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Primary Care
3.30 pm
The Secretary of State for Health (Mr. Stephen Dorrell): With permission, Madam Speaker, I should like to make a statement about the Government's proposals for the development of primary health care services.
The Government have always accorded a high priority to the development of NHS primary care. The last 17 years have seen substantial extra resources flow into the primary care sector, and those resources have allowed general practitioners to extend the range of care provided within their surgeries. More GPs are working within the NHS, employing more nurses and therapists, and there has been an unprecedented investment programme in GP surgery buildings. There has been a continued steady growth of NHS dentistry, and a greater recognition of the role of pharmacists in the delivery of health care.
The development of GP fundholding has also changed the relationship between primary and secondary care, and has allowed GPs--both fundholders and non-fundholders--to use their knowledge of their patients' needs to improve the efficiency and responsiveness of NHS care. From next April, 58 per cent. of the population will be covered by a fundholding GP.
Despite this record of achievement, however, there remain areas of weakness that need to be addressed. Some inner-city areas have not fully benefited from the development of NHS primary care, and many have argued that the statutory framework for the delivery of primary care is now holding back some desirable service developments.
Against that background, I asked my hon. Friend the Minister for Health to enter into consultations with patient groups and the primary care professions, and with others interested in the future of primary care, to develop proposals that will allow the continued development of NHS primary care.
The conclusions of my hon. Friend's consultations were set out in the Government's document "Primary Care--The Future", which was published this June. Similar discussions were held in Scotland and Wales, and similar conclusions were reached. The Government are committed to address the full range of issues set out in that document, and we will make a full response to them around the turn of the year.
One of the key conclusions of my hon. Friend the Minister for Health's consultations, however, concerned the need to encourage local flexibility in the delivery of primary care services. This conclusion matches the conclusion of the Government's 1994 Green Paper "Improving NHS Dentistry".
Therefore, the Government are today publishing a White Paper entitled "Choice and Opportunity" that sets out our proposals for changing NHS legislation to allow greater flexibility in the delivery of NHS primary health care. We intend to introduce a Bill covering these changes at the earliest opportunity.
The proposals do not envisage a new blueprint for NHS primary care. Our approach will be to enable NHS practitioners and local health authorities to develop new ways in which to deliver and improve primary care. Participation will be voluntary, and practitioners who wish to do so will be able to continue to practise under existing arrangements.
In the case of general medical and dental practitioners, the legislation envisaged in the White Paper will allow practitioners and health authorities to propose pilots to test the practical implications of different types of contract. For GPs, these might include practice-based contracts, recognising the important part which nurses and therapists play within the primary health care team. Alternatively, they may involve GPs working as salaried employees, freeing them from the task of running a practice to concentrate on clinical work.
For GP practices that do not wish to pilot new forms of contract, but seek ways of developing services within the existing contractual framework, our proposals will provide health authorities and boards with greater freedom to reward GPs who offer an enhanced service to their patients.
Dentists will also have the opportunity to pilot new approaches to the delivery of care. These might include local contracts to provide greater incentives for offering treatment in areas of greatest need; new ways of ensuring accessibility to services; or contracts for groups of practices.
If pilots are successful, it will be possible to implement more widely the approaches that have been tested in this way. But we must be sure that, in testing new approaches, we do not lose the best of the existing arrangements. Pilots will be monitored and the results will be evaluated.
One principle will be inviolate. Services provided by practitioners in any pilot approved under this legislation will be provided on NHS terms. Family doctor services will remain free at the point of use. Dental services will be subject to the same charging regime as other general dental practitioner services. Patients will retain the same registration rights as at present.
My hon. Friend the Minister's consultations highlighted the potential for community pharmacists to play a greater part in encouraging the better use of medicines, giving advice to the public and health promotion. The White Paper sets out proposals to remove the legal restrictions that prevent health authorities and boards from rewarding community pharmacists who provide a higher standard of service to their patients.
The legislation will also introduce greater flexibility for health authorities and boards in purchasing community pharmacy and optometry services, and resolve an anomaly which prevents NHS community pharmacies from providing certain services for patients who live just over the border in a neighbouring health authority or board area. The proposals will not affect dispensing services and patients will still have the right to take NHS prescriptions to the community pharmacy of their choice.
Finally, the legislation will address a long-standing problem with the appointment of GPs to practices by implementing the recommendation in the chief medical officer's report "Maintaining Medical Excellence" that appointments to single-handed practices should be made only where at least one candidate meets the standards set out in the job description.
Our primary care system is the envy of the world. These proposals support and build on that success story. There is no single template; our aim is to provide choice and opportunity for those GPs and dentists who want to develop and improve services to pilot their ideas. All our proposals rely on the commitment and enthusiasm of
health care professionals who have played a leading part in their development. We look forward to continuing to work closely with them as we take forward this agenda.
Mr. Chris Smith (Islington, South and Finsbury):
I welcome some of the specific proposals in the White Paper. Everyone will welcome the removal of the requirement to make an appointment to a single-handed practice, no matter how bad the applicant, and will be astonished that it has taken so long to put that absurdity right.
We welcome the Secretary of State's rediscovery of the importance of cottage and community hospitals and the particular role that they can play in helping patients to recover from major surgery. Will he therefore explain why the Government have closed 245 such hospitals in the past five years? We welcome the proposals for salaried GPs employed, for example, by NHS community trusts, and particularly those proposals to help to solve the acute problem of GP recruitment in inner city areas.
I also welcome the Secretary of State's sudden and apparent conversion to the vital principle of equity in the NHS. In appendix A of the White Paper he writes:
In relation to dentistry, paragraph 4.7 of the White Paper says:
Does the Secretary of State realise that, this afternoon, the Government have for the first time recognised that GP commissioning is happening and is providing real benefits to GPs and patients alike? Will he now embrace Labour party policy on GP commissioning as the way forward?
One proposal in the document fills Opposition Members with particular alarm. Paragraph 2.4 talks of
"It will be important not to create inequity of resources for patients of different practices."
I quite agree. Where, then, has he been these past five years when so many of the changes made by the Government have quite deliberately created inequity in the NHS? Does he now realise that the creation of two tiers of service for patients is unacceptable in a comprehensive national service? Does the Secretary of State accept what Derek Smith, chairman of King's Healthcare, said on 25 July--that a two-tier health service is now "an everyday reality"? How can the Secretary of State have woken up so belatedly to the reality of what is happening in the delivery of health care?
"patients should continue to have a right to choose the dental practitioner from whom to receive dental treatment".
Does the Secretary of State not recognise, however, that for many people national health service dentistry has in a very real sense ceased to exist altogether? Does not this reveal that what he is doing in much of the document is starting to repair some of the damage that the Government have caused in the first place? It is a bit like an arsonist saying sorry and starting to rebuild the very house that he has destroyed. Is not the whole document an admission that single practice fundholding is not necessarily the panacea that the Government have always claimed it to be?
"a salaried option for GPs, either within partnerships or with other bodies".
Paragraph 8 of appendix A states:
"Ordinary contracts would be used when services were provided outside the NHS".
15 Oct 1996 : Column 594
Does not that reveal that the Government's real agenda is allowing primary care GP services to be provided by private commercial companies? Would not the proposal tear at the very roots of the public service ethos of general practice?
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