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Mr. Woolas: I thank my hon. Friend for what he said early in his remarks. I thought that there would be a "but", and was very pleased that there was not.

I know that my hon. Friend takes a close interest in these matters and has raised this question before. He is right to say that incidents involving uninsured drivers cause great injustice to other drivers. Press reports about last week's tragic rail crash suggest that people with motor insurance policies may have to pick up the compensation bill. My hon. Friend's point is therefore very important and timely. I remind the House that Transport questions take place on Tuesday next week, and I shall ensure that the relevant Minister is aware of my hon. Friend' s comments.

Mr. Heald: On a point of order Mr. Speaker. Perhaps inadvertently, the Deputy Leader of the House suggested that Conservative party chairmen in the 1980s were paid by the taxpayer. I should like to put on record that that was never the case. On the few occasions when the party chairman was also Chancellor of the Duchy of Lancaster, he drew a much-reduced salary to reflect the small number of duties involved in the Duchy. For example, Norman Tebbit drew only £2,000 a year. Is it in order for the Deputy Leader of the House to make such remarks? Is it in order for the present Chancellor of the Duchy of Lancaster to refuse to say what he is doing with taxpayers' money?

Mr. Speaker: As a former trade union officer, I would never advise anyone to take a reduced salary.
 
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Opposition Day

Family Doctor Services

Mr. Speaker: I inform the House that I have selected the amendment in the name of the Prime Minister.

1.25 pm

Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,

That this House places the highest importance on the role of general medical practitioners, working with allied healthcare professionals, constituting a family doctor service; regards this service as the lynch-pin of NHS primary care services and central to public health promotion; appreciates that general practitioners are best placed to provide care for patients, to facilitate their access to NHS services and to manage care of those suffering from chronic diseases and co-morbidities; is concerned by the continuing level of general practitioner vacancies and workload pressures; regrets the Government's devaluation of the family doctor's role in favour of an emphasis on diverse means of access to the NHS; deplores the failure to maintain the out-of-hours service as a general practitioner-led service and the loss of Saturday morning surgeries; calls on the Government to ensure that the NHS Programme for information technology delivers the choice of suppliers and functionality which general practitioners need; further regards the Government's abandonment of general practitioner fundholding and commissioning as a severe misjudgement and urges the reintroduction of the benefits of fundholding through the adoption of practice-led commissioning; and believes that the development of family doctor-led commissioning, alongside increasing patient choice, offers the best means of delivering an effective NHS which is responsive to patients' needs and wishes.

The origins of this debate lie in the many conversations that I and my colleagues have had in recent months with general practitioners and those who work in family doctor services. In the years since the 1999 legislation, when fundholding and GP commissioning were lost, GPs have become progressively divorced from the control of primary care as locality commissioning turned into primary care groups and then primary care trusts. The PCTs are no longer the local representative bodies for GPs and health professionals that they should be. Instead, they have become the local representatives of the Department of Health.

In my experience, one of the most depressing aspects of constituency health casework has been the decline in the influence that GPs can exert over the NHS services available to their patients.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): I rise to give the hon. Gentleman an opportunity to reflect on his remarks so far. Would not it be sensible for him to make it clear also that the role of the PCTs is to represent the needs of local people who rely on NHS services? The PCTs are not there to represent the needs of GPs, however worthy they may be.

Mr. Lansley: The hon. Lady is completely wrong. As those of us who have visited GPs recently have been told time and time again, GPs represent the needs of those patients whose needs they are best equipped to represent. They find that PCTs respond not to the needs of patients, but to the diktat of the Department of Health.
 
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The previous Conservative Government started GP fundholding in 1997, and we were developing locality commissioning. Immediately after the 1997 election, the Government said that they were going to develop locality commissioning. However, that did not result in the establishment of local commissioning groups responsive to local health professionals, and to GPs in particular. Instead, the outcome is that PCTs are dictated to by the Department of Health.

Many people working in PCTs want exactly what the hon. Member for Milton Keynes, South-West (Dr. Starkey) suggests—PCTs that are accountable to their local NHS, through local health professionals, for the needs and interests of their patients. However, that is not what is happening.

Chris Grayling (Epsom and Ewell) (Con): I should like to give a very practical example of that. I was visited by a constituent who wanted to talk about the problems faced by women with endometriosis. That is a major problem for sufferers, and it can cause significant disruption to their lives. My constituent asked me to find out from the local PCT what effort was being made to tackle the problem, and what support was available for people like her. The PCT told me that as the disease was not part of the Government's national service frameworks, no particular support could be provided. Does my hon. Friend agree that that is a perfect example of why he is right and the hon. Member for Milton Keynes, South-West (Dr. Starkey) is wrong?

Mr. Lansley: I met my hon. Friend's constituents when I visited his constituency, and I know that he understands what is going on very well. He offers an excellent example. What I said in my opening remarks is born of experience. Recently, a constituent of mine was trying to access mental health services. She and I talked about her efforts for a considerable time, and in the course of our conversation I asked her what her GP had said. She told me that her doctor was fantastic and sympathetic, but that he had no say in the matter, nor any control over what services were available. That is dictated by the primary care trust. My hon. Friend is right and the hon. Lady needs to understand better what is happening in primary care.

This year, in the context of a new GP contract, GPs were looking for a more assured future and for a sense of support for and direction of family services, but unfortunately they have not found that. For example, the contract implies that GPs will take responsibility for the delivery of improved management of chronic disease. However, GPs then hear the Secretary of State say that regional chronic disease centres are to be established and that 3,000 community matrons are to be recruited to look after the elderly with chronic diseases. There was no mention of the role of GPs. They believe that they provide a service to patients as self-employed practitioners, contracted with the NHS. However, they are increasingly dictated to by PCTs and the Department of Health.

Mr. David Chaytor (Bury, North) (Lab): On the specific point about matrons being appointed, does the hon. Gentleman agree that one of the problems for the NHS for many years has been that GPs have been required to carry out some basic functions that would be
 
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far more efficiently carried out by nurses? Is it not wholly positive that we are devolving responsibility in the NHS to different occupations in that way?

Mr. Lansley: I shall come to that point in a moment. However, my point is not that we should not have additional community nurses. It is clear that they are necessary in order to provide improved chronic disease management, not least because in the years after 1997—up until the figures published by the Department of Health earlier this year—the number of community nurses fell. I shall come to the issue of the distribution of work in a moment.

The NHS programme for IT, to which I shall refer later in more detail, means that GPs are no longer the customers with control over the supply of their IT hardware, or the right to use the software that they have developed. They are told how to manage their patient booking systems. Out-of-hours services are now controlled by the PCT and, in some cases, they no longer deliver a GP service, nor even necessarily one where calls are handled locally.

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