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Polyclinics

May I begin by declaring that I am a member of the British Medical Association and a fellow of the Royal College of Physicians? I am not speaking in order to give any official message from either of those organisations, however; I am speaking entirely on my own behalf, and on behalf of my constituents, local GPs and NHS professionals who have spoken to me. The debate has produced a huge benefit already, in that we should all now know what we mean by a polyclinic and a GP-led health centre. To me, a polyclinic is a body that brings together GP services, investigative services, probably hospital consultant clinics and probably a headquarters for community services, as well as dental services. That could be perfectly satisfactory in certain areas, particularly in big cities, although I note what the hon. Member for Birmingham, Selly Oak (Lynne Jones) said about her part of Birmingham. As for GP-led health centres, the Secretary of State has made it absolutely clear that they need only have three characteristics: they have to be accessible, to be open from 8 am to 8 pm 365 days a year, and to be able to accommodate drop-in patients and registered patients. I am grateful to the Minister for his reply to my parliamentary question of 21 May, which he kindly answered in the nick of time just yesterday. I asked"““whether the decision to have a polyclinic in a primary care trust area is a decision to be made locally.””" If I may, I want to take his answer apart, and agree with certain bits and ask further questions. The first sentence of the answer is as follows:"““How primary care trusts…choose to configure or commission local primary medical care services is a local matter.””" That is absolutely right; it certainly should be. I agree with that. The second sentence of the answer is:"““However, all PCTs have been asked to commission additional general practitioner (GP)-led health centre services and have been given additional funding to secure those services.””" The key word there is ““additional””. I met the chair and chief executive of my own PCT yesterday, and in their paper about their plans for future health services in Worcestershire they state that the Department of Health requires every PCT to establish a"““new GP-led Health Centre””." To my mind, the difference between ““new”” and ““additional”” is vital, and I will return to it. I am a little confused about the reference to extra funding; is it really new additional funding, or is it part of the growth money already announced and passed to PCTs? The final sentence of the Minister's answer to my question is crucial:"““PCTs will decide after local consultation where and how these services should be provided and will carry out an open and fair procurement to secure the services they specify.””" Deciding ““where and how”” is crucial. If extra hours and extra capacity are needed, some of the existing health centres around the country—this is certainly the case in my area—are closed from 6.30 pm and throughout every weekend, so spare capacity exists that could be used. In Worcestershire, the GP-led health centre is likely to be in Worcester, the largest town. If only the money for such services were given to the PCTs without strings attached, it might be feasible in Worcestershire to put in place three of these health centres—one in each major town. That would spread the benefit of 8 am to 8 pm opening and the benefit of such centres being open for the entire weekend across the county, but, as it stands, only those who are near enough in the city of Worcester will benefit. Such an arrangement would almost certainly do away with the need for new premises, because that existing spare capacity could be used. That would lessen the worry about continuity of care, and about the lack of local knowledge and of previous knowledge about patients, and it could even mean a rotation between different practices within a given area. Such an arrangement would be ideal. I am asking the Government to get away from insisting that these must be new services, because they could be additional services in areas where there is the capacity to provide it. Several hon. and right hon. Members have mentioned worries about the back door into commercialisation, and I share that fear. The last part of the answer to my written question stated:"““PCTs…will carry out an open and fair procurement to secure the services they specify.””—[Official Report, 16 June 2008; Vol. 477, c. 768W.]" If it really is open and fair, and if account is taken of the lack of need to build new premises if spare capacity in existing health centres is used, existing practices could probably compete on a fair basis with the huge commercial organisations that are gearing up to compete for the provision of such services. The fears of commercialisation have been rehearsed by hon. and right hon. Labour Members, and, in the interests of speed, I shall not go into them. I just want to remind the House about the need for local consultation and for accountability to local people. I went to a lunchtime launch of the Local Government Association health commission's final report on accountability, the executive summary of which said:"““More recently, there has been a conscious effort to devolve decision-making, giving greater autonomy to NHS providers and setting a smaller number of national standards to sit alongside ones that are locally agreed.””" That is how we should decide on GP-led health centres, where they will be and what they will provide. I am convinced that GPs in their existing practices in the health centres could provide accessible 8 am to 8 pm, 365 days a year, drop-in and registrable services. There are alarms about commercialisation, and I wish to request a meeting with the Minister to rehearse with him some of the alarming allegations that I have received about how some of the commercial organisations function and to share with him two crucial letters in the medical press that sound warnings about commercialisation from the United States. I also wish to share the sensible points made by the organisation that is completely divorced from the BMA and is thoroughly rooted in the interests of patients: Keep our NHS public. I humbly request such a meeting.