---

Emergency Care

We are all very concerned to have better access to primary care. The Commonwealth Fund, which Ministers are keen on quoting, published a report last year stating that of the countries that they examined in the survey that Ministers rely on, access to primary care was worst in the United Kingdom. It stated, for example, that out-of-hours evening and weekend access to primary care was available to 60 per cent. of people in this country, compared with 93 per cent. in Germany. Those figures were self-reported, and there is a big gap between where we are and where we ought to be. A lot of things contribute to that gap, but the central part of it is out-of-hours services. The Government focus on the idea that what really matters is GPs sitting in their surgeries dealing with routine appointments at half-past 7 on a Thursday evening, as if that were the answer. However, they have implemented an out-of-hours GP contract that has had the effect of substantially diminishing access to primary care in the evening, at night and at weekends. It is no surprise that although about 14 per cent. of A and E attendances generally occur on each day of the week, the figure is about 16 per cent. on a Monday. We can therefore see that there is a substantial Monday morning increment in the demand on A and E departments. All the reports that emergency departments make to us suggest that that is a consequence of the poor access to primary care over weekends, which the Government are doing nothing to solve.