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Mr. Philip Hammond (Runnymede and Weybridge): My hon. Friend spoke of doctors being seduced into primary care trusts. She may be interested to learn that,

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under the Health Bill as currently drafted, they will not need to be seduced: doctors can be forced into primary care trusts without their consent.

Mrs. Roe: I am grateful to my hon. Friend for setting the record straight. I take his point: doctors can be forced into primary care trusts.

Conditions of service will be desecrated by protocols that will prohibit the patient from receiving the best--which was a concept guarded carefully by the previous Conservative Government--and which will deliver the cheapest service. The concept of "never mind the quality, feel the width" was never more apparent.

What about the GP who shows initiative? He risks a visit from the thought police of the Commission for Health Improvement, who are able to come into his practice, see and do whatever they like, say whatever they wish and charge him for the costs of the exercise. Conditions for GPs whose partners or colleagues are involved in PCG work have also deteriorated. Inadequately reimbursed for the costs of the locums that they need to employ, they will either be unable to fulfil their PCG roles properly, or will end up subsidising the Government's primary care hyperbole out of their own pockets.

What about conditions for the poor patients who must tolerate those ill thought through ideas? How many sick people will be unable to see the doctor of their choice because he is away at the PCG doing administrative work? Half a million consultations--a number equivalent to the whole population of Sheffield--will be lost each month and patients will have to receive their care from locums, if they can be found.

We should remember the Labour party's theme tune for the previous election. In my view, things have not got better; they have become more expensive, more bureaucratic and more confused; things have only got worse. Burdened with a new range of targets which must be met to enable them to claim the £60 million promised by the Government in recognition for hard work already undertaken, doctors' overall work load is rising inexorably. The demand for surgery attendances increases year on year. Expectations about quality improvements are for ever applied as GPs are required to embrace clinical governance, to prescribe more generic drugs and to improve their education.

Doctors are having to contend with an increasingly litigious population that demands more and more from the finite resources that practices can offer. Legal claims against GPs rose by 15 per cent. last year alone. Ten years ago, a GP had a one in 500 risk of being sued in any year; now that risk is one in 35. Complaints are rising exponentially as GPs fail to meet patients' expectations generated by a Government with no vision and even less consideration. All those demands must be met by a profession that has a recruitment crisis and is starved of the funding for key developments, and what can all that do but destroy morale and suppress enthusiasm?

We must recognise the deteriorating conditions under which GPs are being forced to work. We truly lament the decline in conditions of service that they are having to face, the loss of a service that was the envy of the world and the development of a system that will fragment

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primary care. All that will result in the provision of a rag-bag service in supermarkets and railway stations, and through NHS Direct, the value of which is highly questionable. The outcome will be the loss of consistency of care that has become a byword for the management of patients by United Kingdom GPs.

We are prepared to stand as the champions of primary care and as advocates for the comprehensive services that GPs can now provide. GPs should be supported in their provision of services, with conditions that allow them the flexibility and freedom to provide the best services. The Government's actions have resulted in one fundamental change. The GP can no longer say, "I shall do my best for you." He can say only, "I shall do what they will let me do for you." That is a sad reflection on the Government's policy.

I urge the Secretary of State to think again, to support rather than harangue, to encourage rather than discourage, to build rather than destroy and to restore the conditions of service for GPs to allow them to provide the care for which they are renowned.

8.58 pm

Mr. Kevin Barron (Rother Valley): My right hon. Friend the Secretary of State said, in opening the debate, that he felt that the Opposition had what he called barefaced cheek in putting their motion on the Order Paper. I am not sure which Opposition motion has the most barefaced cheek--this one or the one that we debated a few months ago about national health service waiting lists, which rose considerably under the previous Government. The circumstances described in the motion and the problems in the NHS are those that we inherited in 1997.

I am amazed that the motion has been tabled, but I am pleased that the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) and his colleagues have put their names to it because I believe in a Government facing an Opposition, and I have been waiting a long time for such a development.

I listened to both the opening speeches made from the Opposition Benches. The words "barefaced cheek" did not immediately spring to my mind, but the words "mealy mouthed" did. The Opposition did not attack nurses' pay, but they are now attacking the administration behind it. They say that--although the Government have agreed with the pay review body and agreed that the nurses can have the money straight away, at the beginning of the financial year--the trusts are not administering the pay rise properly and that they are the problem. [Interruption.] I wrote this down: the right hon. Member for Maidstone and The Weald (Miss Widdecombe) said, among many other things, that the trusts are failing to give nurses the money.

The hon. Member for Southwark, North and Bermondsey said that he felt that people did not expect the Government to kick them in the teeth. If this year's nurses' pay award is a kick in the teeth, the nurses have been waiting many years for the Government to do that and to give justice where there has been no justice for a long time.

Mr. Simon Hughes: I want to make sure that the hon. Gentleman and I understand each other. He knows that we welcome the fact that the pay award must be paid in

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one go and is not phased. That is clearly better than phasing an award, which his Government did last year, and the Tories the year before. The kick in the teeth--I do not blame the trusts at all--is that no increase was paid, although the Government said in the press release that the award would be paid in full in April. That was not the fault of the trusts--they were given permission too late to be able to do anything.

Mr. Barron: The hon. Gentleman used the words in that way; let me tell the House some of the other words he used. He read out a letter from a nurse from his constituency who said that the Government had a high-handed approach to nurses pay. If they do, that is most welcome and something that we have been waiting for--it will achieve justice for many years to come.

The hon. Gentleman talked about his travels around the national health service--he always gives us an update in these debates--and told us what people are saying. Some people might be saying what he says they are saying, but the question for him is whether he agrees with them that workers do not trust the Government or that there is widespread concern and distress in the NHS.

The right hon. Member for Maidstone and The Weald said that NHS personnel are thoroughly disillusioned, fed up and demoralised with the Government. If that is what the motion is based on, the Opposition ought to go back to the NHS to talk to people. I remember my postbag at the time when people really were fed up with the Government and demoralised by what they were doing. We regularly received letters from members of the NHS professions because of what the previous Government were doing to the NHS. I do not think that I have received two such letters since the Government took office two years ago, because we are doing the right things for the NHS.

Let us run through what the nurses' pay award in February meant. My right hon. Friend the Secretary of State rightly said that the nurses are to get their biggest real-terms pay rise for 10 years. For the first time in five years, the award is being paid nationally in full and with no staging. That is hardly kicking anybody in the teeth. Starting pay for newly qualified nurses will rise from £12,855 to £14,400, which is a 12 per cent. increase. There will be an 8.2 per cent. increase in basic pay for 70,000 grade D nurses. Other nursing grades are to get a 4.7 per cent. increase in basic pay, although inflation is running at about 2 or 2.5 per cent. I hardly think that that is an attack on nurses and people working in the NHS.

More than 200,000 members of the Royal College of Nursing are working in the NHS and they are getting that type of benefit. For the first time in the history of the NHS, the starting pay for all newly qualified nurses will be more than £14,000 per annum. The inner-London allowance will increase from £1,910 to £2,205 from 1 April. The outer-London allowance will increase from £1,360 to £1,570. That means that starting pay in inner London for all newly qualified nurses will be £17,325, which is a marked increase on what they had in years immediately gone by.

As well as that basic pay, nurses receive, on average, an extra 11 per cent. from the allowances, which means that an average grade D nurse on the minimum of the scale will get about £1,600 extra. That is hardly an attack on NHS personnel working in those different grades.

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The Opposition try to talk down these increases instead of congratulating the Government on bringing to the nursing profession the justice for which it has waited so long.

The Opposition motion does not seem to be supported by the Royal College of Nursing, which recognises what the Government are doing. The royal college welcomes the debate and has sent hon. Members a briefing, which says:

I agree with the RCN on that. It goes on to say:

    "However, it is clear that many more changes are needed throughout the NHS before nursing becomes an attractive profession again. The RCN believes that pay is the single most important way in which nurses' morale can be boosted and nursing valued again. However, there are a number of other vital issues which the NHS must also address."

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