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Mr. Hammond: I am grateful to the Minister. It is not clear from the present wording in the Bill that there will be a formula and that it will be made public, but the Minister has effectively reassured the Committee and me that that will be the case and on that basis, I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. I beg to move amendment No. 3, in page 2, line 24, at end insert—
The Chairman: With this it will be convenient to discuss amendment No. 4, in page 2, line 38, at end add—
Clause 17 New clause 2—Medical Practice Advisory Body—
(2) The Secretary of State may make regulations for the membership, constitution and operation of the Medical Practice Advisory Body. (3) The function of the Medical Practice Advisory Body shall be to advise the Secretary of State on the maintenance of an adequate distribution throughout England and Wales of medical practitioners providing general medical services under section 10 of the 1977 Act or providing personal medical services under section 28C of that Act. (4) Any advice given to the Secretary of State by the Medical Practice Advisory Body shall be published in such manner as that body determines at the time the advice is given.'.
Mr. Hammond: Amendment No. 3, along with amendment No. 4, deals with the question of how the Secretary of State will use the formula with which he is empowering himself in clause 1 in order to ensure an adequate distribution throughout England and Wales of medical practitioners. The amendment would place upon the Secretary of State a specific duty to use the powers in clause 1 in such a way that an adequate distribution was ensured. Clause 17 abolishes the Medical Practices Committee. That raises a number of questions about how health authorities will exercise the powers that will then reside with them when vacancies for GPs arise in their areas and in relation to local versus national priorities. Health authorities will now be working with unified budgets and considering filling GP vacancies in the context of other pressures. My hon. Friend the Member for West Chelmsford (Mr. Burns), my right hon. Friend the Member for North-West Hampshire and I all have experience of health authorities under extreme pressure—sometimes to make cash reductions in order to repay loans. There will be pressures on health authorities to resist filling medical vacancies for general practitioners in order to meet other needs. Dr. Brand: I was not aware that the Medical Practices Committee had the power to extinguish a vacancy. I should be grateful if the hon. Gentleman could explore with the Minister whether the new arrangement will create such a power. The Medical Practices Committee has largely been about the ability to expand rather than to replace retiring partners. Mr. Hammond: My understanding is that the financial allocation mechanism, using as it does a rather crude cash-limiting basis, will in practice constrain health authorities' ability to fill vacancies, as well as constraining their ability to expand the service. The Minister will, of course, correct me if that is a misinterpretation, but it seems that there will in effect be a single global budget, and if the health authority wishes to expand another aspect of its service, or indeed, has to meet a deficit and repay brokerage that it has already incurred within the system, it may find that it has to postpone or cancel filling vacancies. A number of concerns have been expressed about the abolition of the Medical Practices Committee, which has existed for many years—for as long as the NHS, I believe—to provide strategic guidance in the allocation of general practitioners across England and Wales. I am worried that by abolishing the Medical Practices Committee, the Government may be shutting the stable door after the horse has bolted. In a letter to the Secretary of State dated 17 January, the chairman of the MPC said that
4.45 pmHe drew the Secretary of State's attention to the fact that paragraph 13.10 of the national health service plan states that
The data quoted in the NHS plan were already three years out of date when the plan was published. Last week, those assertions were repeated in the House on Second Reading. In fact, using up-to-date figures that are adjusted for patient needs and demands and taking into account the growth of personal medical services—the PMS pilots, which the MPC supports—there will be proportionately more GPs in Sunderland and Barnsley than in Kingston and Richmond or Oxfordshire. What is the Minister trying to achieve by abolishing the MPC? The letter from the chairman of the MPC refers to
so it is not clear whether it was from the Minister or his ministerial colleague, The Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton)—
shared by—
The number of general practitioners is finite, and it may not be true that it is no longer appropriate to retain the existing successful formula for ensuring their equitable distribution in England and Wales. Using a financial allocation formula can only create a market for a scarce commodity—GPs. Health authorities may be able to attract GPs to their under-doctored areas through enhanced financial inducements, but if only a finite number of GPs is available, that activity must occur at the expense of other areas. New clause 2 would create a new body, the medical practice advisory body, to advise the Secretary of State—remember that he has the power to issue directions to health authorities—on action that must be taken to ensure an equitable and adequate distribution of GPs. It would also provide for that advice to be published. That would mean that there was a body—independent of the Secretary of State—considering the distribution of GPs, advising the Secretary of State about how he needs to exercise his powers under clause 1 to address any inequities or inadequacies in distribution, and publishing that information so that interested parties—the professional bodies, the public and whatever feeble watchdogs of the public interest remain after the Government have abolished the community health councils—can see what the advice is and bring the appropriate pressure to bear on the Secretary of State. In the letter, the Minister of State clearly acknowledged the value of the MPC. There is a theme running through the Bill. The Prime Minister's office wrote to the Sedgefield community health council congratulating it on the work of community health councils and wishing it every success in the future, only five minutes before the Government announced that they were abolishing all the CHCs without consultation. In August, the Minister of State wrote to the MPC confirming its excellent work in ensuring the adequate distribution of general practitioners, only weeks before the Government announced that that was to be abolished. A letter of praise from someone in Government seems to be the kiss of death for any public service body. As time is so short, I want to ask the Minister a couple of specific questions on abolition of the MPC. What will the Secretary of State do if an inequitable distribution of GPs develops? If there is a problem when he has published and implemented his formula, what will he do? If the Government intend to regulate the distribution of GPs via resource allocations to health authorities, what consequences will relative local efficiency or inefficiency in the use of those resources have in practice for the distribution of GPs? Will the Minister tell the Committee what transitional arrangements will be put in place? Will the MPC be expected to complete existing applications for additional or replacement GPs before it is wound up? What safeguards will be contained in the Secretary of State's directions to health authorities to ensure and maintain an adequate distribution of GPs throughout England and Wales. Perhaps most importantly, how does he intend to avoid levelling down, which would damage patient care, as GPs are siphoned away from the stronger areas to deal with the acknowledged problem of under-doctoring, but in the process damaging the infrastructure in those areas that are currently not under-doctored? Mr. Denham: It may be helpful if I respond as briefly as possible to the hon. Gentleman's main points. No one is suggesting that the Medical Practices Committee has been a failure or that it has not sought to do its job well, but there is an unequal distribution of GPs throughout the country, despite the MPC's role during the past 50 years.
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| ©Parliamentary copyright 2001 | Prepared 18 January 2001 |
