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Mr. Hutton: I agree with the hon. Gentleman. The problem that he describes is the consequence of the boom and bust in NHS finances that we saw under that lot opposite. We are trying to ensure that the NHS has a steady path of increased resources, so that it can plan accordingly. It makes my blood boil—on the subject of blood pressure—to hear stories like that because that was the old NHS. That is precisely what used to happen: stop and go, start all over again. We can do better than that, which is what we are trying to do.

The hon. Member for South Cambridgeshire quoted a number of voices on primary care. Let me add a further one to the pot. I mentioned earlier that we are successfully recruiting GPs from other European countries. One such recent recruit was Dr. Lefeuvre from France who now works for the NHS in south-east London, and he said recently:

I very much welcome Dr. Lefeuvre's positive endorsement of NHS primary care, and I hope that the hon. Gentleman will be able to do the same.

As all my hon. Friends know, primary care is not just about doctors. There are also over 3,000 more practice nurses working in GP surgeries than in 1997—an 18 per cent. increase. The hon. Gentleman referred to a small fall in the number of community district nurses. It is true that there has been a fall of 800 or so, but the number of nurses who work in the community has risen by 25 per cent. in the same period.
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Mr. Mark Todd (South Derbyshire) (Lab): When my right hon. Friend discusses that interface between nurses and GPs, will he reflect on the example of the nurse-led practice at Chellaston in my constituency, where the doctor is employed by a nurse who leads the practice, which is highly successful, fast growing and popular with patients?

Mr. Hutton: That is a good example. I suspect that my hon. Friend is talking about a personal medical services practice in which all sorts of opportunities have opened up. That model points distinctly to the future of primary care. The situation will not be the same as that in "Dr. Finlay's Casebook"—most of the speech made by the hon. Member for South Cambridgeshire described Dr. Finlay in detail.

The hon. Member for South Cambridgeshire does not have a leg to stand on when he criticises our record investment and work force expansion. We have embarked on a major programme of investment in new GP surgeries and clinics. In the past four years, almost 2,500 GP surgeries have been replaced or substantially refurbished. Over the same period, more than 300 new one-stop primary care centres have been developed. There are 42 new NHS local improvement finance trusts—LIFT schemes—to help to boost investment in NHS primary care premises.

Mr. Liam Byrne (Birmingham, Hodge Hill) (Lab): Does my right hon. Friend recognise that in my inner-city area—I know that many Opposition Members visited it during the recent by-election—it is critical for Eastern Birmingham primary care trust to work in conjunction with NHS LIFT if things are to operate at the necessary scale to transform services? Such work is offering us the prospect of transforming one of the worst eyesores in Birmingham, which is the Leyland club on Alum Rock road. Such plans would be impossible under the Conservative party.

Mr. Hutton: I appreciate my hon. Friend's point. I was one of those who made the journey to his constituency; I thoroughly enjoyed my visit. He makes a good point. The NHS LIFT scheme gives us an important new opportunity to expand primary care imaginatively. We must ensure that while we also plan acute sector re-provision and build up new hospitals—there are 100-plus schemes in the NHS—we look critically at how many of the services traditionally provided in a hospital can be relocated to a primary care environment. I agree with the president of the Royal College of General Practitioners and John Chisholm that it would be good to locate many traditional hospital-based services in primary care, and I would be pleased, as I am sure that my hon. Friend would be, if we could make such progress in his constituency.

The NHS LIFT scheme offers a significant opportunity for primary care, with a total capital value in excess of £700 million. The Conservative party cannot point to similar investment in primary care premises throughout its entire period in office between 1979 and 1997.

The new primary care contracts will provide a better way to reward health care professionals for their commitment to improving patient care. They represent an important movement away from payments based
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largely on capitation to rewards that direct reflect the quality of care provided and primary care professionals' hard work. All the clinical indicators in the new contracts have been chosen by an independent expert group and are based on the best available evidence. GPs agreed to them when they voted overwhelmingly in favour of the new contracts last year. That situation is in stark contrast to that under the previous Administration, who imposed a new contract on GPs after failing to reach agreement with them.

I do not believe that the new contracts devalue the role of doctors working in primary care. Quite the opposite is the case because they properly reflect the hugely important role that doctors play. We inherited a situation in which only half of NHS patients could get a prompt appointment to see their GP—many had to wait for a long time. Some 97 per cent. of patients are now able to see a GP within two days, which is a huge improvement on the situation that we inherited. The improvement has been led by the pioneering work of GP practices throughout the country, including in South Cambridgeshire, where 100 per cent. of the constituents of the hon. Member for South Cambridgeshire are now able to get an appointment within 48 hours. It was disappointing, although not altogether surprising, that he failed to mention that improvement.

People can now choose from a wider range of primary care services, such as the new NHS walk-in centres, 57 of which are now open with a further 25 in development. More than 5 million people have attended NHS walk-in centres since they first opened in 2000. That confirms the value of the new services to the public, as does the support expressed for them by the Patients Association. They operate on a drop-in basis and can help to ease pressure in other parts of the NHS. They filled a gap in primary care that needed to be plugged.

As I said earlier, and as my hon. Friends have rightly noticed, the hon. Gentleman made a big mistake when he claimed that because such services are nurse-led, they somehow devalue the role of doctors. Of course they do not do that, in the same way in which the work of paramedics in accident and emergency departments does not undermine the role of hospital consultants. Such work can complement and support the contribution of other health care professionals who work as part of a wider team. Such work is being performed within properly agreed protocols. The service is safe and effective—it is nonsense to imply otherwise.

We have always been clear about the need to involve fully GPs and practice staff in local decision making in the NHS. In our first White Paper on the NHS in 1998, which was presented to the House by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), we made it clear that we wanted to

That is the aim of practice-based commissioning. It is not a return to the fundholding arrangements of the past. We have consistently made our intentions on the matter clear since 1998, so it is a pity that the hon. Gentleman and his colleagues have not been listening. Unlike under fundholding, no extra resources will go to practices that take up practice-based commissioning.
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There will be a level playing field for all practices irrespective of whether they take advantage of practice-based commissioning. Patients will not be unfairly disadvantaged if their practices decide not to take up the new opportunities, but that was not the case under GP fundholding.

Unlike fundholding, practice-based commissioning will not usher in a huge expansion of bureaucracy because primary care trusts will retain legal responsibility for the contracting process. We will not return to the situation under fundholding when decisions often came down to which hospital could provide a service at the lowest price because the single national tariff will prevent that from arising. Practice-based commissioning will instead focus on quality and efficiency, which will put patients' interests first, as it should be.

My hon. Friends and I believed that it was right to end fundholding because it unfairly discriminated against the patients of practices that chose not to take it up and because it spawned a giant bureaucracy. We will not repeat those mistakes as we take practice-based commissioning forward.

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