| Previous Section | Index | Home Page |
Mr. Simon: Will the hon. Gentleman give way?
"The chief executive replied that the nature of the new . . . contract would effectively see the demise of all other systems and their current suppliers. Professor Lawrenson also observed that the traditional benefits associated with suppliers going to great lengths . . . to meet NHS requirements was in danger of disappearing . . . GPs . . . were currently able to exercise some choice in terms of the systems they used".
That choice would not be available, "once IDX . . . was introduced". The minutes continued:
"The Chairman acknowledged these concerns but remarked that the NHS was undergoing a process of 'ruthless standardisation' as far as IT was concerned and that there were clear advantages to that strategy."
Well, we have not seen any advantages.
3.27 pm
Mr. Doug Henderson (Newcastle upon Tyne, North) (Lab): I promise the House that my speech will be short. I want to raise a constituency issue, which also raises a point of general principle about the way in which the primary care trust operates, certainly in Newcastle and perhaps elsewhere.
To the south-west of my constituency is a community called Lemington, which has a population of about 9,000. At the bottom end of Lemington, right on the banks of the Tyne, is a relatively underprivileged area where a lot of elderly people live. Because of the private housing that is let, a lot of young single mothers live there too.
Until a couple of years ago, there was one doctor working in Lemington. He then left the practice. Having been approached by local people, I asked the health authority how people in Lemington were to gain access to primary care. The health authority told me that there was a perfectly adequate, indeed very good, practice about two miles west of Lemington, in a community called Newburn. In fact, the nearest practice is at the top of the hill. Anyone who has ever walked up the banks of
11 Nov 2004 : Column 977
the Tyne will know how steep they are. The hill leading from Lemington to the nearest community, about three quarters of a mile away, rises 300 or 400 ft. That is not the kind of gradient that an elderly person should be expected to negotiate.
At the top of the hill, on a plateau, is a relatively more affluent area called Chapel House and Chapel Park. There are two doctors' practices within 50 m of one another, each with about six partners. I asked the health authority "Do you think this is the right distribution of resources? Would it not be better if at least one or two of the partners in the two practices at the top of the hill moved a little of their operation to the bottom, where the poorest people live?" The health authority said "We will do what we can, but we cannot compel doctors' practices to locate themselves in any specific place." In that case, I asked, could the authority employ a doctor directly? The authority said that there was a limit to the number of doctors that it could employ directly, and that Lemington did not warrant the appointment of an employed doctor because there were enough doctors in the overall outer-west area. I could not disagree with that in statistical terms.
The question is, why does the authority not have power to require the two practices at the top of the hill at least to provide some facility at the bottom, where the need is greatest? The irony is that far more people own cars at the top of the hill than at the bottom, where there are elderly people and young mothers, many of them single.
The Government should look at the regulations governing the primary care trust. I do not think it right that we cannot require people who are publicly funded to locate themselves in areas of greatest need. The people of Lemington did not expect six doctors to go down to the bottom of the hill, but it would be an improvement if just one or two of the partners were prepared to work from a centre for at least some of the day, or some of the week.
There is, in fact, a new centre at the bottom of the hill in Lemington. It is one of those projects funded partly by regeneration money. There will be some nurses there. That great new facility could be financed because of the increase in health resources, but there is still no doctor for it. That is ridiculous, but the PCT tells me that it can do nothing.
I think that this is a real problem. I hope that the Minister will address it, if necessary taking advice from the health authority in Newcastle. If it turns out that the authority has interpreted its own regulations accurately, I hope that the Minister will consider the possibility of change to provide more flexibility, so that the authority can reallocate resources as circumstances and priorities change.
3.32 pm
Mr. David Amess (Southend, West) (Con): I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on his speech. I agreed with everything that he said. My only criticism would be of his moderate language. There is no doubt that this is a centralising Government: there is not one aspect of our daily lives in which they are not prepared to interfere.
The first thing I ask the Minister to do is stop bashing doctors. The Government bash teachers, they bash the police, they bash our defence forces, they bash doctors,
11 Nov 2004 : Column 978
and the professionals find it absolutely repugnant. Labour Members recently started bashing each other. That I am not too bothered about—in fact I rather enjoy it—but I do think that bashing the professionals is deeply repugnant.
The Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), who is no longer present, spoke about the marvellous atmosphere among GPs. He comes from the area that I represent. Were he to meet GPs in Southend, West, he would find that morale is currently pretty low. Let me give an example. I have received a letter from a local GP. On the "target culture", he said that
"everything we are being asked to do is dominated by collecting numbers and reaching targets. This means that clinical priority is often put behind reaching targets. This is difficult for both primary care physicians as well as hospital doctors.
This government is obsessed by the need for patients to be seen in 24 hours by a nurse and within 48 hours by a GP. To reach these targets the Modernisation Agency has introduced 'advanced access'. This means that in many surgeries patients who need urgent help in fact end up phoning or contacting the surgery for several days before getting an appointment. This means that they are waiting much longer than they used to. It is particularly difficult for elderly people. Doctors should decide when patients are seen and in what priority and should be left to run their own businesses."
On information technology, I do not want to be too unfair to the Minister, given that the Health Select Committee has been graciously invited to Richmond house on Tuesday. I am informed that we will be given
"a demonstration of the Choose and Book software which will enable GPs to make direct referrals to Secondary Care and a demonstration of the NHS Care Records Service which will allow the sharing of consenting patients' records across the NHS".
However, another GP wrote to me saying:
"Primary care doctors now feel more like data input clerks than general practitioners, spending much more time than ever inputting information into computer systems in order to reach targets that achieve points that have no proven clinical basis. Doctors striving to reach these unrealistic targets solely to reap the financial rewards that this brings, are compromising good standards of clinical care and 'Points mean prizes' are now the watchwords . . . . The data input requirements that are part of the Quality Outcome Framework mean doctors spend much time staring at their computer screens during what should be 'face-to-face' consultations. There is a general feeling of frustration that the data collection is detrimental to patient care. The public, who are ultimately funding the massive increase in health spending, frequently complain to primary care providers that they are seeing little in the way of improvement and know full well that there are lies, damn lies and statistics and do not believe the figures put out by the Department of Health."
As the Health Committee Chairman said, the Committee produced a report on this issue in July; indeed, the Minister of State, the right hon. Member for Barrow and Furness, gave evidence to us on it. This issue is obviously important. Approximately 9 million patients receive urgent primary care out of hours, and as the report states,
We took evidence from a number of organisations, and again to be fair to the Minister, as the report states,
"West Hull and East Anglia . . . both . . . appeared to be well advanced in developing innovate solutions to providing GP out-of-hours services for their local populations."
However, it appeared to us that the preparedness of primary care trusts was not uniform across the country. In giving evidence, the NHS Confederation expressed the view that
Having listened to the contribution of my hon. Friend the Member for New Forest, West (Mr. Swayne), one can see the extent of that inconsistency. The NHS Confederation felt that PCTs displayed a lack of understanding of out-of-hours issues and in general were not ready for the responsibility that they are being given. That is very worrying. It also said that PCTs are seen as being reactive rather than proactive. Few primary care trusts were working positively with GP co-operatives, which were mentioned earlier. Indeed, often, instead of being adversarial, they were actually in conflict. Dr. Mark Reynolds gave evidence, saying that people in PCTs were taking on the job "with no real experience". If we consider how important the service is, that is very worrying. The Health Committee felt strongly that PCTs across the country were not universally prepared. The Government certainly need to do something about that.
A local GP wrote to me recently to advise me that there was "considerable concern" about the out-of-hours services being taken over by primary care trusts. He said:
"Many are starting a new service with no previous experience. They have not really consulted the GPs in the locality about how the service will run. They have not asked for advice in setting up the service. The whole thing is being rushed and is a recipe for disaster".
I end with those thoughts: as we all know, everything is driven by primary care trusts now.
Unlike any other hon. Member present, I attended the Committee stage of the Bill that introduced primary care trusts. If anyone took the time to read the Committee proceedings, they would see that every single point raised by Opposition Members has, sadly, come to pass. A GP who wrote to me said:
"General practitioners were conned with the set up of PCTs. Some five years down the line, the ability of local practitioners to have any influence whatsoever on how services are commissioned or run in their area is minimal. They have no power on any PCT board and are often totally ignored."
That was not how the idea was sold to the country five years ago. I hope that the Minister, the hon. Member for Doncaster, Central (Ms Winterton), will take the opportunity when replying to the debate to praise the work of our GPs, stop bashing them and reassure the public that they will be given good quality out-of-hours services. Let us hope that the information technology on which the Health Committee is to be educated on Tuesday will not prove as deficient as it appears to be at the moment.
3.42 pm
| Next Section | Index | Home Page |