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7.43 pm
Mrs. Alice Mahon (Halifax): Although I support the amendment, I am not denying that there are good things in the Bill, such as the new rules for appointing GPs in single-handed practices, and the provision of salaried GPs. I am glad that community trusts will be able to employ GPs, although, like others who have spoken, I am very worried about the acute trusts. I fear that there could be a blurring of the purchaser-provider split, and even--as the hon. Member for Belfast, West (Dr. Hendron) suggested--a conflict of interests in regard to GPs who might be employed as fundholders.
The Secretary of State outlined some of the good aspects of pilot schemes--for instance, the fact that permanent arrangements will not be introduced unless they have been agreed by the Secretary of State. There must be proper assessment, but there is some doubt about who will carry it out. Participation is to be voluntary, but I wonder whether sweeteners will be offered in some instances. Participants must be given an assurance that they can return to current practice if the alternative does not prove satisfactory, and I welcome most of the proposed arrangements. I feel, however, that we need clarification in regard to who will be consulted.
As I said to the Secretary of State in an intervention, past consultation has left some of us less than enamoured of the practice. I mentioned a recent consultation exercise relating to a 300-bed reduction. I do not know whether we shall ever get our new hospital in Halifax--which is
being built under the now infamous private finance initiative--but there has been plenty of consultation about it, and not a blind bit of notice has been taken of any of those who have been consulted. As the winter has gone on, it has become clear that we can hardly manage with the beds that we have now. I hope that the nurse-led pilot schemes will be allowed to continue; I should like to see much more detail in that regard.
The Secretary of State said that primary care should be a friend to patients, but I think that the Bill fails on a number of counts. There are one or two missed opportunities. The question of commercialisation is, I believe, still there. The last link has not been fractured; it is still in the original proposals. It seems to me that the Secretary of State is pandering to the Tory right in his bid for the leadership, which may have clouded his judgment a little and led him into what is essentially another attempt--in at least one part of the Bill--to take more privatisation to the heart of the national health service.
Let me say a little about GPs and the primary care system. Although that system is envied by most of the developed world, we should not overlook the fact that we are facing a crisis. That crisis is best summed up by the British Medical Association, which recently stated:
I know--as do all other hon. Members, if they are honest with themselves--that that statement is true. Only last week, along with other Labour members of the parliamentary Yorkshire group--a fairly large group--I met doctors from the Yorkshire region. Dr. David Smith, a GP, told us that the GP service was in crisis. It was failing to recruit. Patients' expectations had been greatly raised by developments in treatments, but there had been a doubling in night work, and a massive transfer of work from secondary to primary care that had not been properly funded. Many people have overlooked that.
Mr. Spring:
Will the hon. Lady draw a distinction between the morale, as she puts it, of GPs who are in fundholding practices and that of GPs who are not? Following correspondence and conversations with GPs who have entered into fundholding arrangements, I have the clear impression that morale is very high. Those doctors are able to offer a range of services that their patients appreciate, and can raise quality by being able to send patients to the right hospitals for the right treatment. Labour's policies, if implemented, would remove that benefit.
Mrs. Mahon:
The opposite is true. Commissioning would allow all GPs to offer services without added bureaucracy and paperchases.
Dr. Smith and his colleagues also confirmed what we already knew: that equity in care is not a reality. He told us that many GPs had overspent in the past two years keeping fundholding practices, that a two-tier system was developing and that the internal market in health had led to a paperchase. I have many local examples, but I want to refer to one involving Glenfield hospital. This example
might interest the hon. Member for Blaby (Mr. Robathan). I have raised this matter before in the House with the Secretary of State.
A constituent of mine who has been waiting 15 months for a heart bypass operation and who should have gone to Leeds general infirmary but cannot because it has stopped doing elective surgery, has been offered an operation at the Glenfield cardiac care unit in Leicester, but the letter states clearly that it has stopped doing elective surgery except for the patients of GP fundholders in Leicester, so here is a classic example of a two-tier system in his constituency. However, my constituent, who should be going to Leeds general infirmary, can go to Glenfield and jump in front of non-fundholders' patients, regardless of clinical urgency. It is not worst first; it is who can pay.
Mr. Robathan:
There is, of course, a question of funding. As I think the hon. Lady will understand, the whole NHS requires funding and is enormously expensive. I think that she will find that she is incorrect. I have not of course read the letter. There are three general hospitals in Leicester, all of which offer excellent care. I should say that Glenfield offers particularly good care in cardiac surgery because it has some of the latest, most expensive state-of-the-art technology that she will ever have seen.
Mrs. Mahon:
I checked this matter with the administrators, and it is absolutely true. I was looking after the interests of my constituent, and he can have the operation in weeks at Glenfield rather than waiting months for the operation to take place in Leeds.
If the Bill is passed without amendment, the present two-tier system will continue. Patients will carry on being treated on the basis not of need, but of other factors: age, where they live, who their GP is and what status he has. Patients will come well down the list of priorities.
The increase in the number of patients who are being struck off doctors' lists will continue, and that worries me. The Bill does not deal with that because the internal market has encouraged that increase. The trust between the doctor and the patient is threatened by the cash price factor in the internal market.
In November 1995 I introduced a ten-minute Bill to deal with that very problem. I suggested what I consider were modest proposals. At some stage during the passage of this Bill, I intend to table an amendment to try to get the proposals in my Bill written into it. Patients should know at the very least why they have been struck off a doctor's list. Practices are becoming increasingly large. Before such a drastic step is taken, there should be discussion between doctors on whether another doctor can take the patient on board because being struck off has a devastating effect on people.
I make it absolutely clear that the amendment that I hope to introduce is not a "doctor-bashing" amendment, but just a few weeks ago in Halifax I was contacted by an elderly lady, Mrs. Mary Walker, and her husband, who had used the same practice for 47 years. I spoke to her on the telephone and arranged to see her at a later date. She was incredibly distressed that she had been struck off her doctor's list. No reason was given, and of course a doctor does not have to say why. Obviously, the family health services authority got her another doctor, but she died before I could see her. Such cases happen over and over
again, so the Government need to deal with the matter. People should at least be told why they have been taken off or offered another doctor within the same practice, because having to travel outside their region can present major problems for elderly people and for women with young children.
If I table that amendment, it will not be because I am anti-doctor. I have the highest regard for our GPs and the system. I also recognise that they have a legitimate right to say, "The relationship has broken down and I cannot treat this patient." Of course the General Medical Services Committee, in some advice a couple of years ago--which could be tightened up a little--pointed out that a patient may be struck off if there is violent or threatening behaviour towards a doctor or his family. As I have said, there could be a complete breakdown between doctor and patient. Scurrilous and unfounded allegations might be made against a doctor. There could be prescription fraud or the persistent breaking of appointments.
All those things could happen, but the Bill misses the boat. If we are really talking about patients, the Bill could have included measures on that, but it does nothing to deal with the problem. Instead it deals with what I believe is the hidden agenda of the Conservatives: if, God forbid, they ever got in again, privatisation of the NHS would be top of their list. That trend is in the Bill. The Secretary of State has just slightly pulled back from what he was going to do, but a strong link remains and it still threatens one of the abiding strengths of British primary care, that the GP's role as "patient's champion" and "gatekeeper" to the NHS. That could be undermined with this commercialisation.
That undermining of the doctor-patient relationship is destabilising and adds to the destabilisation that we have already seen with GP fundholding. The hon. Member for Bury St. Edmunds (Mr. Spring), who intervened to talk about GP fundholding, has now left the Chamber, but I should like to have drawn his attention to The Mail on Sunday, which showed the downside of GP fundholding. Its article stated:
"GP morale is at its lowest ebb for many years, caused by excessive workload, the continuing out of hours burden, too much bureaucracy and falling remuneration relative to comparable professions".
Those are the BMA's words, not mine.
"Dr. Ian Dunn and his seven colleagues, who look after 16,000 patients in the area"--
I think it is Long Eaton, Derbyshire--
"became fundholding GPs--joining the scheme which has become the flagship of the Tory Party's NHS reforms. Theirs was one of the largest practices in the country to take over management of its own patient budget, in this case around £2.5 million a year.
because the GPs have overspent their budget by £300,000. They did so because they did not want to stop patients from being treated. Therefore, there is an unravelling of that flagship.
Now they have been thrown out"
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