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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): As the hon. Member for Grantham and Stamford (Mr. Davies) supposed, I do
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not entirely agree with everything that he said. I nevertheless congratulate him on raising this important matter and on his interest in health issues. I know that this subject is of great importance to his constituents, and that he is delighted about yesterday's Government announcement concerning out-of-hours services. I have to disappoint him slightly, in that that announcement was not entirely in response to the prospect of this Adjournment debate. The Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), has been concerned about the way in which out-of-hours services are being implemented in certain areas for some time, and has said so publicly. He has worked very hard for some time to produce guidance that will provide Members such as the hon. Gentleman with the assurances that they need.

Mr. Quentin Davies: I understand that the Government have some face to save today; however, the primary issue is the future of health care. Is the Minister seriously trying to tell the House that it was a complete coincidence that, just after Mr. Speaker granted me this debate some four weeks ago, the Secretary of State said that he was contemplating new guidance, and a complete coincidence that the statement was made yesterday, just 24 hours before this debate?

Dr. Ladyman: The Government of course have the greatest respect for Parliament, but on this occasion, yes, it was a coincidence. We recognised that the public are concerned about the way in which out-of-hours services are developing, and we made a statement pointing out that we are going to do something to address that concern.

Mr. Davies: Will the Minister give way?

Dr. Ladyman: Very briefly; otherwise, I will not be able to deal with all the hon. Gentleman's points.

Mr. Davies: Nobody will believe what the Minister has just said. Certainly, no one in Lincolnshire will believe it, and the PCT itself knows perfectly well that it is untrue. This was not a coincidence: it was simply against the backdrop of today's debate that the Government took this decision, which I continue to welcome.

Dr. Ladyman: I am grateful that the hon. Gentleman continues to welcome the decision; we will simply have to agree to differ on the motivation for it. That is not to say that I minimise in any way the importance of Adjournment debates. I do a great many of them and they are valuable in terms both of raising local issues and of focusing Ministers' minds on Members' concerns, thereby ensuring that we focus our officials' minds on them.

I congratulate health service staff across the whole of Lincolnshire on their work and I thank them for their efforts in delivering high-quality services. They are dedicated to producing a good service for everyone, and they deserve our admiration and gratitude.

Back in April 2002, we announced that local health services would be given the freedom to commission care in order to get the best services for their own people,
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subject to the highest clinical standards and best value for money. These wide-ranging health care changes mean that strategic health authorities and locally based PCTs now have the role of running the national health service—of making real health improvements in their areas. It is not for Ministers miles away in Whitehall to second-guess them. At the centre, the Government set the strategic framework, but local delivery decisions are very much for local people in the local NHS. The job of running local health services is theirs, as is that of driving up standards and making improvements.

I will return to the regard in which we hold general practitioners, but I should point out now that if we in any way wanted to diminish the role of GPs, why on earth would we have put the NHS's future and strategy into the hands of PCTs? It is because we understand the importance of primary care and the role of GPs in it that we now devolve 86 per cent. of NHS money to PCTs, so that decisions on such matters are made by local people based in primary care, including GPs themselves.

Mr. Davies: I am sorry to interrupt and correct the Minister once again, but in fact he destroyed the system of fundholding practices, through which GPs themselves commissioned secondary care, and replaced it with another form of bureaucracy. PCTs are responsible for spending a lot of money but they do not necessarily have to spend it on GPs. Indeed, in this case the PCT decided—foolishly and wrongly, as the Minister has now conceded—to spend it on nurse practitioners rather than on GPs.

Dr. Ladyman: Primary care trusts consist of local people who make local decisions. They include decisions on general practice and the funding for it, and on the commissioning of all other health services in the PCT area. I encourage the hon. Gentleman to engage more closely with his PCT, so that he can be better involved in some of the decisions. I have regular timetabled meetings with my PCT, as do the other MPs in my area. As a result, we feel involved in the process, just as councillors, GPs and others involved in the health service do.

South West Lincolnshire PCT has made considerable improvements and I would like to begin by congratulating the trust on achieving three-star status earlier this year, which the hon. Gentleman did not mention in his comments. Not only is it a high-performing trust, it is one of the first PCTs in the country to achieve teaching status, offering wider career development opportunities to clinicians to improve recruitment and retention of staff. Acquiring teaching status means, of course, that it will be very much easier to recruit the general practitioners that are needed in the area.

The trust has been innovative in its approach to service redesign and work force development and has a good track record of consulting local general practitioners and engaging the general public. The hon. Gentleman suggested that there had been no consultation on the changes to out-of-hours services, but 30,000 information leaflets and 500 posters were distributed in his area. There were briefings to all the local newspapers, which featured articles about the changes, and there were a number of presentations at public meetings. For example, two annual public
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meetings of the PCT were held in open, at which these matters were fully discussed. It is a matter of considerable surprise to me that the hon. Gentleman, who I know takes a great interest in his constituency, seems unaware that all that consultation was taking place—very publicly and very openly—over a considerable period of time.

The PCT is responsible for training the first wave of first contact practitioners on behalf of the National Health Service university. It has been actively involved in international recruitment of GPs from Spain and a similar campaign is under way to recruit Spanish dentists. In no way does the hon. Gentleman's PCT underestimate the value of general practitioners. I would say that he should be proud and supportive of its work. It is an excellent PCT.

Of course, Members attach the highest importance to developments in the NHS and the quality of local care within their constituencies. That is absolutely right. It is a matter of great importance to our constituents and Members should be involved in the process. The development of out-of-hours services and unscheduled care services is of great concern to many people. That is why there was an independent review of GP out-of-hours services in 2000, which is when we began the process of review. The Government accepted the recommendations of that independent review in full, and a key principle of them—they have shaped policy for out-of-hours services—is to deliver an integrated model of out-of-hours services, in which a high quality of care is available to everyone irrespective of where they live and who provides it.

Following the review, we introduced national quality standards to act as the benchmark for providers of out-of-hours care. Those standards ensure that out-of-hours care, wherever provided, is delivered to a consistently high standard. They cover areas such as clinical governance, organisational and service standards, patient access and clinical assessment. Those are the standards that we are setting centrally, but I reiterate that delivery is a matter for local discretion.

The hon. Gentleman mentioned the impact of the new general medical services contract, but it fully supports the development of an integrated system of high- quality out-of-hours care. Prior to the contract, most GP practices sub-contracted their out-of-hours responsibility to providers such as GP co-ops. The new contract allows practices to transfer that responsibility to the PCTs—the lead commissioners of NHS services. PCTs are now commissioning services from providers or organising provision themselves. It is a choice that they make and it provides an opportunity for PCTs to rethink and reconfigure the provision of out-of-hours services across their area and to co-ordinate it with other services, including accident and emergency, social care, and NHS walk-in centres. The long-term aim is for out-of-hours to be part of a seamlessly integrated unscheduled care network, which brings together all services meeting patients' unplanned needs.

We have greatly increased investment to support all that at the centre. We have doubled the out-of-hours development fund this year to £92 million. We have
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provided additional resources of £14 million to assist PCTs in very rural and urban areas, and we have made available to them £30 million in capital incentives.

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