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Dr. Andrew Murrison (Westbury) (Con): We have had a good debate this afternoon. We have had a total of six Back-Bench speeches and some very good contributions indeed. It is regrettable that the speech made by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) was not listened to more closely by the Minister who replied to him. The Minister gave us a rendition that he had clearly written some time ago. My hon. Friend was trying to be helpful, as always, and it is a pity that his remarks were not reflected on more closely when the Minister came to make his speech. I am sure that his colleague will not fall into that trap when she comes to make her comments.

It is a time of enormous change for general practice. It is arguably the time of greatest change since the inception of the national health service—in many respects, perhaps even greater than that. Many practitioners and certainly the general public are perhaps not aware of the enormity of what is going on. The bedrock of primary care is shifting. Doctors will no longer have a 24/7 commitment to patients; patients arguably will no longer have a doctor whom they can truly call their own. Functions previously carried out by physicians are now being carried out by others.

General practice was once the lynchpin of British health care and one of its most attractive features; it was unique in the world and renowned throughout the world. It may be that the changes that are under way will improve health outcomes. We must always be on the lookout for how we might improve services, but change brings risk and the risk is that a unique and cherished part of health care delivery in this country is beginning to decline. That is certainly the impression that one gains from talking to many medical colleagues. They have the feeling that perhaps they have seen the best. We have heard some humorous references in the debate to "Peak Practice" and "Dr. Finlay's Casebook". We can joke and laugh about it, but in truth I suppose most people's ideal vision of a general practitioner is someone who has time to listen, to manage chronic conditions and to have a long-term relationship sometimes over many generations with a family.

With so much change, there is little wonder that many in the medical profession are struggling to determine where they will fit into the new scheme of things. Many have accepted the new contract, but privately they fear for their future and that of their calling.
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The hon. Member for Leigh (Andy Burnham) gave us his impression of how things were, especially in urban areas. The Labour party does not have a monopoly on concern for those who live in urban areas or for the underprivileged. We shall have a White Paper next week on public health. I hope that the Minister will tell us how Ministers feel that they might improve the health of those who are worst off. I am happy to send the hon. Member for Leigh some figures that may be of interest to him on improvements in health that have happened among the less well-off since l997. We briefly exchanged some comments across the Floor of the House on that, and I think that he will be interested in the figures that the Department of Health has produced in that respect.

The hon. Member for Leigh may also be interested in the figures for recruitment in deprived urban areas, which have fallen in recent years. The number of applicants for positions in general practices has declined in deprived urban areas. I am more than happy to send him those figures.

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): The hon. Member for South Norfolk (Mr. Bacon) took 14 minutes, which denied me the opportunity to contribute. It is the legacy of my Tory predecessor that I represent the poorest ward in England. We do not have a recruitment problem. Will the hon. Gentleman look at how the primary care trust in Plymouth is performing? The chair of the professional executive committee, Dr. Pete Williams, said to me only this morning—he has been doing a surgery this afternoon as we speak—

Dr. Murrison: I am grateful for that intervention. Plymouth is a city that I know well, and I fully acknowledge that it has its own particular problems. I am delighted that the gentleman enjoys his job. Until recently, I enjoyed being a general practitioner. It is a unique calling, and I am pleased to hear that good news.

My hon. Friend the Member for New Forest, West (Mr. Swayne) talked about Primecare and EMIS, which is used by 60 per cent. of GPs in the New Forest—slightly above the national average. I will say a little about IT if I have a few moments presently.

The hon. Member for Newcastle upon Tyne, North (Mr. Henderson) wants his PCT to be a little more assertive in determining where general practices are located. Given that many PCTs appear to be an arm of central Government, perhaps he might want to have a word with his right hon. Friend the Minister about that.

My hon. Friend the Member for Southend, West (Mr. Amess)—a member of the Health Committee whose remarks were, as ever, robust and knowledgeable—was worried about the collection of data and referred to the fact that points mean prizes in connection with the quality and outcomes framework.

The hon. Member for Luton, North (Mr. Hopkins) focused on spending, rather than outcomes. Of course, spending is relatively straightforward—we can all do that—but getting results is more difficult.
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My hon. Friend the Member for South Norfolk (Mr. Bacon) is, by now, an expert on the national programme for IT in the NHS, given his membership of the Public Accounts Committee. Again, I should like to make a few comments about NPFIT.

The new GP contract has thrown up a number of what are, I think, unintended consequences. We have heard about the demise of the Saturday morning surgery. It is perhaps ironic that, when we are seeing a reduction in out-of-hours services and Saturday morning services, we see the creation of walk-in, quick and easy clinics at railway stations. Most of our constituents want to see their own doctor if they possibly can, and I wonder about the Government's priority in that respect.

I should like to talk briefly about community hospitals. Again, an unintended consequence and perhaps something that the Government have not thought through properly is the threat to community hospitals. I have four such hospitals in my constituency, two of which have been badly affected by the new GP contract and threatened. Previously, GPs have given their services more or less for free to community hospitals because they have been on call out of hours and can bolt on their services to community hospitals relatively easily. Now that they no longer work out of hours, they are looking again at that commitment to community hospitals. Community care cannot be provided without out-of-hours cover. GPs would like to cover community hospitals in most cases; but, frankly, they are more or less doing so for free, and I very much hope that the Minister will consider that and reflect on the fact that the framework document for the new GP contract referred to the need to negotiate terms for GPs who work in community hospitals, but that was the last that we heard of it.

I should like to mention health MOTs because I suspect that they will become a large part of general practice in the future. Certainly, that is the hint that we get in the media. I have no doubt that the Minister will probably want to discuss that at some length next Tuesday, but I should like to sound a cautionary note. All hon. Members would like to see a wellness service—that is for sure—but those health MOTs and health checks should be based on evidence. We do not want gimmicks, because they are likely to divert resources from where they can be arguably better used.

This week, Doctor magazine felt that, under Government plans,


by which I think that it means traditional GPs—

Unless health plans are grounded in evidence and targeted properly, there is a real risk that they will be gimmicks and do very little to improve the health of the population. Health inequalities are growing under the Government. Such non-targeted schemes risk diverting resources from where they might have maximum impact.

NPFIT continues to be rolled out. We all agree that better IT is needed in the NHS, but we are perhaps at risk of indulging in some "group think". We are
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committed to a greater or lesser extent to that approach, so we are not prepared to think of alternatives. The predecessor programme—information for health—was bottom up, rather than top down, and we have perhaps lost some of the good points of that earlier proposal. I very much hope that Ministers will listen to GPs, who feel very badly let down, especially in relation to EMIS.

4.15 pm

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