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Family Doctor Services

The hon. Gentleman makes a thoughtful intervention. There is, of course, the potential for conflict. Ultimately, however, our highly centrally controlled system has failed to deliver in reducing health inequalities; and all the evidence suggests, particularly if we reflect on what happens overseas, that real engagement at the local level and integrating services for health and social care with housing, community regeneration and so forth is the best way to address those underlying inequalities. Change to that extent cannot be delivered from Whitehall; it simply does not work. All the evidence from centrally controlled systems demonstrates that point. For me, then, we are more likely to achieve success if we provide genuine accountability to the communities that are served. The evidence that I have picked up from talking to GPs in many different parts of the country—it was reflected in what the hon. Member for South Cambridgeshire (Mr. Lansley) said earlier—suggests that practice-based commissioning is dead in the water. There is a growing frustration among GPs that all their efforts to try to make something of it and put forward innovative ideas about services that could be delivered in a community setting close to people's homes—perhaps avoiding the need for a long journey to an acute hospital—are falling on stony ground. They feel that there is no longer any political drive behind it, which has resulted in GPs becoming completely disillusioned with the concept, increasingly believing that it is going nowhere. Over the past few weeks, I met a group of GPs in Dorset. I noticed that the Conservative spokesman was in Poole, so I was about 10 miles up the road from there. I met another group of GPs in Norfolk last week and heard how frustrated they were about putting forward their ideas on how to develop services to the primary care trusts, yet getting no reaction at all.