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8.37 pm
Dr. Howard Stoate (Dartford): Thank you, Mr. Deputy Speaker, for calling me to speak in what is an important debate.
As a practising GP who continues with a small number of surgeries, I am now a member of a primary care group, so I register that as an interest. For many years, several changes have been imposed on us by the NHS. We have heard much rhetoric about the pros and cons of various aspects of the Bill, but--
Mr. Hammond:
Will the hon. Gentleman give way?
Dr. Stoate:
No, I cannot give way. I have only 10 minutes.
As someone who is a practising GP and who therefore sees those changes day to day, I am in a better position than many to comment on them. Conservative Members
have waxed lyrical about the benefits and wonderfulness of fundholding, but I tell a different story; it is a personal story, seen at first hand.
We have learned much from the fundholding experience. I would not wish to leave hon. Members with the impression that fundholding has not done a significant amount of good, because it has. We have to be fair: fundholding has taught us a lot. It showed us a lot about management structures and how GPs and others can develop services in their communities, but it has also created enormous problems. It goes completely against the aims and values that Labour Members share.
We have heard that 60 per cent. of GPs are fundholders. That is true, but I can speak from personal experience and for the many hundreds of GPs whom I know personally. Many of those 60 per cent. went into it not voluntarily or with evangelical zeal, but because they had to. They were forced to by all sorts of chicanery and underhand methods. They felt that they had no choice--go into fundholding, or forget about the new member of staff, the development of the practice, the new computer system. Computers were frequently tied to fundholding: no fundholding, no new computer. Pressure was put on my colleagues in an unhappy and underhand fashion.
No Labour Government could accept the two-tier service that was created and the inequalities that were caused by fundholding. It is to the credit to my right hon. and hon. Friends in the Department of Health that fundholding has now been ended.
Of course fundholding produced excellence. It was bound to. The cards were loaded so much in its favour that it had to produce excellence, but every time a patient was seen more quickly by a fundholding GP and referred to a consultant, a patient of a non-fundholding GP was pushed down the queue. Every time a patient was seen by a consultant from an outpatient clinic in a surgery, it meant that another patient could not be seen because the consultant was in the doctor's surgery, not in the hospital clinic to see people who would otherwise have been seen from the waiting list.
Of course, therefore, fundholding produced good things and seemed to be wonderful, but it did so at the expense of so many other people who were not achieving that type of service.
It is ludicrous to say that we could have made every GP a fundholder. Once there was no longer an inequality and a two-tiered service, there would no longer be a benefit in fundholding, and the whole system would fall down like a pack of cards.
The new NHS will be fairer, distribute resources more equitably and eliminate two-tierism. It will be needs-led, it will integrate health and social services and reinstate strategic planning, and it will emphasise quality and reduce inequality.
Earlier in the debate, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) talked about the dispossessed. I listened very carefully to what she had to say and even tried to intervene on her. I ask her, on her proposals for introducing money from the private sector, which insurance company would take on
someone with multiple sclerosis, chronic diabetes or infertility? We would get nowhere by asking the private sector to take on those people.
Dr. Stoate:
I shall give way, as an act of generosity to the right hon. Lady.
Miss Widdecombe:
I am very grateful to the hon. Gentleman for giving way.
Again, there is the confusion that the hon. Member for Cannock Chase (Dr. Wright) showed. Trying to get money in from the private sector is not only about people going and insuring themselves, but about setting up partnerships with the private sector, so that we can benefit from private sector technology, expertise and staffing--as in, for example, St. Peter's hospital in Chertsey, where there is a joint unit, which both partners use and for which the private sector has contributed a huge amount of money. It is a matter of getting additional resources into the NHS, not only of getting people to insure themselves in the private sector.
Dr. Stoate:
Unfortunately, the private sector will follow that type of policy only if it can make a profit for itself, which is its fundamental motive. The private sector will provide a service, but only if people pay for it through private insurance, or if the NHS puts public money into the private sector--which gets us no further, as we will be back to exactly where we started.
In Dartford, the HealthCare Partnership primary care group has piloted primary care groups. It is already one year ahead of many other such groups, as it was a pilot for the National Health Service (Primary Care) Act 1997 and thus has one year's more experience than most. It has already expressed an interest in moving on to primary care trust status. The group has been successful in developing primary care services, cutting bureaucracy and gaining control over how local resources are best used for local patients.
To scotch the idea that fundholding was somehow a good thing and non-fundholding a bad thing, that group in my constituency of Dartford consisted of fundholders and non-fundholders who voluntary came together to pool their resources and expertise, because they realised that the two-tier service created by fundholding was not in patients' interests. When working together as a primary care group pilot, they were able to demonstrate improvements in bureaucratic costs and in services, and genuinely to make a difference to people in Dartford.
The experience of people in Dartford, and the improved care being offered to them, will act as a template for primary care groups across the country, as they begin to catch up with my primary care group--which, as I said, is one year ahead.
One of the Bill's purposes is to allow the formationof primary care trusts, which will be freestanding organisations either commissioning care--at level 3--or commissioning and providing community services at level 4.
Yesterday, I spoke to Dr. Alasdair Thompson, the chairman of Dartford's primary care group. As I said, the group was started as a pilot under the 1997 Act and is one
year ahead in the process. The group has been able to find solutions to many of the challenges and has had much more time to consider its future.
Dr. Thompson gave three main reasons why he believes that it is so important that the Bill's provisions enabling trust status should be passed. The first is that there are limitations in the current process. Although primary care groups have freedom in their budgets, trusts will have much further flexibility in purchasing, in providing community services and in joint working with social services.
Secondly, primary care trusts will be able to develop strategic plans for delivering community health services, based on an integrated approach that is agreed by their work force and signed off by their board. The emphasis on developing community services that are closer to the patient's own environment will make a big differences to local services. The community infrastructure that will be needed to support the new hospital in Dartford--which is the first being built under the private finance initiative scheme--may be developed and managed by the primary care trust. In turn, that will lead to increased professional motivation and better clinical practice.
Thirdly, as freestanding bodies, trusts will have far greater freedoms, within their accountability arrangements, in their use of the unified budget--which is likely to include personal medical services schemes, local development contracts and single-handed vacancies--so that there is scope to develop innovative solutions for future work force problems, as described in the primary care investment plan.
Ultimately, of course, the Secretary of State will approve applications to become primary care trusts. I am looking forward to the day when he will be able to approve the trust application from my own group. It will be up to local health authorities to ensure that the process of application for trust status is wide ranging, and includes as much local opinion as possible. I hope that the Minister will be able to assure GPs that progression to trust status will occur only when a clear majority of local GPs are interested in it.
My understanding is that the Bill will not affect GPs' independent contractor status; I would welcome reassurance from the Minister that that is the case. The House will be aware that independent contractor status has been a great strength of British general practice over the years, and has delivered exceptional value for money and excellent quality primary care. British general practice still represents excellent value for money, and quality envied throughout the world.
GPs now form the majority on primary care group boards, but when primary care trusts are set up, with the increased responsibilities and wider range of skills needed, Ministers may think that no longer appropriate. The current proposals are for lay members to form the majority of PCT boards. GPs and nurses, however, can still form the majority on the PCT executives, which will report to the boards.
Dr. Thompson has asked me to seek reassurance from Ministers that the primary care trust executives, which will largely comprise the doctors and nurses who deliver the services and whose livelihoods will depend on decisions made by the board, will have a clear say in the decisions made by the boards.
Primary care trusts will have the freedom, within their accountability arrangements, to allocate resources, develop service arrangements, negotiate incentives and generate income.
The Bill marks the beginning of the process, not the end. It will clear the way for new ways of innovative thinking about how best to deliver top quality primary care for the next century. In my constituency there is already a clear commitment to the process, and I shall finish by quoting from a discussion paper written by my local primary care group as part of its expression of interest in trust status:
"The Partnership has taken the view that the philosophy underpinning the establishment of PCGs builds on our partnerships approach to developing health care and to community involvement, which started with joint commissioning with West Kent Health Authority, and continued via the Locality Commissioning group pilot. There is now a greater opportunity for the partnership, as a Primary Care Trust, to further develop our partnerships working as both commissioners and providers of community based services."
That was written not by a group of GPs who are disillusioned and dissatisfied, or sorry about the changes that we are making, but by a group that is ahead of the field and has clearly, and voluntarily, shown its commitment first to primary care groups and now to primary care trusts. Fundholders and non-fundholders are working together for the good of the community, and involving nurses, social services and others.
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