---

Dr. Andrew Murrison (Westbury) (Con): Is the Minister aware of a report of a study published in the British Medical Journal today showing that fundholders reduced admission rates for elective procedures considerably? That must be a major consideration when comparing different forms of primary care delivery. Was he aware of that study?

Mr. Hutton: Yes, the study emphasises the important role that GPs can play.

Mr. Lansley: What about fundholding?

Mr. Hutton: We made it clear that there were benefits of fundholding—that is not revolutionary or rocket science. We rejected the fundholding scheme because of its associated bureaucracy and because it was unfair. We did not reject it because it empowered GPs to make local decisions, and we made that absolutely clear in the 1998 White Paper. I shall send a copy of it to the hon. Member for Westbury (Dr. Murrison) and perhaps we can have a discussion in the House about it another time.

Labour Members can safely disregard the comments made by the hon. Member for South Cambridgeshire because they bear no resemblance to the realities of the present or the past.

The final thrust of the motion relates to the changes being made to out-of-hours services. We have previously debated those proposals, but let me make our position clear to Conservative Members again. The new contracts will not lead to the end of GP-led out-of-hours services. They simply move responsibility for organising such services from individual GPs to the primary care trust. Let me remind the hon. Member for South Cambridgeshire of the important facts. The changes have been agreed with GPs, although he failed to mention that in his speech. Would he go back on the new contracts? Would he restore the legal obligation for GPs
 
11 Nov 2004 : Column 960
 
to organise and deliver out-of-hours care? It is transparent to everyone that he would not, which confirms the hollow nature of his criticisms of the new arrangements.

The hon. Gentleman complains about GP work loads, but the new contracts are an attempt to address that for the first time. He cannot have his cake and eat it. GPs have cited the heavy burden of responsibility for organising out-of-hours care as a barrier to recruitment to general practice. We agree with GPs, which is why we agreed to the changes in responsibility. Does he agree with the GPs or not? It is not true to say that out-of-hours service will not be GP-led—they will be. However, over time, there will be a wider role for other health care professionals in the delivery of out-of-hours services. Is he suggesting that that should not happen?

If the hon. Gentleman thinks that the changes should not happen, he needs to explain the difference between, for example, a trained emergency care practitioner working an out-of-hours rota one night and in an accident and emergency department another night. He will need to explain the difference between a trained district nurse working in the community and a trained first-contact nurse visiting a sick patient at home out of hours. The truth is that there is no difference in those scenarios. Other health care professionals can help in the delivery of out-of-hours services, and it would be absurd to argue that they should not.

It makes sense to—[Interruption.] The hon. Members for South Cambridgeshire and for Westbury (Dr. Murrison) chunter away. I have tried to make it clear, but the hon. Member for South Cambridgeshire does not listen, that the services will be GP led. I hope that that deals with his uncertainty.

It makes sense to draw on the widest range of skills available to provide out-of-hours care efficiently, to ease the work-load burden faced by busy GPs and to meet the needs of patients. That is what we are trying to do with the profession. The hon. Gentleman has proposed no alternative whatsoever. That says it all.

The hon. Gentleman's approach can be described as totally predictable. He is a shroud-waver, and that is what he did today. He wants to claim that the out-of-hours services are disappearing and people will not be able to see a GP out of hours any more. His position is ridiculous. We are investing heavily in maintaining those vital services. GPs will still make home visits out of hours. His central argument is without foundation. We all know why he makes those allegations: it is pure opportunism and nothing more.

The hon. Gentleman referred to investment in new IT systems in the NHS. Let me remind him of one or two of the things that have happened over the past 20 years. The NHS has spent a significant amount on information technology over that period, but it has made that investment in a piecemeal fashion, with no strategic vision and oversight. As a result, we have ended up with thousands of different operating systems but no central data network. Compatibility and interoperability have often played second fiddle to local preferences. As a consequence, it is not uncommon for one hospital to be unable to transfer data to another or for one GP practice to be unable to send patient records electronically to another. There are no systematic patient records. So a doctor in Cornwall who has to look after a patient from
 
11 Nov 2004 : Column 961
 
my constituency who is admitted to A and E while on holiday will not have access to that person's medical history. It does not add up to a positive endorsement of the idea that small is beautiful.

Although historically there may have been good local IT initiatives, sponsored by enthusiastic visionaries, those were often inhibited by the overall lack of funding and development priority given to IT at all levels of the service. Typically, good experiences were not highlighted and successful implementations were not scaled from their local beginnings to NHS-wide applications. Even after procurement and implementation was over, there was no guarantee that different local systems would be compatible or scaleable to support patient care across different organisational boundaries. That is the reality, and it is that reality that we are trying to address in the national programme for IT.

The experience of allowing individual trusts to specify and procure their own systems was slow and hugely costly. Having a national programme, which the hon. Gentleman criticised—if I understood him correctly, he doubted the value in having a national programme—makes it possible to harness the massive buying power of the NHS to achieve huge financial as well as clinical benefits. Implementation of the national programme does not, however, mean that all the systems that are currently providing value will be scrapped. The national programme strategy makes it clear that best use must be made of the existing IT asset base. Nor will GPs be expected to change clinical systems while their current system is compliant with the NHS care records service and continues to serve them well.

The national programme has adopted an incremental approach to building up any new applications or systems. That approach is intended to ensure that implementation is achievable and minimises disruption to the day-to-day business of the NHS. Similarly, it does not imply a wholesale replacement of one primary care system by another. EMIS supply a significant number of systems to primary care practitioners and we would prefer it to be part of the ongoing national programme. The national programme has sought to ensure that EMIS engages with local service providers, and I am aware that the company is continuing to work with the national programme to make its systems compliant. For example, it co-operated with the recent upgrade to GP IT systems to support the quality and outcomes framework, which from next April will drive the GP reimbursement arrangements.

The Department's policy on local choice on IT provision, to which the hon. Gentleman referred, remains as stated in the guidance that we agreed with the British Medical Association last year, which is that each GP practice should have a choice of more than one system. Those systems will need to be accredited against national standards and deliver the required functionality. Guidance published on the national programme website makes it clear that existing suppliers play an important role in current and future NHS IT service provision.

I am aware that in some areas, following consultation with local clinicians and representative bodies, a consensus has emerged that it is sometimes in the best interests of the whole local health community if choice
 
11 Nov 2004 : Column 962
 
were exercised on a community rather than an individual practice basis. However, LSPs have been informed of the national programme position that GPs must not be forced to change systems, and I understand that individual practices will continue to be supported if they have expressed a wish not to begin migrating in the short term to the preferred local system.

We are acting to preserve choice for GPs on which IT system they use, but it is absolutely right and proper—this is where I take issue with the Opposition—to ensure that those choices support the important objectives of the national programme itself. Those objectives are that in future the NHS IT network is effectively integrated and capable of providing a smooth flow of information around the system as a whole. That is important because patient lives can depend on it. So we will not be departing from that basic requirement in relation to local IT solutions.

I have set out the steps that we are taking to support the development of primary care services in the NHS. It is a substantial record of investment, growth and improvement. It is a record we intend to build on in future years so that primary care retains the very special role it plays in our nation's health care system. The motion proposed by the hon. Gentleman is an empty and vacuous collection of opportunistic, inaccurate and simplistic assertions. He has jumped on to every conceivable bandwagon he could find. He has presented no meaningful alternative. That is why I invite my hon. Friends to reject it in the Lobby.

2.37 pm

---