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Mr. Davies: No one is going to object to the Minister's bureaucratic jargon about seamless integration and so forth. What is important to my constituents is that they have access to a doctor at night. Can the Minister confirm that, as the PCT told me yesterday, from November, it will once again, after a sad interval of several months, be able to provide such access? In the first instance, the call may well be taken by a nurse—that happens when one walks into a doctor's surgery: one sees a nurse first and it may not be necessary to waste the doctor's time—but the important thing is that patients have access to doctors. Will the Minister also confirm that, if a patient insists on his or her right to speak to a doctor, that right will be granted?

Dr. Ladyman: I can indeed assure the hon. Gentleman that his local PCT is adjusting its arrangements to ensure that where medically necessary, people will be able to obtain access to a GP out of hours. In addition to the funding changes that I have already mentioned—

Mr. Davies: Answer the question.

Dr. Ladyman: I will come back to those issues in a moment, but I want to put on record that, in addition to the other incentives that I have mentioned, there is some £180 million available, which was previously given to practices to pay for out-of-hours services. Under the new contract, which the hon. Gentleman criticised, that money goes to the PCTs to enable them to fulfil the obligations. In total, £316 million is available for out-of-hours services. That does not include the additional investment that we have made available in PCT unified budgets for out-of-hours services. For South West Lincolnshire PCT, that figure is more than £156 million in this financial year.

The most effective out-of-hours care is that which permits patients to receive the advice or treatment they need from the professional with the right skills to deliver it. I am sure that the hon. Gentleman would agree. The effective use of skill-mix and team working is well established in in-hours primary and secondary care. Out-of-hours care is embracing the opportunities of the contract to capitalise similarly on the skills of the NHS.

The new arrangements will depend on the effective use of a multi-professional approach. However, there remains the need for GPs to continue to play a leading role in helping to deliver out-of-hours services, working alongside nurses and other practitioners to ensure that patients get the right service at the right time from the right person.

PCTs need to plan for services that are provided by a number of networked and integrated providers with multidisciplinary teams, making more use of telephony and a wider range of professional skills, including nurses and paramedics. PCTs are already laying the foundations in developing training opportunities for staff and broadening their vocational experiences, so that they can bring their skills and experience to bear in the future.

The model of out-of-hours provision in the South West Lincolnshire PCT provides a good example of that multi-professional working, in its use of GPs, alongside
 
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first contact practitioners and paramedics, working in partnership with colleagues in accident and emergency departments. Patients access the service via a dedicated phone number. Patients can be assessed on the phone and referred to the appropriate course of action. They may be requested to attend the emergency care centre to be seen by the appropriate professional for their needs or visited at home.

The service currently provided meets the national quality standards for out-of-hours care, which all organised providers must meet. Those standards remain in force until the end of the year. From 1 January, they will be replaced by the new national quality requirements, which the Minister of State, my right hon. Friend the Member for Barrow and Furness launched yesterday. The requirements will be a contractual obligation on providers, who will be performance-managed by PCTs in the delivery of their contracts.

Mr. Davies: The Minister is giving me all sorts of answers and abstractions that I do not need. He seems to be intoxicated by his own bureaucratic gobbledegook. Can he just answer my question? Now that the Government have made a necessary reversal of policy, can we look forward in south Lincolnshire to a patient being able to see a GP if he or she considers it necessary, even in the middle of the night?

Dr. Ladyman: That is the position that the new guidance will ensure.

The new requirements provide clear guidance to PCTs on what is expected of their out-of-hours services while continuing to build on the existing high-quality services that all organised out-of-hours providers currently have to meet. The requirements will offer reassurance to patients that whenever they access out-of-hours services, they will receive high-quality, responsive care.

The requirements guarantee that patients will be treated by the professional best equipped to meet their needs. When it is clinically appropriate, patients will be able to have a face-to-face consultation with a GP, including when necessary, at a patient's home. I hope that that is the assurance that the hon. Gentleman seeks. The telephone assessment and subsequent triage will identify clinical need, and determine the nature of the subsequent consultation or referral, which is an established process in out-of-hours services. The new requirements will keep GPs at the heart of out-of-hours services. Indeed, those services will continue to be supported by a large GP work force.
 
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At this point I shall deal with the hon. Gentleman's suggestion that we are underestimating the value of GPs. Had we not made the changes and given GPs the freedom to alter the services that they provide and take advantage of the new arrangements, it would have become increasingly difficult for us to recruit GPs. One of the messages that we got from GPs was that it was necessary to allow them, if they wanted to, to opt out of providing out-of-hours services themselves, because they considered providing those services too great a burden, and it was making it very difficult for us to recruit. Now that primary care trusts are providing out-of-hours services, they can commission them from GPs who want to provide them.

Mr. Davies: I understand that, as the Minister says, GPs should be allowed to opt out of out-of-hours responsibilities individually, but as I have just told him, one of the GP co-operatives in my constituency, Welldoc, offered to take over the whole night-time responsibility, and the offer was not even negotiated on.

Dr. Ladyman: That is a matter for the local primary care trust. It has the responsibility to commission a service that provides the highest quality in the best and most cost-efficient way for its local area. All sorts of providers might want to provide services for remuneration, but that does not mean that primary care trusts have to accept them. They have to make a decision about how best to deliver services for their area, and I am sure that the hon. Gentleman would not want it any other way.

I can provide the hon. Gentleman with the assurance that South West Lincolnshire PCT, and indeed all PCTs in England, will provide a service that will meet the quality requirements from 1 January, so that patients with clinical need can have a consultation with a GP, including, where necessary, a home visit. Trent strategic health authority will also continue to play a strong role in ensuring that out-of-hours services are developed and delivered appropriately for the population of south-west Lincolnshire.

I would like to emphasise that, contrary to recent press comment, there is no evidence to suggest that a rise in accident and emergency attendance is linked to the handover of responsibility for evening and weekend medical cover from GP practices to PCTs. In fact, there has been an overall decrease in emergency admissions at Grantham accident and emergency department, and patient waiting times are falling.

Question put and agreed to.


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