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Dr. Andrew Murrison (Westbury): Does the Minister agree that the Government are putting several new duties on primary medical care providers, which makes the out-of-hours provision mentioned by my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack) impossible, if GPs are to achieve a work-life balance?

Mr. Hutton: I have significant sympathy with that view, which is why the new agreement reached with the BMA and the NHS Confederation provides for the solution that I have just described. GPs will be able to opt out of the responsibility of providing out-of-hours services, mainly for the reasons that the hon. Gentleman suggests. It is important that we do not lose sight of the fact that family doctors voted overwhelmingly for the new contract. It is the right contract for the future of primary care and it strikes the right balance between the need to ensure that patients have access to effective services and that doctors have the chance to lead their own lives and balance their work with their family and other responsibilities. That is our aim.

There has been some misunderstanding about the out-of-hours aspect of the agreement. Headlines in some newspapers claimed that there would be no 24-hour family doctor service. That is not what the new contract is all about. Such provision in the future will be the responsibility of the PCT or local health board, and that is where the responsibility should be located, not—as at present—with the busy family doctor.

Sir Patrick Cormack: How will patients be affected? I presume that as far as they are concerned, the service will continue to be provided through the general practice.

Mr. Hutton: Yes, that is how it is likely to be arranged. The usual arrangement of providing a telephone number for out-of-hours services will continue. One of the clauses that we shall discuss later provides for a new obligation on PCTs to provide such information to everyone in the area they serve. I would expect PCTs and local health boards to send out notes reminding people that the 24-hour services still exist and providing the telephone number. Some practices will decide to provide those services themselves and some will use other out-of-hours services providers, such as GP co-ops or private companies, which provide such services to many GPs now. Whatever the arrangements are, the maximum amount of information must be available to people locally, so that they know when and who to ring. That will be the responsibility of the PCTs.

We will also retain PCTs' ability to make decisions about the suitability of general practitioners to provide primary medical services. We are simplifying the legislative process, but retaining all the effective and

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necessary controls, by merging the current multiple list system into a single list of primary care performers. The detail of the new contract is set out in the agreement document, called "Investing in General Practice", which was published on 26 February. Copies of it have been placed in the Library and the Vote Office.

The new contract will be accompanied by a substantial additional investment of nearly £2 billion for primary care services across the UK. Funding will increase from £6.1 billion this year to £8 billion by 2005–06. That is 11 per cent. per year, each year, for the next three years.

To implement the contract, it has been necessary to make significant amendments to the legislative basis on which general medical services are presently provided, and to repeal a significant amount of primary as well as secondary legislation. It is intended that, after the implementation and commencement of these provisions, the volume of delegated legislation will be less extensive and more transparent than at present. Subsections (5) and (6) of proposed new section 16CC, as inserted by new clause 26, provide regulation powers to clarify what should and should not be considered to be primary medical services. This power could be used, if necessary, to maintain a national range of primary medical services across all PCTs and local health boards.

New clause 40, tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris), seeks to amend a primary care trust's duty to secure primary medical services and to require PCTs to meet the clinical needs of patients. His new clause removes the reference to "adequate" care. The existing duty set out in section 29 of the 1977 Act requires every primary care trust to make arrangements with individual medical practitioners to provide personal medical services, and for the recipients of those services to receive

The PCT duty in proposed new section 16CC replaces that duty, and is intended to be no less stringent than the duty in the existing legislation.

The duty on PCTs is to provide services to the extent that they consider necessary to meet all reasonable requirements. There was some discussion about this issue in Committee, as I am sure the hon. Member for Oxford, West and Abingdon, and the hon. Member for West Chelmsford (Mr. Burns) and the other Conservative Members on the Committee, will remember. They will probably not recall every nuance of the debate—I certainly do not—but I remember that this was registered as a problem. There was, for example, concern that the duty to commission primary dental services was not properly aligned with the duty to provide primary medical services. We have tried to deal with that particular problem in a subsequent amendment, which I shall come to in a moment.

I had hoped that the wording of the duty in respect of primary medical services would provide a more direct read-across, which would satisfy the hon. Member for Oxford, West and Abingdon, following our discussions in Committee. As I said, we have tried to take on board the concerns that were expressed at that time. The similarity in wording for medical and dental services is appropriate because the provision of services by the

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PCT goes towards the fulfilment of the Secretary of State's duty under section 3 of the 1977 Act with regard to primary medical services.

The problem with the new clause tabled by the hon. Member for Oxford, West and Abingdon is that it seeks to amend a section of the 1977 Act that we are about to repeal, so it would be difficult for me to accept it.

Dr. Evan Harris: We tabled that new clause at what we reasonably thought was the last minute, but it became clear yesterday when the Minister tabled his new clause that this was going to be the case. I accept what he has just said.

Mr. Hutton: I am grateful to the hon. Gentleman for that, because we have taken away the comments that he and other hon. Members made and tried to amend the Bill to reflect their concerns. There is a problem with new clause 40 and I am grateful to him for clarifying that point. I assume that that means that he will not want to press the matter to a vote.

Sadly, I also have a problem with the hon. Gentleman's amendment (a) to new clause 27, because it seeks to remove the ability of the Secretary of State to issue payments based on rewarding contractors for reaching a target or

The United Kingdom has one of the most successful vaccine programmes in the world, with high levels of uptake. It has been achieved by the hard work of general practitioners and enforced by the system of targeted financial incentives. The target payment scheme incentivises levels of uptake that protect children not only individually but collectively in the wider community, especially those for whom immunisation is contra-indicated. Removing the target payments could have a negative effect on vaccine uptake, and could perpetuate coverage that is insufficient for the protection of the wider community.

I understand the hon. Gentleman's wider objections to targets; he and I have debated the matter extensively across the Floor of the House and elsewhere. I believe, however, that he is pursuing the wrong issue here. This particular method of incentivising achievement in primary care and general practice has worked; it has helped to protect the health and safety of children. On this issue, therefore, he might not have chosen the strongest ground on which to fight his battle.

Dr. Harris: I accept the Minister's invitation not to go into the whole issue of targets in this debate, but in my speech I shall go into the reasons why, even if this system worked, it would give rise to major problems. Can he provide any evidence that the incentive payments for those vaccination targets have provided the cover that exists—questionable and dodgy though it is, because of other factors—or does he simply think that the system must be working because the incentive scheme exists and we have reasonable coverage? Is there any evidence?

Mr. Hutton: I think that there is, and I should be happy to write to the hon. Gentleman setting out some of the trends involved in immunisation so that he can form his own view on the matter.

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On the future of this type of payment, the new contract makes it clear that we will be discussing with the BMA how we can use the target payments more effectively in a way that meets general practitioners' concerns—I acknowledge that such concerns exist—and encourages even higher uptake, protecting children from potentially life-threatening diseases.

Mr. Lansley: The Minister's exchange with the hon. Member for Oxford, West and Abingdon (Dr. Harris) did not touch on a particularly difficult issue relating to the contract and the target payments. The Minister will be aware that, in respect of this particular set of targets, exception reporting for informed dissent does not apply. The effect of that is that GPs are operating under a financial incentive to raise their level of compliance, regardless of the fact that parents might choose for their children not to have a particular vaccination. I have been consistent in my support of the childhood immunisation programme—including vaccinations for measles, mumps and rubella—but there is a serious question mark over this practice, as perceived by patients.

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