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The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I begin by congratulating the right hon. Member for Berwick-upon-Tweed (Mr. Beith) on securing this debate. I know that this issue is very important to his constituents, and particularly to the families and others whom he mentioned or alluded to; I join him in recognising that importance. I am sure that he will join me in congratulating the NHS staff in Northumberland on their work. They are dedicated to delivering high quality services and they deserve our admiration; they doubtless enjoy his, as well as mine.

I want to begin by saying a little about the policy of out-of-hours medical care. We said that we would introduce these changes in April 2002 and as a result of them we have devolved funding locally, so that people can get the services that they deserve locally, and that decisions can be made at that level. The right hon. Gentleman doubtless fully endorses that principle, given that he believes in taking as many decisions as possible at a local level.

The change to the contract supports the development of an integrated system of high quality out-of-hours care. The right hon. Gentleman said little about integrated systems but he mentioned other good examples of such provision, to which I shall come in a moment. The previous arrangement often involved sub-contracting out to GP co-operatives, but now practices can themselves transfer such responsibilities to primary care trusts, as the lead commissioners of NHS services in their areas. That enables PCTs to rethink and reconfigure the provision of out-of-hours services, and to co-ordinate them with other services such as accident and emergency, social care and NHS walk-in centres, where such centres have been opened. The long-term aim is to have a seamless, integrated and unscheduled care network that brings together all services in meeting patients' unplanned needs.

I recognise that the right hon. Gentleman's comments suggest that the situation in Northumberland is not working out as it should, but before I deal with the points that he raised I want briefly to mention the investment that we are putting in. As he rightly said, we have increased such investment significantly. We have doubled this year's out-of-hours development fund to £92 million, we have provided additional resources of £14 million to assist PCTs in very rural and urban areas, and we have made available to PCTs £30 million in capital incentives. In addition, some £180 million is available that was previously given to practices to pay for out-of-hours services; under the new contract
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arrangements, that money goes to the PCTs. To save the right hon. Gentleman some arithmetic, that totals some £316 million.

Mr. Beith: As I understand it, Northumberland does not qualify for the rural benefit because it is a mixture of a very urban area and an enormous rural area. The Minister might like to consider that point.

Miss Johnson: I am very happy to do so and the right hon. Gentleman may well be right. A number of mixed areas sometimes fall foul of this problem; none the less, there has been investment in the health service in Northumberland as a whole, and a big increase in the number of GPs—from 231 in September 2001 to the current figure of 272. That is an increase of 18 per cent., so it amounts to a substantial increase.

I have already mentioned the arrangements that we believe should work and the opportunities that they provide. As the right hon. Gentleman knows, GPs in Northumberland opted out of providing cover out of hours, although 30 per cent. of doctors there still provide a service under the Northern Doctors Urgent Care arrangement during the week—and they are local doctors. Various arrangements are being put in place, including one GP on duty after midnight at either Alnwick or Berwick, and a driver is supposedly available overnight. I take note of the right hon. Gentleman's comments on that. The majority of local doctors do not provide weekend services and that is when agency doctors are mainly used. A large team is on call, which should allow for flexibility in travel arrangements. The aim is to work to achieve the targets of responding to all urgent calls within two hours and to non-urgent ones within six hours. Again, I note the right hon. Gentleman's comments about the time scale of some of the calls that he has drawn to the attention of the House.

As a result of examining the issue, and mindful of the fact that the trust has had a few months to see the system operate, I am pleased to say that the two trusts—I agree with the right hon. Gentleman about the confusion of the names—jointly agreed to review urgent care systems across the county, and it is expected that the review will be concluded by the end of February. I trust that it will be concluded at that time, as I appreciate that many of the issues raised by the right hon. Gentleman are of significant concern to his constituents—and rightly so. I am aware of worries about journeys to Wansbeck. Sometimes, such journeys are necessary to provide the best possible clinical care, which can often be received only at a general hospital. I am sure that the right hon. Gentleman would not argue with that.

As to coverage, what we aspire to and what is being delivered in other areas is that the service provided should meet the national quality requirements provided by the primary care trust. The PCT must performance-manage the provider to ensure that that happens. Where the provider fails to meet the requirements, action has to be taken to deal with it. Clear times should be specified within which patients should receive an initial clinical assessment and receive clinical treatment, which may vary, depending on the seriousness of the condition or disease. Providers must ensure that patients are treated by the clinician best equipped to meet their needs in the
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appropriate location. Where a face-to-face consultation is necessary, it must take place within clearly defined time scales.

On some occasions, patients may need to travel. They may need to attend an accident and emergency, hospital or clinic-based outpatients' appointment, for example, and the PCT has a duty to recognise that the distance should not be unrealistic, though it should not preclude patients who urgently need a face-to-face consultation being seen within the specified time frame.

As I said, I am pleased that the strategic health authority announced today that it would undertake a review, and I trust that it will be conducted speedily. I will additionally ask the Recovery and Support Unit in the Department to ensure that it supports colleagues at the SHA in carrying out its review of services. The right hon. Gentleman might like to note that in February and March we are also bringing together out-of-hours providers and PCTs in a series of workshops across the country, to focus on ensuring the quality of out-of-hours services and how providers and commissioners can work together on managing performance.

In that connection, I promised that I would turn to the question of how the service is organised elsewhere—in central Cheshire, for example. It is across the other side of the country, but not a million miles from where the right hon. Gentleman is based. There, all 30 practices opted out on 1 April 2004. The PCTs established an all-encompassing out-of-hours service covering an area formerly provided for by five co-operatives. It integrates GPs, nurses and paramedics in a way that has not been widely remarked on. Triage nurses advise patients or refer them to treatment centres in Crewe or Northwich, and home visits are made by paramedics. Between 50 per cent. and 60 per cent. of the area's 140 GPs have agreed to do shifts for the PCT, and salaried GPs are also employed.

I could give other examples from around the country. People are configuring services to reflect how they can best be delivered. Clearly, issues arise in respect of an area's pattern of towns and settlements, as well as its geography and provision of GPs, hospitals and other services. However, a number of areas have taken a creative approach to producing a better and more seamless service, with a much wider skills mix among the people who provide the care. There is a much better
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distribution than was the case historically of the way in which patients are seen by GPs with the relevant skills, at the relevant time and in the most relevant place.

Mr. Beith: May I observe that, under the old system, we were lucky? We had a well integrated GP and hospital service. The GPs provided the hospital night service and used that as the base for attending house calls. Will the Minister clarify how the Secretary of State's promise that there would be Saturday morning surgeries will be met? Patients who are not emergencies but whose needs are pressing must be able to know that they can see a doctor on a Saturday morning.

Miss Johnson: People can see a doctor on a Saturday morning, as I am sure the right hon. Gentleman appreciates. The question of whether they can see their own doctor is a separate matter. Whatever his criticisms of the provision in his area, I understand that people in Northumberland are able to see a GP on a Saturday morning, and that there is no problem about access normally. I do not think that I can say anything more about that.

I shall also ensure that the SHA looks at the regular performance reviews of the interaction between the commissioner and the provider, and that it will consider matters such as performance, capacity, contingency arrangements and the suitability of commissioned out-of-hours service. Prompt action should be taken to resolve any problems that arise.

I appreciate that this is a serious matter, and that the right hon. Member for Berwick-upon-Tweed has raised issues that we must be sure that we can deal with. The SHA and the PCT must also ensure that they can deal with these matters. However, I assure the right hon. Gentleman that we take his comments seriously, and that the local trust will want to address the matters that he has raised.

The PCT is in the lead when it comes to service provision, and the right hon. Gentleman and I will agree that local decisions are best made locally. Appropriate investment has been made to render that possible, and I am sure that the relevant local bodies will be keen to ensure that health provision is up to the standard that we all expect in this century. We want out-of-hours care to be targeted as much as possible in the appropriate way, and to be available to people as necessary, regardless of the hour of day or night.

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