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Family Doctor Services

Sadly, the Secretary of State is not in his place. Unusually for him, the issue has clearly rattled him. He did not set out how he will explain to his constituents that the PCT that covers his constituency has admitted that it sees the imposition of a polyclinic as an opportunity to reconfigure GP services, thereby possibly closing existing practitioners. He did not support the family GP, and, interestingly enough, he did not defend the imposition of health care centres or polyclinics. In response to my intervention—it will be interesting to see whether he confirms this later—he stated that primary care trusts do not have to have a polyclinic or a GP-led health centre and can therefore use the resources that would have been allocated for other, locally driven services. We will wait and see whether he substantiates that point outside this House. The hon. Member for North Norfolk (Norman Lamb) once again explained how his party plans to politicise PCTs' expenditure decisions by direct, local political interference. He rightly highlighted low morale among GPs and the need to review the quality assessment framework. He was also right to highlight the importance of preventive health care and the link to health inequalities. We need greater emphasis on public health. The PCTs with the greatest level of deprivation often spend the least resources on public health. My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) expressed her genuine concerns on behalf of GPs in Bedfordshire and about the imposition of GP-led health care centres in her constituency based on the potential breakdown of the GP-patient relationship. She rightly highlighted the importance of decisions being made locally in Bedfordshire in response to local community needs and questioned the logic behind the imposition of such schemes against local wishes. It will be interesting to hear what the Minister says in response to her points. The hon. Member for Wyre Forest (Dr. Taylor) is a distinguished and knowledgeable Member of this House who always makes an interesting contribution to health debates, and today was no exception. He was correct to highlight the fact that GPs are independent contractors, but it must be right to harness the independent sector to drive improvements in the provision of health care, which should always take place through the prism of patients rather than through the prism of the delivery mechanism. It is right that the Opposition support any willing provider. I can give the hon. Gentleman the assurance that he seeks: the Opposition passionately believe that the NHS should be free at the point of delivery, and we are completely committed to the objectives and ethos of the NHS. As the House knows, the hon. Member for Dartford (Dr. Stoate) is a practising general practitioner, and he is extremely knowledgeable about those matters. However, I wish he would use that expertise and knowledge constructively rather than unconditionally supporting Health Ministers in whatever they are trying to do, regardless of whether those things are in patients' interests. He is right to highlight the additional pressure on accident and emergency departments, which was initially a direct result of the Government contracting both extended and out-of-hours services under the GP contract, which came into operation in 2004. Before I move on, I also want to know whether the hon. Member for Dartford is one of the 3 per cent. of GPs who are happy with the Government's handling of the NHS, or whether he is part of the 97 per cent. The right hon. Member for Rother Valley (Mr. Barron) is a distinguished Chairman of the Health Committee, and his contributions are always thoughtful and serious. He was right to say that GPs are the backbone of the NHS and that less well-represented areas often face serious problems with health inequalities. There is no political difference between the three main political parties that that needs to be addressed. However, the Government amendment deliberately obfuscates and confuses two particular central Government initiatives, which need to be separated and debated independently. As the right hon. Gentleman said, patients demand greater access, and we support that demand where it is necessary. However, we also need to consider why it is there. The reason Members of Parliament found significant constituency concern when the contract was changed was that patients found that access to their GPs was not as it had been before. That concern has died down because patients have found a way of circumventing the problem, by going to accident and emergency and putting additional pressure on ambulance trusts. We need to make sure that the decision in respect of services used is with the patient, not with central Government. We then heard from my hon. Friend the Member for Wellingborough (Mr. Bone), who made a significant contribution based on experience in Northamptonshire. He was absolutely right to highlight the possible loss of the relationship between GPs and their patients. I missed out my hon. Friend the Member for Peterborough (Mr. Jackson), but I should not have done—he is an assiduous and tireless defender of his constituency's interests. He was right to highlight the Government's failure to deliver improvements, particularly in the context of the significant amount of taxpayers' money that has been invested in the national health service. He was also right to point out the important requirement for GPs and their patients to be consulted properly about the central Government proposals. My hon. Friend was right, again, to point out the benefits of consultation when Governments listen to what local people want. He gave a direct example of how that had benefited his constituents in Peterborough. My hon. Friend was correct to put on the record the significant inward economic migration, which has affected his constituency and mine and put great stress on public sector services in Peterborough and Boston. In the time that remains, I want to highlight some of the key issues. I turn first to the GP contract. We should not allow the Government to get away with the view that GPs are somehow responsible for the reduction in out-of-hours and extended hours provision. That reduction was the direct result of the GP contract that was imposed by the Government and effectively led to reduced patient access. Furthermore, the cost of out-of-hours provision has increased by two or three times because the Government have insisted that it should be provided by primary care trusts rather than general practitioners. That has led to announcements, even last week, of cuts in out-of-hours services by contractors to primary care trusts. The subsequent Government reversal, as they attempted to reinstate what they were responsible for withdrawing, has shattered the relationship between the Government and GPs, resulting in GPs being very upset. In a poll, 98 per cent. of them said that they thought that the Government's methods of negotiation were unacceptable and 97 per cent. said that they had no confidence in the Government's handling of the national health service. All that is not the responsibility of the current Secretary of State. However, he has exacerbated the problems through his Department's tactics. The Government seriously miscalculated the number of points that GPs would earn. They rewarded GPs for a level of activity that was already in place, and that has been a significant contributory factor in the drop in productivity, leading to an additional cost of £1.76 billion to the taxpayer. We Conservatives are not against polyclinics or GP health centres; in fact, when they are supported by the local community, via GPs and patients, we support them. However, we are deeply concerned about the Government's plans to impose polyclinics or GP health centres in every primary care trust. That is imposition without consultation or evidence. According to the Department of Health website, the consultation process is supposed to finish on 15 May, three weeks' time. However, in certain circumstances there has, to date, been no consultation at all. The House must understand that we are not talking about some minor tweak to primary care. The establishment of GP-led health centres and polyclinics will be the largest change to primary care since the establishment of the NHS 60 years ago. We have heard stories about how polyclinics and GP-led health centres will be inconvenient for some individuals. They will be suitable for some, particularly in urban areas, but there is real concern among GPs—and, more importantly, their patients—in rural communities. The framework for action, which was specifically about London, set out that polyclinics will be cheaper and more convenient. There are arguments against the contention that they will be more convenient, particularly in respect of rural areas. In fact, polyclinics are more expensive than traditional GP surgeries, in respect of not only infrastructure, but the occupancy costs per patient. In addition, the Government must not underestimate the importance of GPs acting as gatekeepers controlling access to expensive secondary care. We Conservatives will not coerce GPs and their patients into polyclinics against their will. Other mechanisms and structures could be put in place and need to be considered. For example, an innovative system is operating in the floor above the Boots store in the centre of Poole, where a consortium of GPs is providing a range of services that are proving much more accessible than those at the traditional GP practice. Let me ask a few brief questions. Ministers are not—or were not until the Secretary of State seemed to change the policy earlier—allowing PCTs to consider the appropriateness of a polyclinic or GP-led health centre for their area. Will the Minister confirm his view? Ministers are not insisting on consultation, ensuring consideration of the impact on patient care or basing their decisions on evidence. Ministers are not allowing PCTs to use their money instead to improve the provision of health care through existing practices. Why, for example, will they not allow PCTs to use this money to invest in community hospitals rather than GP-led health centres—the point made by my hon. Friend the Member for Beverley and Holderness (Mr. Stuart)? Why will not they allow non-spearhead PCTs to invest this money for smaller GP practices in socio-economically deprived areas, thereby reducing health inequalities? Why will they not allow this money, if desired by a primary care trust, to be invested in, for example, occupational health? In short, the Government have been holed below the waterline as regards any suggestion that the central command and control era is over—in fact, it is going in exactly the opposite direction under this Prime Minister. At a time when the Government are closing and downgrading rural services such as post offices, local schools and police stations, we cannot have yet another local service under threat. Local accountability, local decision making, local consultation and local needs and requirements are all being overridden by Ministers. We will change that. We will empower local GPs and patients to reflect local communities' needs and requirements, driven by quality of service and by patient outcomes. Our plans will drive improvement in the provision of health care and deliver a better, more effective, more efficient and patient-focused national health service.