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Mr. Kenneth Clarke : Our proposals will produce a better quality of care for all NHS patients, including elderly and chronically sick people. We intend to bring all services up to the standard of the very best and to make certain that taxpayers' money is used to best effect from the patients' point of view. The proposals reflect our strong commitment to the principles on which the NHS was founded and will ensure that it is more than ready to face the rapidly changing and rising demands upon it as medical science progresses and the average age of the population rises.
37. Mr. Ground : To ask the Secretary of State for Health whether under the proposals in the White Paper, "Working for Patients", a patient could go without necessary drugs if a general practitioner overspends on his or her drug budget.
Mr. Kenneth Clarke : No. As a result of our proposals no patient could ever go without necessary drugs in any circumstances. Indicative prescribing budgets for GPs will be set at sensible and realistic levels and in discussion with each practice to reflect the needs for drugs of patients in that practice. While general medical practitioners will be expected to aim to contain their prescribing within their indicative budgets, we fully accept that the legitimate demand for drugs may not follow a consistent pattern at practice level and that some practices may exceed their indicative budgets with good reason. There will be no question of any doctor ever being prevented from prescribing necessary medicine for any patient, whether or not he or she has overspent or will overspend his indicative budget.
Mr. Kenneth Clarke : As I announced to the House on 5 May, we have now reached agreement with the general medical services committee's negotiators on all the major outstanding issues on the new contract for GPs. We have modified our proposals in several ways which will be welcomed by GPs serving rural areas. We have agreed to retain the present rural practice payments scheme pending its revision by the Central Advisory Committee on Rural Practice Payments. We have included home visits in the hours of availability to patients required of GPs, although in consequence we have raised the number of hours to 26 per week. We have agreed that the requirement for GPs to be available over five days a week may be reduced to four days where the GP carries out other health-related activity in the public service (for example, service in a community hospital).
Column 478We have also agreed that ad hoc minor surgical operations may be aggregated for the purpose of claiming entitlement to the new minor surgery sessional payments. Many GPs serving rural areas will benefit from retention of seniority payments (though reduced in value) and from the extension of the higher night visit fee to rotas of up to 10 GPs. Retention of partnership average list size for calculating entitlement to basic practice allowance, and the lowering of the threshold for full basic practice allowance to 1,200 patients rather than 1,500 as previously proposed, will also benefit GPs in rural areas.
The general medical services committee has agreed to put the agreement to the annual conference of local medical committee representatives in June on the basis recommended by its negotiators.
45. Mr. David Nicholson : To ask the Secretary of State for Health what representations he has received on the proposals affecting family practitioner committees in the White Paper, "Working for Patients".
Mr. Mellor : We have received responses to the White Paper "Working for Patients" from a large number of organisations and individuals. Many of these have included comments on the proposals affecting family practitioner committees.
Mr. Mellor : We have received a large number of representations on the White Paper proposals, from statutory, voluntary and professional bodies and from individuals including right hon. and hon. Members. Many have welcomed the proposed relationship between health authorities and general practitioner practice budget holders on the one hand and hospitals as the providers of services on the other since this will allow contracts to specify services, quality of standards and levels of agreed funding, enabling money to follow patient choice. We will take careful note of these comments in taking forward our plans for implementing our policies.
49. Mr. Colvin : To ask the Secretary of State for Health whether he will commission any pilot studies of general practitioner practices operating practice budgets similar to those proposed in the White Paper "Working for Patients".
Mr. Mellor : Eligibility for practice budgets will be confined, at least initially, to practices or groups of practices with a registered list of at least 11,000 patients to provide sufficient budgetary flexibility. Practices will also need to be able to demonstrate the ability to manage budgets including having adequate administrative support and IT and information systems. On this basis we see no need for separate pilot studies of practice budgets but we will of course keep the system under review once it has started to operate in April 1991 and make any improvements which are necessary in the light of experience.
61. Mr. Robert Hicks : To ask the Secretary of State for Health how many representations he has received to date in response to his proposals for National Health Service reforms ; and if he will make a statement.
Mr. Mellor : None. However, I understand that the West Midlands regional health authority has received a number of expressions of interest in self government from hospitals in the region ; these will be sent to the Department by 31 May.
Mr. Mellor : Indicative prescribing budgets will improve patient care. They will provide a further incentive to general practitioners to examine their prescribing patterns critically to ensure that they prescribe in the most effective way possible. This includes prescribing only when and for as long as necessary. More effective prescribing is better for patients. All patients will always get the drugs they need.
Mr. Mellor : We are making good progress in developing details plans for implementing practice budgets for GPs from 1 April 1991. These budgets will be available to GPs who fulfil the eligibility criteria and choose to opt for them in view of the new freedoms of choice they will confer on the practice.
Mr. Mellor : Regional health authorities are currently considering expressions of interest in individual hospitals becoming self governing. They have been asked to send the expressions of interest to the Department, together with their comments, by 31 May.
Mr. Harry Greenway : To ask the Secretary of State for Health what he estimates to be the optimum size of practice for a general practitioner in an average urban area ; and if he will make a statement.
38. Mr. Michael Brown : To ask the Secretary of State for Health what assessment he has made of the effects of the increased capitation element in the general practitioners' contract on doctor-patient relationships.
Mr. Mellor : We believe that the increase to 60 per cent. of the proportion of general practitioners' income represented by capitation payments will stimulate greater competition among general practitioners and make services more responsive to patients' needs. Our proposals for making more information available to patients and making it easier to change doctors will encourage patients to choose the general practitioner who provides the best service. We expect therefore that general practitioners who provide a wide range of high-quality services will gain patients, and those who do not will have to improve their services in order to maintain income. List sizes will, however, settle at levels consistent with the provision and maintenance of high-quality services, because patients will not join or remain on the list of a general practitioner whose services are below standard. We do not consider that there is an optimum list size, because the quality of services depends on a range of factors (for example, the size and skills of the practice team) of which list size is only one.
Mr. Austin Mitchell : To ask the Secretary of State for Health what estimate the Government have made of the effects of the proposed changes in the remuneration of general practitioners on the gross income of those who do not opt for their own budgets ; and what is the intended effect of the new arrangements in terms of (a) the number of patients per doctor and (b) the number of staff employed by doctors, and their remuneration.
Column 481for Slough (Mr. Watts) and for Colne Valley (Mr. Riddick) today. Under the proposals for GP practice budgets set out in the White Paper "Working for Patients" and working paper 3, practices that opt to become budget holders may invest any savings on their annual budget in improving the services they offer to patients. The Review Body on Doctors' and Dentists' Remuneration will continue, as now, to recommend the average net income and indirectly reimbursed expenses of all GPs, whether budget holders or not. Other expenses incurred by GPs are reimbursed directly.
We expect the number of staff employed by GPs to increase as a result of our intention to invest more in practice teams, and to remove the present restraints on their number and the range of qualifying duties. By enabling FPCs to target funds on areas of greatest need, the deployment of practice team staff will become more cost effective.
Mr. Butler : To ask the Secretary of State for Health what was the target number of patients to be treated in Halton district general hospital in 1988-89 ; and what was the actual outcome in that year.
Mr. Freeman : The level of funding for the NHS is a matter of considerable interest, often raised in correspondence and at meetings and visits ; since 1979 expenditure has increased by some 40 per cent. in real terms and we are now spending more on the National Health Service than ever before.
62. Mr. McCrindle : To ask the Secretary of State for Health to what extent the additional funds allocated to the National Health Service this year are to be used to repay deficits accumulated in earlier years.
Column 482improvements in efficiency, including planned rationalisations of service, authorities are expected to plan to bring income and expenditure into balance. Where a region has funded excess spending by districts in earlier years the repayment of such funding, including use of the additional resources made available this year, is a matter for agreement between the region and districts concerned.
Mr. Mellor : From 1 April 1989 the full cost of the Medicines Control Agency work is to be funded by the pharmaceutical industry, save for the costs of the work of the British Pharmacopoeia Commission whose staff are provided by the agency, the cost of NHS inspection work and certain other minor matters. Payment will be made through licence and inspection fees.
Mr. Mellor : As at 31 March 1989 the Oxfordshire DHA had 4,232.1 "worked whole time equivalent" nursing and midwifery staff. Recruitment of trained nursing staff is satisfactory in most specialties and an additional £200,000 has been made available by the district to the John Radcliffe hospital to deploy additional staff on medical and surgical wards. A new nurse training scheme, due to start in October, has attracted a large number of applicants.
19. Mr. Ashton : To ask the Secretary of State for Health how many letters he has had from members of the public or local organisations in Bassetlaw supporting the application from the Bassetlaw health authority to turn the Bassetlaw hospital, Worksop into a self governing trust.
Mr. Kenneth Clarke : None, but only one against. If an application is made for Bassetlaw health authority to become self governing I will look to the Trent regional health authority to seek the views of all those with an interest.
Column 483placenta to a commercial organisation. I understand this is used for therapeutic purposes (for example the manufacture of albumen and gamma globulin) and that a small handling charge is paid to participating health authorities to cover storage costs.
21. Mr. Couchman : To ask the Secretary of State for Health what are the intended effects of the changes in composition of the family practitioner committees proposed in the White Paper "Working for Patients".
Mr. Kenneth Clarke : Family practitioner committees will have a greatly enhanced management role in future as a result of the implementation of the proposals in the two White Papers : "Promoting Better Health" and "Working for Patients". I therefore intend to create committees more suited to taking the necessary decisions and managing the contracts of the doctors, dentists, opticians and pharmacists in contract with the NHS in their area. I believe that FPCs should play a significant role in protecting and raising the standards of primary health care for patients.
Mr. Kenneth Clarke : I understand from newspaper reports that the BMA wishes to meet me again to discuss the White Paper on NHS reforms. I expect therefore to have a meeting with it on that subject in the near future.
25. Mr. Wareing : To ask the Secretary of State for Health if he will make a statement on the financing of local authority and health authority services for the disabled for which his Department has responsibility.
Mr. Mellor : It is not possible to identify separately the financing of National Health Service expenditure on services for this client group. They will have benefited, however, from the growth in expenditure on the National Health Service by around 40 per cent. in real terms since 1979. The Chartered Institute of Public Finance and Accountancy estimates that in 1988-89 gross expenditure on local authority personal social services for physically and sensorily handicapped people will total over £200 million.
26. Mr. Andrew F. Bennett : To ask the Secretary of State for Health what was the total amount of National Health Service health care expenditure spent in the north-west region as a percentage of total National Health Service health care expenditure, for the most recent year for which figures are available.
Mr. Freeman : In 1987-88 total revenue and capital expenditure by health authorities comprising the north-western region was £1,078.4 million, which represented 9 per cent. of the total expenditure of all regional and district health authorities in England.
27. Mr. Atkinson : To ask the Secretary of State for Health when he expects to respond to the recommendations put to him by the Royal National Institute for the Deaf in the fair hearing campaign ; and if he will make a statement.
Mr. Mellor : The Royal National Institute for the Deaf is currently refining its proposals in the light of comments it has received from a number of organisations concerned with the provision of hearing aids. We shall need to consider the very complex issues involved in the context of RNID's revised proposals.
30. Mr. Summerson : To ask the Secretary of State for Health if he can give an estimate of the savings made in the last available year from the contracting out of services within the National Health Service.
Mr. Mellor : All midwives have been regraded within the new clinical grading structure with effect from 1 April 1988. Information on the assimilation from old grades to the new has been placed in the Library. A number of appeals against gradings are outstanding. Assimilation to the new structure resulted in an average pay increase for 1988-89 of over 20 per cent. The new structure provides greatly improved career opportunities.
Mr. Mellor : We have received over 270 representations from hon. Members, organisations and members of the public about Sir Roy's recommendations. Recent responses have been received from a number of national organisations and professional groups. We are studying all responses carefully as we formulate our own proposals.
59. Mr. Speller : To ask the Secretary of State for Health if he will make a statement on the availability of IVF within the south-west region, with particular reference to (a) its availability free of charge in Bristol and (b) its non-availability in the North Devon health area.