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Polyclinics

The motion is all about patients and the provision of health care for the maximum benefit of patient outcomes. This debate has been very revealing, in that the only speakers who supported the Government's policy came from that diminishing dying breed, the ultra-supporters of the Government. The debate was opened by the shadow Secretary of State for Health, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who gave a timely and devastating critique, mentioning the potential serious problem and the detrimental impact on patient care. He was right to highlight the problems of potential closures, the potential increase in travel distances, and the danger to the fundamental GP-patient relationship. In direct contradiction of what the hon. Member for Cleethorpes (Shona McIsaac) said, he mentioned the dynamic, strong feelings that patients and GPs have on the issue. He also highlighted the funding uncertainties: where will the money to support the policy come from? Even more importantly, he mentioned the fundamental lack of evidence to support the Government's policy, in relation to quality, access and service. We then heard the Secretary of State's response. He is usually highly polished and has a Teflon quality to him, but today he was clearly slightly over-excited, rattled and very confused. I suspect that he does not really want to have to defend the policy, because he knows that it does not make sense, particularly in the context of localised decision making—an idea that the Government trumpet—and clearly he was not enjoying himself. He tried to make a difference in definition between polyclinics and GP health centres, but it was clear from other contributions that they are the same. He quoted a London MORI poll in an attempt to support his policy, but the only recent poll that matters in London is the mayoral election, which was clearly won by Boris Johnson. The Secretary of State took an extraordinary, uncharacteristic and slightly sarcastic sideswipe at the hon. Member for Birmingham, Selly Oak (Lynne Jones), who made an extremely thoughtful and balanced contribution. Like us and, I suspect, the Liberal Democrats, she is trying to argue for more devolved decision making on how the money is spent. The Secretary of State's response to her contribution was extraordinary. Tellingly, he confirmed that primary care trusts would not be allowed to convert and expand existing practices, even if that was in patients' interests; there had to be a new polyclinic or GP-led health centre in every primary care trust, and even more in London. He made a bizarre attack on Conservative party policy, which is to try to find ways of improving primary care in socio-economically deprived areas, so that we can reduce health inequalities and improve things for those who do not have sufficient access. A significant contribution was made by the hon. Member for North Norfolk (Norman Lamb), who rightly confirmed the necessity of local decision making. He made a critical point about the importance of continuity of care, and about the danger that GPs' understanding of individual patients' medical histories could be eroded by the policy direction being taken. We next heard from the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, let us not forget, is an ex-Secretary of State for Health. The current Secretary of State's view is that there is uniformity of opinion in London that polyclinics are a good idea, but that view was clearly shot to pieces by the right hon. Gentleman's contribution. The right hon. Gentleman was right to highlight the fact that the drivers of the polyclinics policy are Ministers in the Department of Health. The policy is not a response to patients' needs, to the NHS in London or to primary care trusts' desires elsewhere in the country. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill) made a significant contribution. He was right to challenge the idea that the proposals would be the best use of resources in his constituency. In a lucid, considered contribution, my hon. Friend the Member for Basingstoke (Mrs. Miller) highlighted concerns in her constituency. At the time of his speech, the hon. Member for Dartford (Dr. Stoate) was the only Member to have supported the Government line. He is clearly very knowledgeable about the health service as a result of his professional qualification and his career, so it is sad that he always rises to defend Government policy, irrespective of what it is. He does not, perhaps, use his expertise and knowledge to make constructive suggestions for the Government. The hon. Member for Wyre Forest (Dr. Taylor) made a telling contribution, as always. He made one particularly good point: the policy should not be about buildings, but about patient services and pathways. That is one of the fundamental errors in the direction of Government policy. I will not allow Conservative Members to be painted into a corner and seen as the representatives of the British Medical Association. We are not its representatives; we are here to fight for patients and the improvement of patient services. We are not against polyclinics or GP-led health centres per se. In fact, when they are supported by patients, GPs and the local community, we will be supportive and will facilitate them and enable them to be introduced. However, the decision should be taken locally, and should be based on clinical evidence, and evidence on health inequalities and prevention measures. There should also be a comprehensive understanding of the impact on existing provision. The House needs to understand that we are not talking about a minor tweak to primary care. The establishment of polyclinics and GP-led health centres will be the largest change to primary care since the establishment of the NHS. In many places, including the Secretary of State's constituency, it has been said that the change would act as a catalyst for the reconfiguration of local GP services. It should be for local primary care trusts and patients, not Ministers in the Department of Health, to make the decision. Of course the Secretary of State is right that there are circumstances in which health centres of polyclinics would have a beneficial impact. He rightly gave the example of preventing multiple appointments and additional travel, particularly for the elderly and the vulnerable. We also recognise that there should be greater access to diagnostics and follow-up appointments, and it may be that such centres are the appropriate place to provide those services, but not everywhere, not uniformly, and particularly not in rural areas. Very specific criteria were set down by Darzi that the polyclinics and GP-led centres would be both cheaper and more accessible, but some hon. Members' contributions have demonstrated that that is not the case. The Government need to answer some specific questions. They do not seem to understand that there is a direct correlation between GPs and patient care and a threat to that relationship. Will the Minister also explain in winding up the debate whether a GP-led health centre means a GP presence all the time, from 8 to 8, seven days a week, 365 days a year? Why are there no pilots to produce evidence that the Department of Health can analyse? The Secretary of State confirmed for the first time that, on average, there will be five GPs per centre outside London. That amounts to an additional 605 GPs. Where will those additional GPs come from, in the context that there were only six more last year, if they do not come from surgeries that are already in place? Why will Ministers not allow PCTs to invest instead, where appropriate, in community hospitals or other GP-led health centres—a point made by my hon. Friends the Members for Beverley and Holderness (Mr. Stuart) and for Scarborough and Whitby? Why will Ministers not allow additional facilities to operate in non-spearhead PCTs—for example, outreach services? The policy is confusing. Lord Darzi said in his framework document that PCTs would not be allowed to reconfigure services until a PCT clinic review has taken place, giving evidence of the benefits. Where is the evidence—I hope that the Minister will explain this—to support the supposed benefits of a centrally prescriptive solution that is odds with locally determined reconfiguration? I suspect that the answer to those questions is that a one-size-fits-all proposal is not really about patient outcomes, but about political outcomes. There is an inherent contradiction between devolving commissioning responsibilities to a PCT through practice-based commissioning, and proposing a centralised approach to service design, with plans for polyclinics or GP-led health centres in every PCT. The Opposition will not coerce doctors into polyclinics against their will. GP-led health centres should be able to offer additional services, such as physiotherapy and phlebotomy, but they can be provided in other facilities as well in the existing system. This is not just about new buildings. Under the next Conservative Government, primary care will be patient-centric, responsive to local communities and free to innovate, ultimately to drive better patient outcomes.