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Family Doctor Services

11 am

Andrew Selous (South-West Bedfordshire) (Con): I am delighted to have secured this debate. Today, 1 million of our fellow citizens up and down the country will go to see their general practitioner. A fact that is perhaps not stated often enough is that nine out of every 10 consultations in the national health service are with a GP: about 1 million per day. I should like to start the debate by praising GPs for the fantastic work that they do on behalf of all our constituents. I should also like to praise all their support staff. I picked up a booklet in my excellent local surgery, the Kirby road surgery in Dunstable, and noted the two doctors who have been there the longest: Dr. O'Toole joined in 1980, so he has 25 years of continuous experience, and Dr. Curt joined in 1984. I was further interested to note that there are some 23 members of staff in that excellent surgery of four GPs. It is important that we do not forget to recognise the contributions made by practice nurses, receptionists and other support staff in our surgeries.

I want first to find out whether the Government are committed to supporting general practice and, in particular, to ensuring that there is a level playing field in relation to the new APMS—alternative provider medical services—private sector arrangements for primary care. APMS need not necessarily be a problem, provided that there is a level playing field. The example from secondary care, where independent sector centres have provided treatment at a cost that is 9 per cent. higher than hitherto in the health service, is illustrative. I should be grateful if the Minister reassured me that there will be an absolutely level playing field and that the Government are fully committed to supporting and taking forward general practice, because, by and large, it does an outstandingly excellent job.

Continuity of patient care is tremendously important to so many of our constituents. However, some of what the Government have done—clearly with the best of intentions—such as the 24 to 48-hour access targets, have undermined that continuity of patient care. Patients wanting to see their own GP, who has seen their particular condition many times before, are not as likely given those targets to be able to do so unless they are prepared to wait for a considerable length of time. Could the Minister enlighten us on whether the Government are reviewing their thinking? A commitment to general practice as a whole from the Minister would be welcome.

Secondly, I should like to consider the premises out of which GPs operate. I have spent a lot of time during the past few days talking to GPs and those involved in primary care in my constituency. I understand that the ring-fencing of funding for premises has, paradoxically, made the situation worse. Many practices in Leighton Buzzard, which is the largest town in my constituency, are quite desperate to know how they are going to be able to expand their premises. I learned yesterday that one major practice is extremely upset to find out that it has lost out on the second wave of premises development funding. It had hoped to get funding, and is looking to expand its premises, but Bedfordshire Heartlands primary care trust has told it that there will be no extra notional rent to pay the interest on the mortgage that the practice would need to take out to expand the premises.
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Leighton Buzzard remains one of the largest towns in the country to have no hospital—not even a community hospital or a minor injuries unit. Within the three counties to which I am closest—Bedfordshire, Hertfordshire and Buckinghamshire—many much smaller towns, and even villages, have their own community hospitals. Leighton Buzzard is a large town that takes a long time to cross, after which people have a journey of at least 8 miles to get to Stoke Mandeville, the Luton and Dunstable hospital or Milton Keynes general hospital. My constituents are seriously worried about that. That worry is exacerbated because Bedfordshire Heartlands primary care trust has a £14.3 million deficit. That is the unaudited figure; I understand that it could possibly rise slightly.

I spoke to the trust's chief executive this morning, and part of the reason for that deficit is that it has made a significant commitment to the QOF funding for GPs—the quality and outcomes framework—and has put nearly £3 million towards local GP practices. I very much welcome that, of course, but the huge deficit is a worry. I understand that there is a £50 million deficit Bedfordshire-wide. We are twinned with Hertfordshire under the strategic health authority, and it is a running sore of contention among all the Bedfordshire MPs—three Labour, three Conservative—that historically, Bedfordshire has kept within its budgets, whereas Hertfordshire has often overrun. It seems to us in Bedfordshire that those overruns have become entrenched and that Bedfordshire has lost out. The hon. Member for Bedford (Patrick Hall) has raised the issue many times from the Government Benches, and the three Labour MPs joined the three Conservative MPs from Bedfordshire to see the former Secretary of State of Health to discuss the matter. That issue remains as pressing as always.

Thirdly, I should like to mention the training of GPs. The Government set a target for some 2,000 more GPs between 1999 and 2004. They did pretty well, although they did not meet the target in full-time equivalent GPs: an extra 1,750 only were recruited. I am delighted that we have those extra GPs, but it is instructive that the British Medical Association estimates that we need around another 10,000 GPs nationwide if we are to serve our constituents properly.

I am extremely concerned to learn that in Bedfordshire and Hertfordshire—indeed, as I understand it, across the whole of the eastern region—there has been a 75 per cent. cut in the number of final-year, self-construct GP registrars. That is extremely serious. There were 16 in training in 2004–05, but there is now a budget across Bedfordshire and Hertfordshire to train only four. That is a significant cut in the budget. I first learned about that when I was making detailed inquiries for this debate yesterday. Could the Minister respond to that point? If she does not have the facts and figures at her fingertips today, would she agree to write to me about the matter, because if the figures are true, we will be in a difficult situation?

Dr. Andrew Murrison (Westbury) (Con): The training of GPs is highly important, and there have been cuts, as my hon. Friend is right to point out. Does he recognise that there has also been a reduction in the number of applications for GP registrar places? He might invite the Minister to comment on why she thinks that that is so. It could be owing to the reduction in the attractiveness
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of general practice and the commodification of primary care, over which her Government appear to be presiding.

Andrew Selous : My hon. Friend makes valuable points from the Front Bench, and I look forward to the Minister's response to them.

Fourthly, I should like reassurance from the Minister that her Government are fully committed to allowing GPs to practise in a variety of settings. Will she allow small GP practices with just one, two or three GPs who are providing a good service with which patients are happy to continue to practise, as well as the larger groupings of GPs? There are worries about that. I understand that it was reported at the end of March that the Department of Health's head of primary care development told a conference that a typical GP practice would in future have 10 or more GPs. Does that mean that the Kirby road surgery, which has only four GPs, will not be allowed to practise? Does that mean that Dr. Haq and Dr. Donald, who both have single-GP practices in Dunstable, will not be able to carry on practising? Those two practices score consistently highly on patient satisfaction. I would be very worried if there was any threat to our single-GP or small practices that are clearly meeting patients' needs.

I shall read some comments from a petition that I will shortly be presenting on the Floor of the House from 700 patients of a single-GP practice in Dunstable—I think that they are patients of Dr. Donald. One couple wrote:

Other comments included:

I could go on and on, but that gives a flavour of the comments and of how well regarded our small GP practices are. I know that there was great concern when Dr. Evershed closed his single-GP practice in Leighton Buzzard and when a single-GP practice in Markyate, which was just outside my constituency but served a number of my constituents, also closed.

May we have a pledge from the Government that there will be no "one size fits all" definition of a GP practice? Let GPs work in the framework that suits them best. Some GPs would hate to be on their own in a small cluster and would much prefer to be with a larger grouping of 10, 12 or more GPs. Others are more individualistic and prefer the freedom and autonomy of working on their own or in a small group. We must have the flexibility to allow GPs, their practice nurses and their staff to work in the environment that is best for them.

My last point, which concerns information technology, is in many ways the most important given the financial implications. Computers are essential to every area of our life these days. The Government's national programme for information technology—I understand that it has been renamed NHS Connecting for Health—is budgeted by them to cost £6.2 billion. It is of great concern that there have been suggestions that
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that is a significant underestimate and that the true cost could be between £18.6 billion and £31 billion. Where will the extra £12 billion—or, possibly, £25 billion—budget overrun come from? My understanding is that it will be clawed back from the primary care trusts and from hospital trusts generally.

I speak as a former member of the Select Committee on Work and Pensions, which is relevant because the Child Support Agency has been trying for five or six years to get a new computer system up and running. There have been horrendous cost overruns and much suffering to our constituents as a result. Will the choose and book system still be operational by December 2005, as the Government have promised? Why is it necessary? Why is it so prescriptive? Why, for instance, will a GP have to prescribe two private sector options? Why not let the GP decide where the best places are locally to send local patients? Has there been a proper gateway review process on the massive amount of spending on IT?

Mr. Richard Bacon (South Norfolk) (Con): In the week that one of the local service providers for the national programme for information technology, which I believe is now called NHS Connecting for Health, has been sacked, does my hon. Friend agree that one of the problems is the Government's failure to understand that GPs are ahead of hospital IT and not behind it? The reaction of GPs is not because of their being Neanderthal, but because they are afraid of having imposed on them systems that replace those that work but which, in some cases, have not yet even been written.

Andrew Selous : My hon. Friend makes an excellent point, which I will not repeat.

Will the Minister give a reassurance that in the typical 10-minute GP consultation the national programme for information technology and choose and book will not be so onerous that more time is spent looking at a computer screen than dealing with the patient? If the cost overruns are as significant as we have been led to believe, as has so sadly happened on many Government IT projects, where will the extra money come from?

11.16 am

The Parliamentary Under-Secretary of State for Health (Caroline Flint) : This is my first Adjournment debate as the public health Minister and I congratulate the hon. Member for South-West Bedfordshire (Andrew Selous) on securing it. As he rightly said in his opening words, the GP practice is the cornerstone of health care throughout England and Wales. I assure him that as the public health Minister I am keen to ensure that we continue to value the services provided at the primary level, an essential part of which are GP practices. We should also examine how we can develop those services.

In the past few weeks, I have received a number of different stock-takes on the issues that lead to treatment in the acute sector. It is clear to me and, I am sure, to everyone in this Chamber, that work at the primary end could help reduce the load on the acute sector, by ensuring that we prevent the development or worsening
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of illnesses which then need to be dealt with in a hospital environment. I assure the hon. Gentleman that my time, commitment and attention in this role will be very much spent examining how we can celebrate good practice. There is already a lot of good practice among GPs, in providing services directly and connecting with others to provide services for their patients. I want to make that clear from the outset. I am not the only one who signs up to that; across government there is recognition of the importance of primary care.

In the Department of Health it is clear that support for NHS primary care has never been greater. The Government's assistance to family doctor services has demonstrated itself in several ways. First, there has been an unprecedented increase in investment in primary care. Secondly, we have fostered innovation, with a greater range of services being offered to patients. We all realise, not only as MPs but as potential patients, that public information about the different forms of treatments available influences patients. In addition, as technology advances and as treatments improve, there are many more options at a GP's disposal in order to deal with an illness and to prevent one through screening or other procedures. The climate of medical advances, public concerns and public demand in which we live is very different from that when the health service started all those years ago.

Thirdly, we have increased the importance of primary care in the NHS. I assure the hon. Gentleman that we are set to continue that trend. In fact, my right hon. Friend the Secretary of State will launch a White Paper on primary care services in July. We want to engage all health professionals—of whom GPs are an essential part—MPs, councillors, the public, community organisations and other groups to help us examine what primary care people would like locally. That is not about wholesale reorganisations but about trying to engage in health at the most local level. Some of the issues we raised in our manifesto complement that. Fourthly, we have improved the rewards for NHS workers in primary care both financially and in terms of professional responsibility, and we continue to invest more money in the NHS than ever.

However, it is not just a case of having more resources but about how those resources are used and GPs in particular feeling that they have an influence over the use of resources at their disposal. Investment in primary care health services in England has risen by a third over the past three years. That increased spending means that more GPs work in primary care than at any time in the history of the NHS.

The hon. Member for Westbury (Dr. Murrison) raised a point about training. I agree that we must be constantly watchful and I will consider in more detail the issue of registrar GPs. However, the number of GPs increased by 3,752—13.4 per cent.— between 1997 and December 2004, and the number of practice nurses increased by 20.4 per cent.—nearly 3,800—over the same period. As a result, people can see GPs and practice nurses more quickly.

The hon. Member for South-West Bedfordshire talked about constituents being able to see a GP within 48 hours and a practice nurse within 24 hours and raised a concern about people not necessarily being able to see their own doctor in that 48-hour period. A small minority of GP practices do not provide longer-term
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bookings, and the Department of Health, strategic health authorities, primary care trusts and practices are actively examining that together. If someone needs urgently to see a GP within 48 hours, they should be able to do so, which is why we set that target. However, given that GPs have to manage their own practices, it may not be known which GP they will see.

On the other side of the equation, people with ongoing illnesses should be able—as is the case in most practices in Don Valley—to book ahead and see the GP of their choice. In asthma and antenatal clinics, and other facilities in which there might be a specialist GP, that can be planned for. Therefore, it should not be the case, as came up during the election campaign, that people are told that only the 48-hour option is available to them. I am pleased to say that that does not happen in the majority of practices, and we are working actively with PCTs and other organisations to deal with cases where it does. As a Member of Parliament rather than a Minister, I cannot understand why most practices in Doncaster can deal with the problem through straightforward planning whereas others cannot.

Andrew Selous : Will the Minister write to me as soon as possible in response to my specific point about the cut in Eastern Deanery's funding, which has led to a reduction of 12 places—a 75 per cent. cut—in the number of final-year, self-construct GP registrars? That cut greatly concerns my local medical committee and I hope that the Minister will look into it and get back to me.

Caroline Flint : I will find out further details about that and write to the hon. Gentleman.

There are not only more GPs but more specialised GPs developing their expertise in particular areas depending on the service that they want to provide for their patients. There are also better facilities. Some 1,400 GPs with special interests deliver a range of extended services, such as dermatology, in a local setting that is convenient to patients. Since July 2000, 2,848 general practice surgeries have been replaced or refurbished as we modernise the NHS's infrastructure after years of under-investment. More money also means more services. Bedfordshire Heartlands primary care trust is investing £4.9 million this year in the treatment of people with long-term conditions, and has been developing means of care that will allow people to be treated at home instead of in hospital.

The hon. Gentleman talked about decisions on premises in his constituency, and I know that he has spoken with the chief executive of his local trust. He will be aware that a decision has not yet been taken on any premises and that the trust cannot give the go ahead to the Leighton Buzzard surgery plans independently of the other three premises being considered. I know that he is actively engaged with the PCT and I hope that the lines of communication are open so that he will feel that there is real engagement in determining the facilities to provide services to the local community and that his concerns are being addressed. No final decisions have been made but the PCT is considering the matter.
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One of the Government's priorities, as I hope the hon. Gentleman is aware, is to create healthy and sustainable new communities in the south-east. There are 44 PCTs in the four growth areas of Ashford, London-Stansted-Cambridge-Peterborough, Milton Keynes and south midlands, and the Thames Gateway, and the Bedfordshire Heartlands PCT falls within that area. We must deal with housing growth and the development of health services to meet the needs of population growth. I know that the PCT is considering those issues in the medium and long term, and additional funding has been incorporated to take account of that. Discussions must take place alongside development to deal with the long-term health care needs of the communities that he and other MPs in the surrounding area represent.

We are trying to provide innovative ways to access care to meet patients' demands. The hon. Gentleman raised concerns about the independent sector and whether its involvement at primary care level would too strongly undermine the role of the GP practice. We do not want to undermine the role of the GP practice but we are examining options for other service providers, which could include entrepreneurial GPs wanting to expand. As I have said, a number of GPs specialise in certain areas of health care and may want to use those skills to provide, for example, satellite services outside the GP practice.

The voluntary sector could also be involved. As a former Home Office Minister responsible for the national drugs strategy, I know that the voluntary sector often plays a key role in helping GP practices—for example, with referrals for drug treatment. There is no prescriptive, "one size fits all" approach; it depends on what services are needed. There is not a blueprint to be handed down. We want to engage GPs in the process and are not seeking to undercut them.

Andrew Selous : In the final moments available will the Minister deal with the cost overruns of NHS Connecting for Health, which could be as high as £25 billion and may come from primary care?

Caroline Flint : The hon. Gentleman raised scepticism about the choose and book system. One reason for creating the system is that it will deliver choice at the point of referral and booking, giving patients a choice of time, date and place for a first out-patient appointment. Also, GPs will be provided with instant information to make those referrals. It is planned that some 80 per cent. of practices should be using the choose and book system by the end of 2005. The system has been implemented through pilot schemes across England and that has provided a foundation for how the service will be developed. I will write to the hon. Gentleman about the finances if that is helpful. I acknowledge that some GPs have introduced their own computer systems, but it is one thing to have a computer system in an individual practice and another to have a connected system helping GPs to help their patients.

The hon. Gentleman raised the issue of time. Research carried out for the Department of Health by the health information company, Dr. Foster, found that discussing the choice of hospital lengthened GP consultations by just 36 seconds. Obviously that would
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not always be the case; for a start, it would depend on the patient and how many questions they ask. However, demonstrations and testing have shown that booking an appointment with a patient takes approximately one to two minutes. The heart of the consultation should be about what is wrong with the individual.

11.30 am

Sitting suspended until half-past Two o'clock.

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