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Mr. Kenneth Clarke : With the leave of the House, I assure hon. Members that I shall speak briefly so that I shall not intrude into the time for the debate on education ; that means that I shall not follow the hon. Member for Peckham (Ms. Harman) into the things that she said about the hospital service. I shall reserve my reply for the full debate on the White Paper.

As I am short of time, let me take it at face value that the hon. Lady is interested in producing a better National Health Service. When we debate the proposals for self-governing hospitals and when she sees the expressions of interest that come forward, we will be able to debate the subject more seriously. Those expressions of interest will be taken for what they are described as--expressions of interest with a great deal of detail left to be considered by all in the hospitals concerned or by anyone who wants to commit himself to the proposals. People will want to know, for example, exactly what capital charges will mean for their hospital and for every other hospital in which the

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system is being introduced. I reassure the hon. Lady that nonsense about all our great hospitals in London being sold for office blocks is wide of the mark.

Ms. Harman : Two fifths.

Mr. Clarke : Even the suggestion that two fifths of hospitals in London will be sold to property developers for office blocks is very wide of the mark. When we get to the sensible discussions, I hope that that childish parody of our proposals is abandoned and that we can talk about how hospitals which have management in their own hands can contribute to the care of patients.

Most of the debate has been about general practitioners. There was a great deal of letter-reading on all sides. I shall not go as far as the hon. Member for Newham, North-East (Mr. Leighton) who read into the record more of his constituents' letters in 10 minutes than I have ever heard any hon. Member do before. As we were challenged to produce letters, I cannot resist producing just one from a professor in the department of general practice and primary care in a great London teaching hospital not far from the hon. Gentleman's constituency. I shall quote just two paragraphs :

"I am in constant contact with several hundred practices scattered over the United Kingdom and it appears that there is a consensus which is not reflected in public statements, and which is positive. The general feeling is one that the reorganisation is long overdue and that the efficiency of the Health Service has to be materially improved. There is also a considerable welcome for the beginnings of integration of general practice with secondary care."

I too have a sheaf of letters. I could go on quoting consultants and GPs from all over the country.

My hon. Friends keep producing the views of their doctors. We are taking note of those and other views. I was asked by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) and by my hon. Friend the Member for Thanet, South (Mr. Aitken) whether we have over the years considered other possibilities. It is not true that the idea of improving the contract for general practice is an overnight thought that occurred during the Prime Minister's review. Discussions go back five or six years. The hon. Member and my hon. Friend quoted other views and asked whether we had considered other options.

I have not read the recent letter of Professor Morell, but it sounds as though he was commending the idea of a good practice allowance as a feature of a contract based on medical audit. We were discussing that five or six years ago. I remember it well. It was rejected because of medical opposition, which was organised and very strong. Because it was thought that the whole idea of clinical audit and peer review would be jeopardised if linked to payment, we turned away from that and considered other methods of evolving an acceptable contract that reflected the aims to which the Government remain committed--rewarding those doctors who work hardest and best, setting new standards for the introduction of services, particularly in health promotion and disease prevention, and setting new targets for services such as immunisation, screening and so on.

My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) pressed all the points made by her general practitioners upon me without reading them into Hansard, as the hon. Member for Newham, North-East

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did. Contrary to what was said, she and my hon. Friends the Members for Harlow (Mr. Hayes), for Newbury (Sir M. McNair -Wilson) and for Gloucester (Mr. French) seemed to support the principles behind the White Paper. They wished to take up particular points that general practitioners had put to them about the present state of the contract discussions.

I would welcome a resumption of those discussions. They had been going on for a long time and were broken off at the behest of the negotiators while the conference was held last week. That conference lifted the threat of resignations and began to talk of discussions again and how those discussions should be renewed. I have made it clear throughout that, as long as we reach a conclusion soon at the end of a six-year process, I am prepared to seek to reach agreement on a form of contract with doctors, so long as they demonstrate to me that their negotiators share the aims that I have just enunciated.

Mr. Michael Morris (Northampton, South) : As my right hon. and learned Friend is prepared to put forward proposals with my right hon. and learned Friend the Secretary of State for Scotland, which seem broadly to meet general practitioners' requirements, now that the conference is over, is it his intention to meet the English general practitioners and to anglicise those proposals?

Mr. Clarke : I do not want to take the discussions much further on the Floor of the House. The Scottish contract, the so-called tartan contract, was put forward by my right hon. and learned Friend the Secretary of State for Scotland to represent particularly Scottish problems a few weeks after I had put forward my English proposals. We both took account of the views put to us in producing the Scottish contract. I shall be interested to hear whether general practitioners in Northampton and elsewhere will be interested in accepting what the Scots have so far on offer. I shall be interested to hear whether Scottish general practitioners are content with the tartan contract. No doubt the hon. Member for Angus, East (Mr. Welsh) knows. Various matters have been raised about which I cannot go into detail here. My hon. Friends the Members for Harlow and for Newbury asked about rural practice. I am perfectly content to continue to discuss the rather curious disagreement between us on rural practice. My negotiators and the BMA negotiators are determined that there must be some special arrangements for rural practice. In discussions so far we have both been convinced that our respective suggestions are better and fairer for those who live in rural areas and scattered districts, but, as we are both agreed that special arrangements have to be made for rural areas, it must be possible to reach agreement. A similar situation applies to deprived inner-city areas. I have been proposing extra capitation for those who practise in deprived areas because, again, general practitioners there cannot build up their lists. There has been no pressure in our contract proposals on any general practitioner with average or near-average lists to raise his list size, which is a fear that has been voiced. Other fears can also be met in discussion.

I was asked about the position of women practitioners by my hon. Friends the Members for Newbury and for Gloucester and by Opposition Members. The nature of general practice will change in many ways. One is that many more practitioners will be women. More than half

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the students in our medical schools now are women and we must accept that equal opportunities must be presented to all women who go into general practice, including those who will have family responsibilities at some time or another. The contract proposals are friendly to women seeking to enter general practice.

The notion of job sharing is floated in my proposals, as is the idea of part-time women being full principals in a practice. Therefore, the differences between me and my negotiators on the one hand and some women general practitioners on the other are not differences of aim ; they are based on what I regard as an unusual interpretation of some of the changes that we are making to basic practice allowance. I am prepared to talk through a contract which in the end will encourage more women to go into practice and accept a desirable change in the contract.

I mention those matters not to trail any further what we might discuss, but to make it clear that discussions were broken off only because the BMA asked for that. The BMA carried out a leaflet campaign and held its conference, and, as far as I am concerned, discussions can now be resumed. My proposals were evolved after 12 months of detailed discussions, but they were plainly open to further discussions. That is the way that we should proceed. If both sides show common sense and are genuinely committed to a better NHS, raising standards of general practice and improving service to the patient, it should be possible to reach agreement. The remuneration of individual general practitioners should not be the great stumbling block to progress. Other reforms should not be regarded as sanctions where consent can be withheld unless a proper deal on the contract is arrived at.

The contract should now be resolved by sensible discussion, and further examination of the White Paper will reveal what my hon. Friends have all said has been revealed in sensible discussions with small groups of doctors throughout Britain--that, on balance, almost all agree that it is beneficial. When details are explained, most general practitioners will agree that. As we proceed with the implementation, it will be seen that this is just the next step in the Government's commitment to a better NHS, a free NHS financed out of taxation, and one that keeps up with the times to deliver the best of modern medical practice to patients who will be proud of it in the future.

Question put, That the original words stand part of the Question :--

The House divided : Ayes 181, Noes 279.

Division No. 182] [7.05 pm


Abbott, Ms Diane

Alton, David

Anderson, Donald

Archer, Rt Hon Peter

Armstrong, Hilary

Ashley, Rt Hon Jack

Ashton, Joe

Banks, Tony (Newham NW)

Barnes, Harry (Derbyshire NE)

Barnes, Mrs Rosie (Greenwich)

Barron, Kevin

Battle, John

Beckett, Margaret

Beggs, Roy

Bell, Stuart

Benn, Rt Hon Tony

Bermingham, Gerald

Bidwell, Sydney

Blunkett, David

Bray, Dr Jeremy

Brown, Gordon (D'mline E)

Brown, Nicholas (Newcastle E)

Brown, Ron (Edinburgh Leith)

Bruce, Malcolm (Gordon)

Buchan, Norman

Buckley, George J.

Caborn, Richard

Campbell, Menzies (Fife NE)

Campbell-Savours, D. N.

Cartwright, John

Clarke, Tom (Monklands W)

Clay, Bob

Cohen, Harry

Coleman, Donald

Cook, Frank (Stockton N)

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

Column 78

Cousins, Jim

Crowther, Stan

Cryer, Bob

Cummings, John

Cunliffe, Lawrence

Dalyell, Tam

Darling, Alistair

Davies, Rt Hon Denzil (Llanelli)

Davis, Terry (B'ham Hodge H'l)

Dixon, Don

Dobson, Frank

Doran, Frank

Douglas, Dick

Dunnachie, Jimmy

Eadie, Alexander

Eastham, Ken

Evans, John (St Helens N)

Ewing, Mrs Margaret (Moray)

Fatchett, Derek

Faulds, Andrew

Fearn, Ronald

Field, Frank (Birkenhead)

Fields, Terry (L'pool B G'n)

Fisher, Mark

Flannery, Martin

Foot, Rt Hon Michael

Foster, Derek

Fraser, John

Fyfe, Maria

Galbraith, Sam

Galloway, George

Garrett, John (Norwich South)

Garrett, Ted (Wallsend)

Godman, Dr Norman A.

Gordon, Mildred

Gould, Bryan

Griffiths, Nigel (Edinburgh S)

Griffiths, Win (Bridgend)

Grocott, Bruce

Hardy, Peter

Harman, Ms Harriet

Hattersley, Rt Hon Roy

Hinchliffe, David

Hogg, N. (C'nauld & Kilsyth)

Holland, Stuart

Home Robertson, John

Howarth, George (Knowsley N)

Howells, Dr. Kim (Pontypridd)

Hughes, John (Coventry NE)

Hughes, Robert (Aberdeen N)

Hughes, Simon (Southwark)

Ingram, Adam

Janner, Greville

Jones, Ieuan (Ynys Mo n)

Jones, Martyn (Clwyd S W)

Kinnock, Rt Hon Neil

Kirkwood, Archy

Lambie, David

Lamond, James

Leighton, Ron

Lestor, Joan (Eccles)

Lewis, Terry

Litherland, Robert

Livsey, Richard

Lloyd, Tony (Stretford)

McAllion, John

McAvoy, Thomas

Macdonald, Calum A.

McFall, John

McKay, Allen (Barnsley West)

McKelvey, William

McLeish, Henry

Maclennan, Robert

McNamara, Kevin

McWilliam, John

Madden, Max

Mahon, Mrs Alice

Marek, Dr John

Marshall, Jim (Leicester S)

Martin, Michael J. (Springburn)

Martlew, Eric

Meacher, Michael

Michie, Bill (Sheffield Heeley)

Michie, Mrs Ray (Arg'l & Bute)

Mitchell, Austin (G't Grimsby)

Morley, Elliott

Morris, Rt Hon A. (W'shawe)

Morris, Rt Hon J. (Aberavon)

Mowlam, Marjorie

Mullin, Chris

Murphy, Paul

Nellist, Dave

Oakes, Rt Hon Gordon

O'Brien, William

Orme, Rt Hon Stanley

Patchett, Terry

Pendry, Tom

Pike, Peter L.

Powell, Ray (Ogmore)

Prescott, John

Primarolo, Dawn

Quin, Ms Joyce

Radice, Giles

Randall, Stuart

Rees, Rt Hon Merlyn

Richardson, Jo

Roberts, Allan (Bootle)

Robertson, George

Robinson, Geoffrey

Rogers, Allan

Ross, Ernie (Dundee W)

Ruddock, Joan

Sedgemore, Brian

Sheerman, Barry

Sheldon, Rt Hon Robert

Shore, Rt Hon Peter

Short, Clare

Sillars, Jim

Skinner, Dennis

Smith, Andrew (Oxford E)

Smith, Rt Hon J. (Monk'ds E)

Soley, Clive

Spearing, Nigel

Steinberg, Gerry

Stott, Roger

Strang, Gavin

Straw, Jack

Taylor, Mrs Ann (Dewsbury)

Taylor, Matthew (Truro)

Thompson, Jack (Wansbeck)

Turner, Dennis

Vaz, Keith

Wall, Pat

Wallace, James

Wardell, Gareth (Gower)

Wareing, Robert N.

Welsh, Andrew (Angus E)

Wigley, Dafydd

Williams, Rt Hon Alan

Wilson, Brian

Winnick, David

Worthington, Tony

Wray, Jimmy

Tellers for the Ayes :

Mr. Frank Haynes and

Mrs. Llin Golding.


Aitken, Jonathan

Alexander, Richard

Allason, Rupert

Amess, David

Amos, Alan

Arbuthnot, James

Arnold, Jacques (Gravesham)

Ashby, David

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