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Family Doctor Services

Absolutely. All sorts of innovative things are being developed. In many practices, there is a commitment to speak to a patient by telephone on the same day, if an appointment cannot be arranged. Often, a telephone consultation is just what the patient needs. We should certainly support the use of e-mail and telephone consultations. Surely it should be for local commissioners to drive through decisions on increasing hours and making access more flexible in order to meet their local needs, rather than having a one-size-fits-all solution imposed from the centre. I want to return briefly to the question of osteoporosis. When I asked about the loss of that valuable work at the NHS Confederation briefing yesterday, I was given an indication that there would be an announcement shortly on ways—outside the QOF system—of encouraging GPs to test for osteoporosis. I understand that there was a written statement yesterday, although I have not seen it. I would welcome an intervention from the Secretary of State to tell us what might be about to happen. We understand that an announcement is imminent. Will he tell us, either now or through the Minister of State, the hon. Member for Exeter (Mr. Bradshaw) at the end of the debate, what is proposed? A lot of people who care a lot about this matter want that work to be incentivised, because it involves good, preventive health care. In an earlier intervention, I challenged the Secretary of State about the fact that the GP contract often ends up paying more to GPs in the leafy suburbs than it does to those in the most deprived communities. I want first to look at the minimum practice income guarantee. The Health Service Journal has highlighted huge variations in payment to practices, regardless of the number of patients they serve or the needs of those patients. The article highlights two practices in Westminster, one of which happens to be based at Buckingham palace. That practice gets twice as much money as it ought to, because of the minimum practice income guarantee. The article states:"““Under the allocation formula, the Buckingham Palace practice was due to get just £14,657 this year. But the guarantee added another £16,505. That left the practice with payments of £113 for each of its 276 needs-weighted patients, compared with the sample average of £63.””" How on earth can the Government justify that system? They are paying more money to practices—often in the more affluent communities—that do not need it. As the Health Service Journal and many others have said, that money ought surely to be used to address health inequalities. Another issue highlighted by the Health Service Journal is practices excluding patients under the QOF system. I hope that the Minister will be able to respond to this when he winds up the debate. Massive variations have been highlighted, with some practices excluding 10 times more patients than the national average. As I understand it, if patients can be excluded from the QOF target, it is easier to hit the target and to get the money. There is no evidence, however, that the problem is most serious in practices that genuinely find it difficult to approach patients because they are in hard-to-reach communities. For example, Tower Hamlets and the Heart of Birmingham primary care trusts have among the lowest levels of exclusions in the country. The point made by the Health Service Journal is that this is a misapplication of millions of pounds of public money that ought to be going towards reducing health inequalities in some of the most deprived communities. Overall, the highest payments under the QOF system of incentivising GPs to undertake preventive health care, which is so important to reducing health care inequalities, go to practices in leafy suburbs. How on earth can the Government justify that system? My fear about the Conservative perspective is that if we simply give all the responsibility and power to GPs, that will ultimately do nothing to change such inequalities. Ultimately, if we are to ensure that money and funding is directed to the most disadvantaged communities, there is an essential role for strong commissioning.