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Mr. Christopher Chope (Christchurch) (Con): Will my hon. Friend comment about the situation relating to Egton Medical Information Services? The Government are centralising and imposing upon GPs a system of medical information that they do not want. Fifty-five per cent. of GPs are using Egton but the Government are going to prevent them from doing so in future. Is that not ludicrous?
Mr. Lansley: I shall deal with that point directly; I am grateful to my hon. Friend. As he says, out of hours is not the only area where GPs feel let down. For many GPs, the implementation of the NHS programme for IT is indeed a matter of deep concern. The Government originally said that it was going to be a national strategy for local implementation. In June 2002, however, they said that they would centralise the IT programme. When we discussed this in July 2003, in the short debate to which I previously referred, I expressed concern—I shall quote myself if my hon. Friend will forgive me—
I wondered, in the context of the negotiation of the contract,
"whether the BMA is entirely confident that GP practices will be able to exercise the same control over their service providers that they do at present".—[Official Report, 8 July 2003; Vol. 408, c. 1048.]
Since that warning back in July of last year, we have become aware of serious disquiet among general practitioners about the system that the Government are putting in place. As my hon. Friend the Member for Christchurch (Mr. Chope) said, they have put a lot of investment into the EMIS system and 50 per cent. of GPs have adopted it, but this system is not the one that has secured a contract with a local service provider to provide GPs with their IT systems under the new arrangements. The GP contract says:
"Each practice will have guaranteed choice from a number of accredited systems that deliver the required functionality"—
yet GPs are not getting the choice that they want, nor the required functionality.
It is also my understanding that the Department of Health has assured GPs that they will not be forced to change systems, but—with this Government there is always a but—GPs are being told that if they wish to keep their existing system and it is not one of those offered by their local service provider, they may have to pay for it from their own budget. Not only do GPs have cost concerns about the new system, but they are rightly concerned about moving from a system in which they have invested, that they and their staff are trained to use, and that they trust, to a system that is unfamiliar and untested.
Will the Minister today take the opportunity to tell us what consultation he has had with GPs about the IT programme? If a GP wishes to remain with an existing IT system that is compatible with the NHS system but which is not offered by their local service provider, will they be able to do so at no extra cost? Can the Minister assure the House that all new accredited systems can deliver the same functionality as existing systems? What assurance can he give the House that safeguards have been put in place that ensure that GPs who transfer to a new accredited system will not lose any confidential patient data in the process?
It is clear that the Government have a long way to go to convince doctors and the public—and, indeed, many of us—that they were right to take central control of the NHS IT programme, to explain why they have not secured the buy-in from GPs and users that is vital to any IT project, and especially to show that the IT programme will in fact deliver the service and the functionality that GPs require.
The NHS needs to be a primary care-led service, and the family doctor service is the lynchpin to primary care. In GPs we have 35,000 advocates of better public health who are best placed to intervene early and effectively—but it is a service under stress. GP numbers in the five years after 1997 rose by less than in the preceding five years. The number of applicants for GP training places is way down on five years ago. Vacancies reported in the last recruitment and retention survey were over 40 per cent. higher than during the previous year.
The Government's amendment to our motion demonstrates their failure. They are forced to recognise the value of a return to GP fundholding, although they will not admit it. They admit the lack of clinical engagement, as they term it, which actually means that they are admitting the lack of ability for GPs to control clinical services provided to their patients. They still fail in their amendment to express their appreciation of the central role of the family doctor service. The
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Government are clearly in denial over the problems experienced with out-of-hours services and the NHS IT programme. The Government's priority in their amendment seems to be to promote walk-in centres and NHS Direct. Our priority is to promote the family doctor service and GPs as the lynchpin of successful primary care.
I commend our motion to the House.
2 pm
The Minister of State, Department of Health (Mr. John Hutton): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the increase in general practitioner numbers; supports the expansion of primary care provision through walk-in centres and NHS Direct to meet the needs of patients; welcomes the new arrangements for the National Health Service out-of-hours services that provide an opportunity to integrate primary, secondary and social care, whilst guaranteeing high quality urgent care across the country including Saturday mornings and improving the quality of life for general practitioners; acknowledges the progress made on the NHS Programme for information technology; supports the introduction of practice-based commissioning which fosters clinical engagement whilst mitigating the worst excesses of general practitioner fundholding; and believes that the general development of practice-based commissioning will deliver improved patient care."
I agree with the hon. Member for South Cambridgeshire (Mr. Lansley) about one thing at least—it is important that where we agree, we make that clear. I agree with him about the importance of primary care and delivering high-quality health care services to NHS patients. Primary care has always been the cornerstone of the national health service, and our family doctors have always been at the forefront of change and innovation. Primary care is the cornerstone of the NHS because it is where the vast majority of patients are seen and receive their treatment. Ninety per cent. of all patient journeys in the NHS begin and end in a primary care setting. Some 300 million appointments are made in general practice every year. Every fortnight, one in four people in Britain will see their GP or practice nurse.
It is for those reasons and others that primary care has played a critical role in advancing the health of every single person and every community in Britain, so it is not a surprise that GPs are the most respected and trusted professionals in our country or that primary care always gets and continues to get—despite the impression given by the hon. Gentleman—the highest levels of patient satisfaction of any part of the NHS. It is a proud record, deservedly so, and despite all of its detractors, I believe that our primary care model is admired across the world.
GPs have played an important role in bringing about some significant improvements in the health of our population in recent years, none of them documented by the hon. Member for South Cambridgeshire. For example, death rates from cancer are down by more than 12 per cent.; death rates from cardiovascular disease have fallen by more than 23 per cent. That is real
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and solid progress. I disagree strongly with the hon. Gentleman on both his analysis of the present state of primary care and on the best way to secure its future.
Mr. Drew: I wonder whether my right hon. Friend will respond to something that the Opposition spokesman said. One of the arguments for freeing up the time of GPs is that it allows them to develop sub-specialisms. By chance, yesterday the all-party health group held a session on primary approaches to pain control. It was abundantly clear that GPs had to develop specialisms in order to make early diagnoses and pass their patients on for treatment. Unless we can free up time for GPs, which the Opposition do not seem to have any idea how they would do, it will not be practicable for them to develop such specialisms. Does my right hon. Friend care to say something about that in terms of the logic of what the Government are doing?
Mr. Hutton: I want to come back to that issue in a moment. It is important to recognise that much of the skill mix and much of the change that has taken place in primary care and the increasing role of other health care workers in supporting primary care and family doctors has been welcomed by GPs. They see it as an important part of making sure that their expertise is concentrated on those parts of their work that they need to do.
In relation to specialisation in general practice, we have seen some welcome and significant progress—progress that was not seen in the 18 years to which the hon. Member for South Cambridgeshire conveniently forgot to refer. His vision of primary care is very much the "Dr. Finlay's Casebook" version, and with great respect, I do not think that anyone in the Chamber today can recall those times. Times have changed and things have moved on. One of my problems with the hon. Gentleman's argument today is that, sadly, he does not appear to be in that process of change.
The essence of the hon. Gentleman's argument today has been that the Government have failed to support primary care services in our national health service. That is simply untrue. It is a claim that cannot be justified by reference to the facts. He has chosen to ignore every indicator that points in the direction of the progress that is being made. He has ignored the views of Britain's GPs, having appointed himself today as their national champion. They have signalled in opinion poll after opinion poll conducted by the British Medical Association that their view of the quality of patient care that they are providing is that it is improving, not decreasing. He showed a blissful and wonderful disregard for his party's record on primary care when it was in government.
I am not surprised that the hon. Gentleman chose to say nothing about the previous 18 years, but let me remind him and his hon. Friends of one or two of the facts, because they reveal a different story from the one that the hon. Gentleman tried to tell. For example, between 1991 and 1996 there was a fall of 20 per cent. in the number of GPs in training, with a reduction in every single year. So much for his claim to value the role of primary care. Average list sizes are lower today than they were both in 1997 and in 1992. That undermines his claim that we have failed to address work load issues.
In relation to the new contract, about which the hon. Gentleman spoke at length, let me remind him of one rather interesting fact. The previous Administration
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imposed a new contract on GPs in 1990, having failed to negotiate an agreement with them. That rather puts paid to his argument that we are the ones who are not listening to the views of general practitioners. He has yet again completely failed to establish a clear alternative, which I think is a pretty important yardstick by which people reading and listening to his contribution today are likely to form a view. He does not plan to spend any additional resources on primary care. We know that he has no plans to change the new primary care contracts.
What the hon. Gentleman has said would make matters worse, not better. He intends to scrap our plans to improve GP premises, because he is against all those national targets. He would take away the right of the patient to be seen by a GP or practice nurse within 24 or 48 hours, because he is against that target as well and would not take any measures to implement it. There would be no targets for recruiting more doctors or nurses in the NHS. He would return the NHS—we know this from the Opposition motion and from what he said today—to the bureaucracy and unfairness of GP fundholding. All that would be a huge step backwards for our national health service. That is why his contribution will be seen as shallow and superficial and devoid of serious proposals.
I want to set out what I believe are the important facts, but I want to make one thing clear at the beginning. It is not my argument today that every problem facing our family doctor services has been solved. We all know that that is not the case. Neither is it my contention that we cannot improve the quality and range of services on offer to patients. We all know that we can. My argument today is that we are making real progress in expanding primary care services and in the process giving patients a wider range of services to choose from; in short that primary care is heading in the right direction.
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