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Laura Moffatt (Crawley) (Lab): I am pleased that the House has got back to debating the quality of care for patients, which is the focus of the Government's amendment. I was concerned that all we seemed to be worried about was the way in which the contract is to be implemented. Will my right hon. Friend comment on the views expressed by a local GP? Dr. Amit Bhargava took the trouble to write to our local newspaper to explain to people in Crawley how important the GP contracts are and what changes they will involve. It is important that we move forward and provide a range of services for people and Dr. Bhargava congratulated the Government on taking the steps to do that. We need to return to that issue.

Mr. Hutton: I am grateful to my hon. Friend for that contribution because it introduces a different perspective from that provided by the hon. Member for South Cambridgeshire. I shall return to his assessment shortly.

The other problem with the hon. Gentleman's remarks is that they reflected a profound misunderstanding of the new contract. They gave rise to the obvious questions about what changes he would introduce to the new contract if he is as concerned about the situation as he claims to be. As in all the main arguments that he deployed, we heard absolutely nothing of substance from him.

As the hon. Gentleman well knows, the new contracts are designed, in part at least, to deal with the long-standing concerns of GPs about the onerous nature of their statutory obligation to organise the delivery of out-of-hours services themselves. Under legislation agreed by the House last year, that obligation has been transferred to primary care trusts. It has not been dispensed with or evaporated; it is still there and is now the responsibility of PCTs where it properly belongs.

As I do on many occasions, I agree strongly with Dr. John Chisholm, the chairman of the BMA's general practitioners committee, who, on the new contract and the existing responsibility of GPs, said:

"The current 24-hour responsibility has deterred many young doctors from pursuing a career in general practice and has contributed to the current shortage of GPs"

Mr. McLoughlin: The Whitworth hospital in Darley Dale in my constituency provides a first-class service. It is a community hospital staffed by GPs and has a minor casualty unit that serves more than 8,000 patients each year. Does the Minister believe that the new GP contract reflects the work that the local GPs do and is there any danger that the services that I have described could be under threat?
 
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Mr. Hutton: I do not want to see any threat to such services. The new GP contract has absolutely nothing whatever to do with the work of GPs in community hospitals. That is secondary care, which has never been covered under the terms of their employment in primary medical services. The activity in secondary care that the hon. Gentleman describes has nothing to do with the primary medical services contracts of GPs, but I shall deal with that point in a minute because it is another one about which the hon. Member for South Cambridgeshire was not particularly well informed.

The changes do not mean the end of out-of-hours cover. We know already that GPs will continue to be involved in delivering these services. We have made extra investment available to provide for that—something that the hon. Gentleman and the motion now seem to be concerned about. As he knows, GP practices are required to give proper notice of their wish to opt out so that appropriate alternative contractual arrangements can be made.

The hon. Gentleman said that he drew some of his information from Pulse. I do not whether he has seen it, but I have a story that appears under the headline "Smooth start for first out-of-hours services after GP opt-outs". Perhaps he has simply not had the chance to see it or perhaps he decided not to use the story for reasons that others will speculate upon.

Dr. Stoate: My right hon. Friend is being too modest about the achievements of the new GP contract. John Chisholm, in particular, is so enthusiastic about it because, for the first time, it allows GPs to broaden the range of services that they offer, to ensure that patients can be seen within 24 hours of request when that is considered necessary and to offer a new range of services that are currently carried out in the secondary sector. It has been shown many times that patients would far rather be treated by their own GP locally. Clearly, if GPs are to provide so much extra during the daytime to enhance patients' services, they will have to be able to rely on other professionals such as pharmacists, paramedics, nurses and other health personnel to take some of the burden off them for the services that might best be provided by other people anyway. The whole point is the enhancement of services and the integration of different skills within the health service to ensure that patients get a better deal throughout the entire patient experience and not just when they attend a GP's surgery.

Mr. Hutton: I am grateful to my hon. Friend, because I can now dispense with what is left of my speech. I am sure that that is probably what everyone wants me to do. He is right. With respect to the hon. Member for South Cambridgeshire, he did not address those aspects of the reforms in any substance. In hindsight, I am sure that he would want to reflect upon that.

We should also put the issue into its proper context, because the hon. Gentleman failed to do that. At present, fewer than 5 per cent. of GPs provide their own out-of-hours cover. Most practices have already delegated that function, prior to the new contract, to GP co-ops or have contracts with private providers, but that
 
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has not stopped GPs deciding to work additional out-of-hours shifts. I believe that that will continue to be the case.

I am sorry that the hon. Member for Isle of Wight (Mr. Turner) is not here, because I was struck by the comments of one GP on the Isle of Wight recently. His practice recently decided to opt out of its statutory out-of-hours responsibilities, but he, along with his colleagues, is working additional out-of-hours shifts. That is being made possible because of the extra investment that we are making in those services.

Sandra Gidley: I had quite a lot of sympathy for the Minister's arguments until he said, "because of the extra investment that we are making in these services". I have spoken to the three primary care trusts covering my constituency and they all say that they are having to find extra money to introduce the type of service that they think the public expect and deserve. The amount that will be clawed back from GPs themselves will cover only about half the cost of the services that have been designed, and those services have been cut from the original gold-plated services. Will he assure me that, if my local primary care trusts need extra resources, something will be available?

Mr. Hutton: It is always good, in these debates, to hear from a Liberal Democrat because clearly, for Liberal Democrats, there is no such thing as an NHS budget. On out-of-hours services, the hon. Lady is right: to opt out, a practice has to pay a proportion of its income back to the primary care trust, but that is only half of the investment available to trusts to fund out-of-hours services. We have doubled, in overall terms, the investment going into those services, and we have ring-fenced that money. It is one of the very few parts of the NHS budget that is ring-fenced, and that is precisely to avoid the difficulty, which the hon. Lady and others will, I am sure, speak about in a minute, of PCTs not having additional investment. It is up to trusts to make effective use of the resources that we have given them.

I agree with my hon. Friend the Member for Dartford (Dr. Stoate) that we should make wider use of specialist nurses, and we should integrate out-of-hours services with walk-in centres and accident and emergency ambulance services. That is not a step backwards, as the hon. Member for South Cambridgeshire implied, but exactly the opposite. Out-of-hours services will continue to make full use of the services of GPs. The contractual vehicle will be different, but that is what GPs and the BMA have asked us to provide. We are working with them and with the National Association of GP Co-operatives to ensure that the new arrangements work well and in the interests of patients.

I am not at all clear what the hon. Gentleman's position is. His motive, however, is crystal clear: to undermine public confidence in the arrangements that are being made by PCTs to provide out-of-hours cover. To give him some credit—I want to be even-handed—he has not wasted any time in setting about that task. The contract only came into operation three weeks ago, and only 10 per cent. of trusts have so far taken on responsibilities for out-of-hours services from their GP practices. He certainly got his shroud-waving in at the earliest opportunity.
 
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On community hospitals, the hon. Gentleman completely missed the point. The new contract for GPs has no bearing on the arrangements whereby GPs may provide medical cover for patients occupying beds in community hospitals; neither were those arrangements covered by the previous contract. Changes to the out-of-hours obligations in the new contract are therefore nothing to do with any instances where there may be a local dispute about payment for such cover.

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