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Mr. William O'Brien (Normanton) rose--
Mr. Dorrell: I should like to make a little more progress before giving way to the hon. Gentleman.
I want to stress that it is important that the White Paper that led to the Bill, and the White Paper on primary care, "Delivering the Future", which was introduced in December, are seen together, because they reflect the output of my hon. Friend the Minister's work in the listening exercise. As I said, they bring together more than 70 changes in the primary care regime, which underlines the Government's determination to see the service continue to develop.
As a consequence of my hon. Friend's work, we introduced in December entitlement for primary care practice staff to the NHS pension scheme, the improved general practitioner retainer scheme, the extension of nurse prescribing, updated cost rent schedules, to be negotiated with the profession, a resolution of the long-standing issues surrounding the state of decay of and the perverse incentives on the use of health authority health centres, a new distribution formula--a weighted capitation-led distribution formula--for the general medical services cash-limited budget, and a total of £100 million of new money for the primary care sector, to deliver the service development to which my hon. Friend's work led.
The Bill does not simply introduce new contract models, although that is important. It is introduced as part of a broad-based strategy to improve, strengthen and reinforce NHS primary care as the essential front line of the health service: accessible, high-quality care, being delivered with the strong support of the Government; a patient-focused service, where the Government have seen important improvements over the past 18 years. The two White Papers reflect our determination that such improvements should continue through the five years of the next Conservative Government.
Mr. William O'Brien:
The Secretary of State will be aware that, from 1 April next year, Wakefield health
Mr. Dorrell:
The hon. Gentleman makes an interesting proposal. If that is a model that practitioners and local health authorities wish to follow up, I certainly do not want to do anything other than encourage them to do so.
In coming to the House this afternoon, I had not expected bids for pilots to be promoted on the Floor of the House before the Bill had even received its Second Reading, but I am pleased to accept any bids for pilots from hon. Members who may have ideas, such as the hon. Gentleman's interesting and innovative idea on how the powers envisaged in the Bill might usefully be used to strengthen the delivery of primary health care.
Mr. Dorrell:
The hon. Gentleman can barely contain himself. He is bubbling over with another pilot proposal.
Mr. Bayley:
It is not another pilot proposal, but in the spirit of agreement across the House on certain aspects of the Bill, I welcome the introduction of a needs-based formula for the cash-limited part of the general medical services budget. Its introduction has, however, highlighted significant disparities in funding, with some health authority areas underfunded, relative to the national average, and others overfunded. Can the Secretary of State say how soon he thinks it will be before funding meets the targets--in other words, before each health authority is funded according to its need, rather than on the old historical basis?
Mr. Dorrell:
As the hon. Gentleman correctly says, in the distribution that I announced in November, we introduced, for the first time, a needs-led assessment. Hitherto, the distribution pattern was shaped by demand. Introducing needs-led targets creates quite wide disparities between the top and bottom of the scale, between different health authority areas.
As to how quickly we move towards more even funding between different health authority areas, that will need to be judged year by year, in the light of the circumstances in the national health service budget as a whole and the GMS cash-limited element of it. Every time we use the weighted capitation formula system, it is important, where possible, to use it to allocate growth money without creating the feeling in one part of the service that the opportunity for growth or improvement in patient services has been exhausted or stopped for a significant time. The pace of advance is inevitably a function of the amount of money available and the other uses to which it might be put. It would be wrong to seek to reduce that to a time-limited commitment or a formula basis. It is properly a matter of judgment year by year.
Mr. Gareth Wardell (Gower):
Does the Secretary of State agree that, unless far better information is collected,
Mr. Dorrell:
The hon. Gentleman is quite right to say that the better management of needs-led health care will increasingly demand higher-quality information on patient experience, the incidence of disease, the prospects of recovery from disease and, indeed, outcome indicators on the effectiveness of treatments that are offered to individual patients. That is an area where the quality of information is improving year by year. I agree with the hon. Gentleman that there is a considerable way to go in improving the quality of the information that is available to the health service.
Against the background of the broad-based commitment to the development of primary care that I have described, I want to go on to talk about the philosophy of the Bill. It makes possible a more flexible approach to the contracts that underwrite the relationship between the health service and the independent contractor professionals who are responsible for delivering NHS primary care.
There are four essential principles underlying the approach set out in the Bill. The first, and perhaps the most important, is that the Bill does not provide for a single, broad-brush change in the contractual relationship between the health service and independent contractors. It provides for the Secretary of State to have power to authorise pilots of new contract models, and part I sets out the provisions that would determine the terms on which those pilots would be allowed to proceed.
Part I is concerned with the terms under which pilots of new contract models are allowed to be authorised by the Secretary of State; part II sets out the terms under which those new contract models can be converted into permanent arrangements. Clause 19(3), at the beginning of part II, makes it explicit that the Secretary of State must have cognisance of the results of pilots before authorising permanent arrangements of the kind envisaged by the Bill, be they for personal medical or dental services or for any of the contract models. Only when the pilot phase is completed do the powers under part II come into effect.
I emphasise that that is an approach to change in the contract models for those practitioners who want to take up that option, based first on pilots; only when pilots have been properly undertaken does the Secretary of State have the power to make the changes general.
Mr. Simon Hughes (Southwark and Bermondsey):
I think that the pilot approach will be generally welcome. It appears that at the moment the Secretary of State envisages including general and dental practitioners but excluding nurses, for example, from being able to lead pilots.
As a simple example, there is a project for homeless people near the Imperial War museum that, it strikes me, could well be nurse-led rather than GP-led. Does the Secretary of State accept that it would be perfectly reasonable for a nurse-led or other professional-led pilot scheme to be recognised, if it proved satisfactory after appropriate testing?
Mr. Dorrell:
The hon. Gentleman raises an important and interesting point. The Bill, as currently drafted,
Rev. Martin Smyth (Belfast, South):
Will the Secretary of State deal with the concern that the Medical Practices Committee may not have any control over qualifications, and the allegation that there will be no central working party controlling the pilots?
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