours. That is the reality. An NHS Confederation briefing yesterday confirmed that the political imperative had involved increased hours and that all the evidence-based work—especially the work on osteoporosis—had gone of the window. That is what frustrates clinicians who care about their patients more than anything. A one-size-fits-all extension of hours has now been forced through. I fully support the case for extending hours and for making access more flexible. I am sure that everyone in this Chamber finds it difficult to see their GP—because of the hours we work and the fact that we work away from home—quite apart from those on low incomes who feel anxious about taking time off work and who would like to see a GP outside normal working hours.