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Mr. Kenneth Clarke : I last met him formally on 22 February, when I discussed with him the remuneration of hospital doctors in the light of the Government's decisions on the nineteenth report of the Doctors' and Dentists' Review Body.
Mr. Kenneth Clarke : I disapprove strongly of the BMA leaflet which grossly misrepresents the Government's proposals. It is inaccurate and misleading and I believe could cause unnecessary and unjustified alarm to more vulnerable patients. I have therefore written to all GPs to set the record straight on the BMA's five key untrue allegations.
1. None of my proposed reforms will result in doctors running out of money, leaving them unable to prescribe for ill patients. 2. The Government's intention to reward doctors who deliver high quality care to an average list of patients will not reduce the time given to patients when they need it. Doctors who choose to have more patients will need to be available for longer hours than their colleagues with small lists. However, the contract encourages new services and higher performance rather than bigger lists. Patients will not move to doctors who have little time to see them. 3. No hospital is being encouraged to opt out of the NHS nor to reduce the range of services provided. All essential local services will be safeguarded by the DHA's legal powers and duty to require local delivery of them.
4. The Government do not wish to save money by doctors taking the cheapest option. They wish to ensure that, within the resources available, more patients receive high quality care. Doctors who are given more choice and control over resources will make judgments over quality of care more than cost.
5. The commitment of the Government to the NHS is absolute and will remain so. However, after 40 years, it is sensible to seek ways of improving the way in which its huge and growing resources are used. I will continue to take every opportunity to set out an accurate account of my proposals and to try to engage members of the medical profession in serious discussion of them.
|Number --------------------- 1959 |2,300 1960 |2,305 1961 |2,308 1962 |2,322 1963 |2,343 1964 |2,379 1965 |2,428 1966 |2,470 1967 |2,490 1968 |2,494 1969 |2,495 1970 |2,478 1971 |2,460 1972 |2,421 1973 |2,398 1974 |2,384 1975 |2,365 1976 |2,351 1977 |2,331 1978 |2,312 1979 |2,286 1980 |2,247 1981 |2,201 1982 |2,155 1983 |2,116 1984 |2,089 1985 |2,068 1986 |2,042 1987 |2,020
Date |Number of unrestricted |principals in England --------------------------------------------------------------------- 1 July 1959 |18,467 1 July 1960 |18,643 1 October 1961 |18,905 1 October 1962 |19,031 1 October 1963 |19,065 1 October 1964 |18,978 1 October 1965 |18,784 1 October 1966 |18,612 1 October 1967 |18,617 1 October 1968 |18,732 1 October 1969 |18,901 1 October 1970 |19,099 1 October 1971 |19,374 1 October 1972 |19,775 1 October 1973 |19,997 1 October 1974 |20,219 1 October 1975 |20,377 1 October 1976 |20,551 1 October 1977 |20,796 1 October 1978 |21,040 1 October 1979 |21,357 1 October 1980 |21,812 1 October 1981 |22,304 1 October 1982 |22,786 1 October 1983 |23,254 1 October 1984 |23,640 1 October 1985 |24,035 1 October 1986 |24,460 1 October 1987 |24,922
Mr. Battle : To ask the Secretary of State for Health what prior consultations were held with the medical profession before the publication of the new contract proposals for doctors in general practice.
performance-related contract for GPs being a widespread subject of discussion with members of the medical profession about six or seven years ago. The need for a new
Column 501contract for general medical practitioners was first set out formally by the Government in the Green Paper "Primary Health Care : An Agenda for Discussion", published in April 1986. Eight months public consultation with the medical profession resulted in the proposals for a new contract set out in the White Paper "Promoting Better Health" published in November 1987.
Detailed discussions of the proposed new contract with the general medical services committee, which negotiates for GPs, began in March 1988. Between March 1988 and the publication by the GMSC of its account of the negotiating position and my publication of "A New Contract", my officials held 17 meetings lasting 80 hours with the GMSC. I also held two meetings personally with the negotiators before publication and a third, protracted one afterwards. Subsequent meetings between my officials and the GMSC have taken the total time spent on detailed negotiations past 100 hours.
The GMSC is now consulting its local medical committees and has summoned a conference for 27 April 1989. I wait to see whether it will wish to resume constructive discussions after the conference. In the meantime my officials are now preparing amendments to the regulations governing the GM services, including amendment to GPs' terms of service, and revised sections of the statement of fees and allowances (which sets out GPs' entitlement to those payments). The new contract will not reduce the average remuneration of GPs. It will however result in good GPs--those who provide all the services that patients need, attract patients to their practices and achieve high levels of performance--being paid more. This will be achieved by redistribution of existing levels of remuneration enhanced by increased investment in the family practitioner services as promised in the White Paper "Promoting Better Health".
I believe that the GMSC agrees that the existing contract should be changed and that the changes should be introduced with effect from 1 April 1990. I hope, therefore, that the longest, most protracted, detailed and painstaking discussion of amendments to a contract in which I have ever been involved will soon come to an end. Both sides are agreed that our sole aim is to provide incentives to and fair reward for good quality primary health care and that publicly professed agreement should assist in any further discussions.
57. Mr. Hayes : To ask the Secretary of State for Health what representations he has received on the British Medical Association's campaign against the proposed general practitioners' contract ; and if he will make a statement.
Mr. Mellor : Since the publication of "General Practice in the NHS-- A New Contract" on 23 February, I have received about 800 letters from individual GPs and their representative organisations. Prior to 23 February
Column 502discussions on the GPs' contract with the GPs' representatives, the general medical service committee, were confidential.
Sir David Price : To ask the Secretary of State for Health what progress has been made in negotiations with the general medical services committee over a new contract for general practitioners since his publication of the Government's proposals on 23 February ; and whether any of the outstanding issues have been settled.
Mr. Mellor : I refer my hon. Friends to my right hon. and learned Friend's reply to my hon. Friends the Members for Fylde (Mr. Jack), for Wyre Forest (Mr. Coombs) and for Basingstoke (Mr. Hunter) earlier today.
32. Mr. Robert B. Jones : To ask the Secretary of State for Health whether he has any plans to replace the General Medical Council with an independent body to investigate ethical complaints against general practitioners.
Mr. Freeman : The General Medical Council is an independent statutory body whose constitution and functions are regulated by the Medical Act 1983. Under this legislation the council has power to provide advice for members of the medical profession on standards of professional conduct and on medical ethics and to discipline doctors found guilty of serious professional misconduct. There are no plans to change existing arrangements.
Mr. Mellor : The proposals set out in "A New Contract" are based on a year's intensive discussions with the general medical services committee negotiators. The principles are now settled but there will be plenty of opportunity to consider amendments to the detail as we proceed with the preparation of amendments to regulations and the statement of fees and allowances.
Mr. Kenneth Clarke : I propose that general practitioners should receive a rural capitation supplement to their basic practice allowance for each patient on their list who lives in a sparsely populated area. I envisaged three payments, the highest being for patients in the most sparsely populated areas. The amounts of these payments has not yet been decided.
Mr. Mellor : We remain committed to a policy of promoting the development of community services so that people can return to, or remain in, the community and live as independently as possible, wherever this is best for them. We are currently giving active consideration to the future organisation and management of community care following Sir Roy Griffiths' report and hope to be in a position to bring forward our own proposals in the near future.
Mr. Wigley : To ask the Secretary of State for Health how many representations he has received (a) generally in favour and (b) opposed to the main principles of the Griffiths report ; and if he will now make a statement on the Government's intentions with regard to these recommendations.
Mr. Mellor : The representations we have received contain a wide and varied range of views on the Griffiths report. We shall take all reactions into account in framing our own proposals, which we hope to be in a position to bring forward in the near future.
Mr. Mellor : The Department has, for a number of years, grant-aided national voluntary organisations directly concerned with the needs of carers. In 1988-89 these grants totalled nearly £ million. Total grant -aid to the voluntary sector by the Department now exceeds £36 million per annum, a substantial proportion of which is directed at organisations providing services for sick, elderly and disabled people and their carers. I have recently approved a grant of £150,000 for a carers training project and we have provided funding of £19,000 for an information pack about carers' services to accompany a forthcoming BBC local radio series. Under our helping the community to care programme we have made available £10.2 million for projects to support people looking after sick, disabled and elderly people in the community, including £ million to the King's Fund informal caring support unit and £1.8 million to develop services for carers in three demonstration districts in Sandwell, Stockport and East Sussex. We are also funding a programme of research on carers at the university of York and have commissioned some further analysis of the carers data from the 1985 general household survey which, together with data emerging form the OPCS surveys of disability, will inform decisions about the future planning of community care policies.
Mr. Mellor : We are currently giving active consideration to the future organisation and management of community care following Sir Roy Griffiths' report. We hope to be in a position to bring forward our proposals in the near future and will consider requests for meetings from the organisations involved at that stage.
27. Mr. Cran : To ask the Secretary of State for Health what monitoring is undertaken by his Department of the numbers of mixing of elderly physically frail patients and elderly mentally ill patients.
Mr. Freeman : It is departmental policy that there should be separate services for elderly physically frail patients and elderly mentally ill patients. But where elderly people have multiple disabilities they are likely to be in the sort of facility best placed to meet their major need. The provision of services is the responsibility of the district health authority concerned. Overall levels of provision are monitored through the regional review process and through the Health Advisory Service programme of visits.
Mr. Mellor : We are presently considering comments from professional and other interested bodies on a proposal that in the case of private sight tests a patient, under certain circumstances, will be able to choose to have a vision only test to determine whether spectacles are required. No decision on the proposal has yet been reached.
Mr. Mellor : Indications are that fees for private sight tests range between £7 and £15, though one chain of opticians is offering sight tests for old age pensioners at £2.50. Some opticians I understand who are charging about £10 are offering package deals which may give a discount on glasses if these are bought at the branch where the sight test takes place.
29. Mr. Michael Brown : To ask the Secretary of State for Health if he will make a statement on the consequences of the increasing use of private sector laboratory facilities within the National Health Service.
Mr. Mellor : I am pleased to announce that representatives of the private sector, the English National Board and the Department have recently established a joint working group to identify the extent of the private sector's capacity to participate in pre-registration nurse training. The group will also identify the sector's demand for post-registration nurses and its capacity to provide an input consistent with its capacity to train, and its demand for, staff.
Mr. Mellor : We are encouraging the continued development of voluntary local formularies (locally agreed lists of drugs which would normally be prescribed in the majority of cases) as a means of achieving more effective and economical prescribing by general medical practitioners. Formularies might cover a single practice, a group of practices or a family practitioner committee area. As we stated in working paper number 4, "Indicative Prescribing Budgets for General Medical Practitioners", it will be a responsibility of regional health authorities to encourage the development of joint formularies between FPCs and district health authorities.
Mr. Mellor : My right hon. and learned Friend the Secretary of State last met the chairman of the West Midlands regional health authority, together with the chairmen of all other regional health authorities, on 14 and 15 March. NHS hospital trusts were among the many questions that we discussed.
Column 506paragraph 4.2 of working paper No. 5 "Capital Charges" together with details of asset register software which is available to them free of charge. The Department is forming a capital charges unit, headed by an experienced and professionally qualified financial manager seconded from the NHS, which will be available to advise authorities.
38. Mr. Kirkwood : To ask the Secretary of State for Health what will be the extent of control over professional and budgetary matters available to speech therapists under the White Paper "Working for Patients" proposals.
Mr. Kenneth Clarke : The White Paper proposals apply to all branches of the professional services delivered by the National Health Service. The question is too vague to permit any precise answer at this stage.
Mr. Mellor : Health authorities follow the practice of Government Departments, which normally do not insure unless it would be more economical for them to do so than to carry the risks themselves. This long- standing arrangement is something authorities take into account in deciding what provision for contingencies should be made in their financial plans.
40. Mr. Patnick : To ask the Secretary of State for Health what resources have been allocated for 1989-90 to the waiting list fund ; and of this what proportion will be allocated direct to regional health authorities.
Mr. Mellor : The sum of £31 million will be made available through the waiting list fund in 1989-90. Of this, £25.3 million has already been allocated to regional and special health authorities to fund projects aimed at reducing the time patients have to wait for hospital treatment. The remaining £5.7 million will be targeted, through regions, at health districts with particular waiting problems.
|c|Average daily available acute beds, West Midlands regional health|c| |c|authority, 1979 and 1987-88|c| |Available beds |In-patient cases treated ---------------------------------------------------------------------------------------------------- 1979 |14,669 |414,865 1987-88 |13,179 |550,698 Source: SH3: 1979. KH03: 1987-88.
43. Mr. Duffy : To ask the Secretary of State for Health if he will make a statement on the regulations governing the preparation and distribution of the products of the prepared food industry ; and if, as a matter of urgency, he will discuss this with representatives of the industry.
Mr. Freeman : The provision of the Food Act 1984, together with the food hygiene regulations, made the Food Hygiene (General) Regulations 1970 and the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966, as amended, apply to the preparation and distribution of food products. The wider application of storage temperature controls in the food hygiene regulations, including those required for delivery vehicles, is currently being considered and revised draft regulations will be issued for consultation shortly. Food industry concerns will be included in this exercise.
Mr. Mellor : The Government have maintained the wide-ranging exemptions from prescription charges under which more than 75 per cent. of all items dispensed in the NHS are free of charge as well as continuing to provide pre-payment certificates for persons who are not exempt but who need frequent medication.
52. Mrs. Maureen Hicks : To ask the Secretary of State for Health how much on average is being spent in the current year on each family from the current health budget ; and how much is planned for each of the three subsequent years.
Mr. Freeman : Average gross NHS spending (current and capital) per head in England will be £442 this year (1989-90) and is planned to be £461 in 1990-91 and £479 in 1991-92. If the average family is considered to consist of four persons the average spending per family will be £1,767
Column 508this year and £1,845 and £1,917 in each of the following two years respectively. Planned expenditure figures for future years are subject to further consideration in future public expenditure surveys. The level of planned spending on the NHS for 1992-93 has not yet been decided.
Mr. Mellor : The Registered Homes Act 1984 and associated regulations place the responsibility on local authorities and district health authorities as registering authorities to register private and voluntary residential care homes and nursing homes respectively and inspect them at least twice a year ; the inspections may be unannounced and "out of hours". In addition, general guidance on the running of these homes is available in "Home Life" a code of practice for residential care, and the National Association of Health Authorities' "Handbook on Registration and Inspection of Nursing Homes", and in departmental guidance. Local authorities are also responsible for ensuring adequate standards in their own homes. The Department's social services inspectorate monitors and advises local authorities on the discharge of their duties.
55. Mr. Litherland : To ask the Secretary of State for Health if he will make a statement on the number of district health authorities in the north-west expressing an interest in hospitals opting-out.
Mr. Kenneth Clarke : It is too early to do so. Mr. Duncan Nichol, the chief executive of the National Health Service, has asked for outline expressions of interest relating to proposals for self-governing hospitals within the NHS to come to my Department through RHAs, by 31 May.