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Sarah Teather: That is a particular problem in Brent, East, where underdeveloped land is scarce and property prices are high. The only way in which doctors can solve the problem is to buy a Victorian property and convert it. However, if one adds the cost of the property to the investment required to convert it, the cost is greater than its overall value, and the PCT will only reimburse GPs up to market value.

Mr. Burstow: My hon. Friend is right to raise that concern, which I know that she has raised with her PCT. GPs often wind up in negative equity as part of acquiring a property, which cannot be sensible. Although NHS LIFT is certainly part of improving existing accommodation and providing new accommodation, PCTs should surely have the freedom and flexibility to find solutions that fit local circumstances.

The motion refers in misty-eyed terms to GP fundholding. Many GPs whom I talk to do not have fond memories of how Conservative proposals on fundholding worked in practice. Fundholding caused a huge equity deficit in the way in which NHS care was accessed; whether one's GP was a fundholder determined how fast one was treated, which was not an acceptable basis on which to provide health care. Serious questions also remain over the cost-effectiveness of the fundholding experiment. Practice-led commissioning must avoid that pitfall, and some of the Minister's comments this afternoon have reassured me on that point. No patient should be left behind in the new system.

A balance must be struck between freeing the frontline to innovate—the reason why I would scrap targets and support practice-led commissioning—and the need to develop and maintain coherent community health services from one part of the country to another. To date, little research has been conducted into the impact of practice-led commissioning, and as that policy is rolled out, I hope that how it works in practice will be carefully evaluated.

I have already said that the Government are obsessed with targets and handing out tick boxes. When it comes to family doctor services and primary care, "Shifting the Balance of Power" has not resulted in a bonfire of targets and red tape.

Mr. Simon: Will the hon. Gentleman give way?

Mr. Burstow: I have already said that I will not give way to the hon. Gentleman.

A PCT executive board member recently told me that after all the spending commitments tied to Government targets, the trust had already allocated 105 per cent. of its budget. That leaves no room for local innovation and no scope to ensure that services are aligned to the
 
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health needs of the local population, in which case unmet need remains just that. The NHS needs good local performance management; it does not need poor national political targets.

We carefully examined the Conservative motion, but we cannot support it because it does not offer the right vision of primary care service, while the Government amendment pats the Government on the back, and we will therefore vote against both of them tonight.

GPs are the backbone of the system in this country and are vital to delivering closer-to-home health care, and this debate is an important contribution to that vision. I urge my hon. Friends to vote against both the Government amendment and the Conservative motion, neither of which offers a coherent vision for the future.

3.4 pm

Andy Burnham (Leigh) (Lab): To be fair to the Conservative party—I am not often inclined to do so—I congratulate it on securing today's debate and focusing our attention on primary care services, because the debate about health and the NHS in this country too often focuses on secondary care and hospitals, rather than primary care.

The motion describes family doctor services as the lynchpin—perhaps it is the bedrock or backbone—but whatever word we use, they are crucial to all our constituents. Given that the Conservative party has focused on the issue today, why on earth did it not prioritise family doctor services and primary care during its 18 years in power?

The Conservative Government left primary care in a sorry state, particularly in our more deprived communities and inner cities. Between 1991 and 1996, GP registrars fell by 20 per cent., which is why we now have a problem with GP vacancies. Let us make no bones about it: the motion discusses problems with GP vacancies and we can lay the blame at the Conservative party's door—GP numbers were slashed between 1991 and 1996. This Government have barely been in power long enough to see a GP through his training, which takes six or seven years, so we must make that point plain from the start.

The Conservative Government left GP practices in many communities in a terrible state—for example, located in old terraced houses without consulting rooms. The primary care estate, if we can call it that, was in a terrible mess. What are the answers in the motion? The motion discusses the reintroduction of fundholding, but is that really the answer to the problems facing primary care today? Fundholding placed an arbitrary label on patients, which dictated how they went through the system. Treatment was provided not on the basis of how urgently it was required, but according to funding status. Fundholding is incoherent. The motion mentions providing more Saturday surgeries, but it bemoans GPs being told what to do and being subject to targets. How can one want Saturday morning surgeries and also defend GPs' independence as contractors who can dictate their own work load?

The motion says nothing—not a word—about the state of primary care premises, on which I shall concentrate for a moment. In some of the more deprived communities, the state of the facilities led to general
 
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practice becoming moribund and lacking a clear vision for the future. The Government's vision for primary care is beginning to emerge in my constituency. That vision includes high class, modern facilities where GPs want to come and work, in all the towns in my constituency. GPs can obtain professional satisfaction from working in such facilities because space is available to deliver new services and because they can locally develop services previously provided by secondary care. The future of primary care involves GPs developing their skills and their role, which is linked to the quality of premises.

My constituency contains one of the 42 LIFT pilot areas, and it is probably true to say that our scheme is one of the most developed. A couple of weeks ago, I visited the Atherton site, where a brand new facility for GPs has already been built. The facility is huge and looks like a cottage hospital: it has ample space and includes consulting rooms, while the facility is first class and looks lovely, too. LIFT will take services out of secondary care sites such as Wigan infirmary and Leigh infirmary and put them on the doorsteps of mining communities, where transport is not good and people must travel to access services. That can only be good.

The Atherton scheme was one of the first, but a scheme is also in progress in Golborne. The first phase of the Golborne scheme, Leigh health park, has already opened. A new GPs clinic is planned for Hindley in my constituency—it will be located next to the Sure Start building and the swimming baths. Those developments will transform the quality of primary care at a local level.

The Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), knows that primary care is particularly important in communities that have a legacy of ill health from mining, because she kindly visited my constituency earlier this year. We have much higher levels of chronic long-term illness than other parts of the country and people find it harder to travel because they have mobility problems. That is why it is crucial that these services are developed and improved locally and people are saved from making needless trips to hospital.

General practitioners will be enthused if they are given modern facilities in which to work. That will tell them that they can begin to develop their careers and interests and to deliver far more than they are able to deliver in the cramped and poor conditions that they often have at the moment. The quality of the estate is crucially linked to tackling GP vacancies. Moreover, the improvements that have taken place in secondary care are linked to general practice. As GPs can begin to navigate their patients around the system as capacity is opened up and waiting lists fall, they can once again become the true advocates, or champions, of their patients, because they will be able to assert themselves on their behalf to secure the best of the care that they think they need. The role of the GP is about to flourish again, and it could become a very rewarding job.

In my constituency we face problems with GP vacancies and, as I have told the Minister before, with dentist vacancies. Contrary to Conservative Members, I would make a plea for salaried GPs and dentists in our communities, because they can provide services
 
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when patients want them at a time that they find convenient. That is the answer. My hon. Friend should reject the calls about "Dr. Finlay's Casebook" and give us salaried employees who can deliver services to my constituents.

I wholeheartedly endorse the Government's vision and direction, but funding is also required. As I say, health in my constituency is poorer than in many other parts of the country. The Minister talked about the increases in funding that have gone into primary care. That is indisputable, and they are welcome, but from the viewpoint of a PCT such as mine the imminent three-year spending round must go further in taking all PCTs as close to their target funding as possible. Otherwise, it will not be possible to deliver the desired improvements in general practice and family doctor services in areas such as mine. My PCT is some £12 million below its target funding in this financial year. I am led to believe that in PCTs in other areas where health is even poorer—such as Easington, central Manchester and parts of Liverpool—funding is even further below target. Yet many other PCTs in leafier parts of the country are significantly over the target that the Department of Health says that they need in order to tackle the health needs of their communities.

The Healthcare Commission recently recommended that the Government should move much more quickly towards bringing all PCTs up to balanced funding. That is because a couple of years ago the chief medical officer said that death rates in some communities in the north-west and the north-east have not improved since the 1950s. That shames every person involved in public policy, because it has not delivered the health gains to the communities that it should have done—health gains that other parts of the country are enjoying.

This spending round, in which a significant amount of extra money is going into primary care, gives us the chance to take a great leap forward in lifting the baseline of PCT funding in areas where the need is greatest. [Interruption.] The hon. Member for South Cambridgeshire (Mr. Lansley) may laugh, but that is morally the right thing to do. Extra health care revenue—new money—should be spent in the areas where need is greatest. There is no point in continuing to overfund areas that are already well provided for when we have serious health care problems in areas that are below their target funding allocation.


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