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I am dissatisfied with the way in which this legislation is being handled. People look to this Chamber to legislate in the best interests of everyone, and I hope that the Minister will realise that the disparity in treatment that will be caused by new clause 18 is not in the best interests of his own constituents, of my constituents or of the constituents of my hon. Friends the Members for Altrincham and Sale, West, for Buckingham (Mr. Bercow), for Uxbridge (Mr. Randall), for New Forest, West, for South Holland and The Deepings (Mr. Hayes), for Runnymede and Weybridge, for Rutland and Melton (Mr. Duncan), and for my right hon. Friend the Member for Maidstone and The Weald. The Minister should withdraw new clause 18 because he should admit that it has been defectively drafted. If he thinks that we will accept it without question or that it will not be properly scrutinised when it returns to the other place, he will be disappointed.
I appeal to the Government to give the House detail on the five points that I have raised and the other points made--so succinctly--by my hon. Friends.
Mr. Denham:
I shall try to answer as many points as possible, but the hon. Gentleman will understand if I have sometimes missed his meaning during the past hour.
It is worth remembering what I said earlier. We estimate that about 3,500 patients will be affected by the Bill, which is the number of patients in England and Scotland who are registered with a GP practice on the other side of their border. I would not be introducing the new clause if I had not been assured that it had been fully explained to health authorities and boards and the other groups involved and that they had been fully consulted. Everyone who has responded has been in favour of our approach. The new clause addresses practical problems that have faced GPs who provide primary care in what are often scattered rural communities.
Mr. Brady:
What about the health authorities or boards not immediately adjacent to the border? Were the next ones up consulted too?
Mr. Denham:
I am fairly certain that they were not; I see no reason why they should have been. The health authorities and boards concerned are responsible for areas rather larger than those covered by the practices involved. I could see no point in extending consultation further south or north of the border. I had to be sure that the measure was supported. In fact, the idea was initially suggested not by the Government, but by general practitioners who have complained about the current position for several years.
Mr. Swayne:
In what detail were the health authorities consulted? How the Government intend to proceed is not clear from the new clause. Presumably, the health authorities were given detail that we have been denied.
Mr. Denham:
As I have already said, they were told that we intended to use the new clause to enable health
The hon. Member for Runnymede and Weybridge (Mr. Hammond) asked about part II services.
Mr. Bercow:
Was the estimate that 3,500 people are likely to be affected based on current figures, which could increase or decrease? Alternatively, was it predicated on the assumption, to which my hon. Friend the Member for Altrincham and Sale, West (Mr. Brady) has referred, that lists would be frozen?
Mr. Denham:
For 1998-99, the exact estimate was that 2,313 English residents were on lists of GPs in Scotland, while 1,125 Scottish residents had GPs in England.
Several hon. Members have asked about how orders would be made and which patients would be affected by them. Although it is highly unlikely that people will sign up for a practice many miles from their homes to gain some perceived benefit, I can assure the House that any order would be specific about the category of people to whom it would apply, which gives us the ability to tackle that unlikely scenario. I was asked whether orders could fix the number of patients at the time of their introduction. Order-making powers might enable us to prevent people from signing up for practices many miles from their homes where it would be unnecessary or perverse. However, we see no need to fix lists and have taken no such decision. New patients are always moving in and out of areas and registering with a GP practice.
Mr. Brady:
Surely there must be many cases--beta interferon, for example, or any other expensive drug or treatment--in which it would be entirely rational for someone to move house into an area covered by an order. However an order is drafted, it cannot possibly preclude people who do that from being allowed to register with a GP.
Mr. Denham:
The position has been misunderstood. If people felt now that it would be better to move either north or south of the border, they could do so. We must focus on the need to sort out the practical problems faced by GP practices and patients when it comes to the delivery of health care in border areas. The new clause is a sensible means of dealing with those problems.
Mr. Bercow:
Will the Minister give way?
Mr. Denham:
I have given way several times and would like to get on. We have had a lengthy debate and I want to move on to some of the other reasonable questions that were posed.
Mr. Hammond:
I have listened carefully to the Minister. Without going to the extreme solution of moving house, will the hon. Gentleman clarify one matter? Where a health authority area includes a number of people who are patients of a GP over the border, would anything prevent any other persons residing in that authority area from signing on with that GP if they wished to do so, or can only certain people in the area access that privilege?
Mr. Denham:
I may have missed the hon. Gentleman's point, but at the moment if a Scottish patient, for example,
At present, if one crosses the border to register with a GP one none the less remains treated by one's own, English or Scottish, health service. That decision was taken during the early 1990s, I presume. That causes GPs or primary care groups practical problems, such as being able sensibly to commission treatment on behalf of their patients. That is why it is more sensible for treatment for all patients of the practice to be commissioned because they are attached to that practice rather than according to the health authority in whose geographical area they live.
Mr. Hammond:
I thank the Minister for that explanation, which was extremely useful. However, he did not deal with my question. Is he telling the House that only people who live in a tightly defined sub-region of the health authority or health board area can access a GP on the other side of the border, or would I be right in thinking that any patient who lives in the area has the right to transfer? Would he not anticipate an exodus of patients to those border GPs, if there were sufficient incentive--for example, if there were significant differences in treatment and service availability on either side of the border?
Mr. Denham:
I do not anticipate that trend developing in practice. One can construct such a theoretical argument--the hon. Member for Altrincham and Sale, West (Mr. Brady) did so--but in practice, most people, sensibly, want their GP to be within a reasonable distance. We are talking about vast rural areas. GPs can be a long way away and it is unlikely that people will want to go even further. Also, it is unlikely in practice that such a disparity in services will arise. Indeed, had real concern that that would happen existed, I am sure that it would have been mentioned by the people we directly consulted--the GPs themselves, who are concerned about their patients, and the health board in the area.
There are two further protections. The hon. Member for Runnymede and Weybridge asked whether anyone could theoretically sign up to a GP over the border. The order can specify the persons to whom it applies and the functions affected. Also, as I said--this answers the question about overruling the Scottish Parliament--each order will be subject to affirmative resolution both here and in the Scottish Parliament. Therefore, the provisions being made under the new clause could be scrutinised.
Mr. Bercow:
Will the Minister give way?
Mr. Bercow:
I am grateful to the Minister, whose patience and charity are well established throughout the House. Will he explain whether the order could not only specify categories of people to whom the arrangements would apply, but limit the number to whom they would
Mr. Deputy Speaker:
Order. That was not a very brief intervention.
Mr. Denham:
I had quite settled back into my seat, Mr. Deputy Speaker.
7.15 pm
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