---

David Taylor (North-West Leicestershire) (Lab/Co-op): The House will agree that an NHS without targets could not possibly work efficiently or effectively. Does my right hon. Friend agree that those who supervise the delivery of general practice should apply their role in a sensitive and intelligent fashion to avoid the extra stress that is placed on GPs? Will he see me immediately the inquiry report is published into the suicide of Dr. Stephen Farley, a doctor in my practice in North-West Leicestershire? The report is due on 2 December, and the issue of stress may feature in its recommendations.

Mr. Hutton: I give my hon. Friend that assurance. The death of Dr. Farley was a terrible tragedy for his family and his patients, and we want to study carefully what the report says. The best way to deal with some of the work load pressures is to continue with the reforms and expansions that we are making in primary care, so that we can recruit more GPs and practice staff and the undoubted pressures that affect GP surgeries up and down the country can be managed more seriously.

We have been able to make progress, first, because of the additional investment that we have been able to put into the NHS—something that, of course, the Conservative party opposed at the time and described as reckless and irresponsible—and, secondly, because we have been prepared to challenge, which the hon.
 
11 Nov 2004 : Column 954
 
Member for South Cambridgeshire clearly has not today, some of the traditional assumptions about what primary care services should look like in the modern day and age.

The hon. Gentleman continues to define primary care largely in organisational terms—that is very much what I took from his comments today—and in terms of the services provided by doctors. That is a mistake on his part because primary care is much more than that. Primary care represents instead a concept of care that can be provided perfectly well by different professionals and organisations. What matters is the quality of care that is provided, not the organisational structure of the care provider who delivers it.

Primary care has benefited from new services led by nurses, such as walk-in centres and NHS Direct. Clearly, the hon. Gentleman takes a very different view. For example, both those services are viewed in the motion as undermining primary care because they are not led by GPs. He is completely wrong on that point, and I want to return to that in a moment.

Dr. Starkey: May I draw my right hon. Friend's attention to a scheme that is being implemented by the Co-op Pharmacy in my constituency that involves going to working men's clubs, measuring people's blood pressure and cholesterol levels and giving appropriate dietary advice? That is not GP led, but it is reaching men, in large part, who would never go near their GP and causing them to modify their behaviour and improve their health, so they are likely to be less of a burden on the NHS and their local GP. Should not those services be encouraged, not denigrated, as the hon. Member for South Cambridgeshire did? Most GPs would support exactly that sort of service.

Mr. Hutton: My hon. Friend is absolutely right. From my experience of working men's clubs, it is probably a pretty good idea to go into them fairly regularly to test blood pressure there. I am member of the Cemetery Cottages working men's club in my constituency, and blood pressure testing there is probably a quite a good idea. Of course, she speaks an awful lot of common sense, and she has made much more eloquently than I could the argument that I am trying to make.

Mr. Lansley: The Minister is proceeding on a misrepresentation of not only what I said, but what he ought to know we have made clear in our policies. I do not define primary care in organisational terms. In fact, we wish to define care increasingly in terms of its being patient centred, with patents having individual care plans. I do not denigrate walk-in centres. I visited one in Loughborough recently, which was run not by GPs, but by emergency care practitioners and nurses, and it was run very well. The point, however, is to understand that patients need the relationship with their GPs to be able to structure the manner in which they gain access to services, to recognise the co-morbidities and to understand how such care is best put together.

Mr. Hutton: Of course, they do. That is why we are investing additional resources in primary care to ensure that that can happen. Walk-in centres are not a substitute for the relationship that registered patients will have with their own GP; they provide an additional
 
11 Nov 2004 : Column 955
 
service. If the hon. Gentleman had wanted to make that point, he should have chosen his words more carefully in his speech.

On investment, NHS primary care services are benefiting from the significant additional resources that we have made available. Funding for primary care services will increase from £5 billion to £6.8 billion next year—an increase of more than 30 per cent. over that period. That progress would be immediately undermined by the policies that the Conservative party now advocates.

The hon. Gentleman's patient's passport would take more than £1 billion away from the NHS to help well-off people jump the queue for NHS treatment by going private—a typical Tory policy of looking after the interests of the few at the expense of the many. If that money were taken away from the NHS, as he intends, it would be quite impossible for primary care trusts to maintain the investment that is going into the NHS front line. Primary care would suffer in the same way as hospitals from those reductions in resources. So there is no accuracy behind his claim that we are not properly investing in NHS primary care services—we are— and his proposals would make matters worse. [Interruption.] It is clear from his comments from a sedentary position that he thinks we are investing the right level of resources in primary care. If he is not clear about that, let him come to the Dispatch Box.

Mr. Lansley: Clearly, the Minister wrote his speech before he heard my speech. He is referring to what he supposed I would say. He thought that I would criticise the Government's investment in primary care, but I did not do so. If I were to do so, I would say, for example, that between 2001 and 2002–03—let us look at the book, rather than into the crystal ball—investment in general medical services and personal medical service increased by just 9 per cent. As we would expect, the Minister is talking about what he will do in the future, but not holding himself accountable for what he has done in the past.

Mr. Hutton: I am happy to hold myself accountable for the actions of Ministers and my right hon. Friend the Secretary of State for Health. It is true that I wrote the speech in advance—I confess to doing so—and I can tell him why I did so: the hon. Gentleman makes exactly the same speech every time that he comes to the Dispatch Box. He makes exactly the same arguments, and we can see him coming from a very long way. It is ludicrous for him to say that he was not implying that we were not sufficiently investing in primary care because the motion is about our failure to support family doctor services. He is probably the only Member in the Chamber who thinks that the level of investment is not important to the support that we provide to our family doctors.

We are using those additional resources to invest more than ever before in our family health services. Our priorities are clear. We need more GPs and practice nurses. We need to improve as many surgeries as possible, so that patients can be treated in the best possible environment. We need to reward GPs and practice staff who are working hard to improve the quality of the care they provide. We need to improve
 
11 Nov 2004 : Column 956
 
access to primary care, so that patients can be seen wherever possible at a time of their own choosing and in a way that fits around their own needs and requirements. We need a wider range of services for patients to choose from, and we need to involve GPs and practice staff fully in the process of fashioning services around the needs of patients and shaping the key decisions that affect the design of local health services. In all those areas, we are making solid progress.

There are more GPs working in the NHS than ever before—over 3,000 more since 1997. We are increasing the number of GPs in the NHS at twice the rate achieved by the previous Administration. Vacancy rates for GPs, which were not even collected by the Conservative Government, are now falling, not rising, as the hon. Gentleman suggested. The number of doctors training to become GPs has increased by 80 per cent. compared with a 20 per cent. fall under the last Conservative Administration.

Mr. David Rendel (Newbury) (LD): I should declare an interest: my wife is a GP. Does the Minister agree that one of the troubles with the NHS is that there have been times of famine and times of good supply? What tends to happen is that a large number of doctors go into the GP service at one time, all of whom are roughly the same age, and then there is a period when many fewer go in because all the places are filled, followed by another period when a lot go in. Somehow, we need to smooth that out.

---