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Making sure that every citizen has access, free of charge, to a local GP if they are sick or worried about their health was the major premise on which the NHS was established, by a Labour Government in the face of fierce opposition from the Conservative party and its
allies in the profession 60 years ago—it is really good to commemorate that in this anniversary year. We continue to support that premise. The role of the general practitioner as provider and commissioner of care, and as a strong advocate for their patients’ health and well-being, is central to everything that we are doing. It is why we have made an unparalleled investment in GP services, from £3 billion in 1997 to £8 billion today. It is why there are now 5,318 more GPs and 4,471 more practice nurses than there were in 1997. It is why GPs now spend, on average, 50 per cent. more time with each patient than they did in the 1990s. And it is why we have increased the pay and reduced the hours of GPs, thus resolving a serious recruitment problem, while introducing a quality and outcomes framework regarded with admiration around the world, which helps to make GPs central to the care of people with long-term conditions, achieving documented improvements in health outcomes for conditions such as asthma and diabetes. The Tory motion describes all of that as “undermining and undervaluing...GPs”. I can think of lots of professions that would love to be undermined and undervalued in such a way.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): Given what the Secretary of State has just said, does he agree that GPs represent one of the most cost-effective and efficient aspects of health care in the UK?
Alan Johnson: I believe that absolutely. GPs are fundamentally important to everything that happens in the NHS, and we have world-class primary care. That is why we have introduced those measures over the past 10 years—to bring in more investment and to attract more GPs, while ensuring that they are better rewarded and can spend more time with their patients.
Let me deal with the rather pathetic attempt by the hon. Member for South Cambridgeshire (Mr. Lansley) to misrepresent our position. There is no national policy for replacing traditional GP surgeries with health centres or, indeed, polyclinics. There are no plans to herd GPs against their will, or the will of patients, into super-surgeries. We are not seeking to reduce the number of GP practices. I quote from the interim report of my noble Friend Lord Darzi—this also answers the intervention made by the hon. Member for Mid-Bedfordshire (Mrs. Dorries)— who said:
“More than 80 per cent of NHS patient care takes place in primary care... Our registered GP list system is renowned internationally. Our primary care system co-ordinates care for patients in a way few other countries match. There are strong bonds between staff and their patients, families and carers.”
Mr. Stewart Jackson: One always knows that the Labour party’s arguments on health are vacuous when it is shroud-waving about the events of 60 years ago. In the week when the Government’s own Back Benchers are revolting—even more than normal—over the abolition of the 10p tax band, is it not ironic that these proposals will potentially have the most significant impact on the oldest, the poorest, the sickest and those with the least voice in Government and policy making? That is from a Labour Government of 11 years’ standing.
Alan Johnson: The hon. Gentleman will have to do better or I will not allow him to intervene again.
What are we doing? What is the destructive policy against which the Conservative party has decided to take up arms? Of what crime against humanity are we guilty? What devastating blow are we dealing to communities throughout the country? We plead guilty to investing an additional £250 million to enable the local NHS to develop more than 150 GP-led health centres in every part of the country, open seven days a week from 8 am to 8 pm, and more than 100 new GP practices in some of the most deprived areas of the country—deprived not just in terms of poverty but in terms of people’s inability to access primary care because they live in so-called under-doctored areas. A clear correlation is seen in the areas with the lowest life expectancy and the fewest GPs per head of population.
What is the Conservative party’s policy for dealing with under-doctored areas? We see it in the rather vacuous petition—“anodyne”, as one GP described it—that they have launched. It says that GPs should be free to determine where they practise. That is the situation now and, by and large, they do not choose to practise in deprived areas in sufficient numbers. If they are to do so, under the Conservatives’ primary care policy, it must be for more pay. In the words of the petition, they must be
“rewarded for working in socio-economically deprived areas.”
The Opposition motion asks right hon. and hon. Members to support
“rewarding GPs who choose to provide services in deprived areas”,
but the inequalities of access have existed for 60 years. By and large, GPs have chosen not to locate in such areas, which is why we have taken the decisive step of investing new money in new health centres to provide extra services—not to replace existing services. Those health centres will have a strong focus on the promotion of health and the prevention of health inequalities. Most will provide physiotherapy, pharmacies, district nursing and minor surgery services.
Andrew George: A moment ago, the Secretary of State said that he pleaded guilty to making a major investment in primary care, and without question the extra money is welcome. However, he is not pleading guilty to contradicting his welcome words of 4 July last year, when he said that he would give the NHS a
“sustained period of organisational and financial stability”
“there will be no further centrally dictated, top-down restructuring”.— [ Official Report, 4 July 2007; Vol. 462, c. 962.]
If he wants to realise those aims, why does he not allow local communities to decide how best to achieve the objectives, which he rightly identifies, that will meet the needs of deprived communities, instead of having this centrally dictated, top-down restructuring, which could produce the same sort of ridiculous results as the independent treatment centres that have wasted millions of pounds in Cornwall?
Alan Johnson:
I announced last July that there would be no more structural reorganisation in the NHS—no more changes to strategic health authorities and no more merging of PCTs—and we have kept to that. As I hope the hon. Gentleman will accept when I come to
the gist of my speech, we are not imposing a top-down measure. We are providing £250 million for investment in the expansion of the primary care service, mostly to take services away from hospitals and bring them into local communities. That is the major reason for the investment.
Dr. Brian Iddon (Bolton, South-East) (Lab): Does my right hon. Friend agree that in areas such as mine, which is a heavily and densely populated one, with narrow streets and little car parking, many GPs have welcomed the chance to move into modern premises with car parking for ambulances and patients’ cars, and the ability to expand their services and share support staff?
Alan Johnson: Indeed, and that is the experience throughout the country. It is the experience of my constituency, which the constituency of the hon. Member for South Cambridgeshire is a long way away from. In Hull, there has been a revolution in primary care services, which is happening in cities and communities throughout the country.
Tom Levitt: Further to my right hon. Friend’s point, I am grateful for the assurances that he has given about structural change and GP practices. Has it not been the case over the years that GPs have, by and large, migrated from single-handed practices into common practices precisely because they can deliver more and better services on the spot? Will he ensure that there is no ban on single-handed practices, while acknowledging that the pattern may well be for such practices to refer patients on to multiple-handed practices so that people can receive their care locally?
Alan Johnson: My hon. Friend makes an important point. We can take the example of London, where polyclinics are a specific proposition. A review of health services in London, carried out by NHS London and involving London clinicians, pointed out that for 40 years people have been trying to revamp, reorganise and update services there. In London, 54 per cent. of GP practices are single-handed, compared with an average of 40 per cent. throughout the country, and 97 per cent. of patients have to go to hospital for out-patient appointments. That figure stands at 90 per cent. in the rest of the country, which is still too high. The vast majority of people want to access such services in the community. In London, we have the worst problem of people going to A and E and clogging it up when they should go to primary care. That is why Lord Ara Darzi, working with clinicians in London, has devised a specific model for London, which is not a blueprint for the rest of the country.
Mark Simmonds (Boston and Skegness) (Con): The Secretary of State said that the policy was not centralised or imposed. If a primary care trust told the Department that it did not want to provide a polyclinic, but preferred to use the resources in another way, would he allow it to do that?
Alan Johnson:
There would be no problem with that, given that we are not specifying polyclinics as any part of the exercise. The crucial point is that the local NHS will develop services in ways that best meet the needs of
the local population by engaging members of the public and local doctors, nurses and other health care professionals. That is the way to implement the proposal.
Norman Lamb (North Norfolk) (LD): The Secretary of State referred to the extra investment in new practices in under-doctored areas, and I fully support that. Does he agree that it would be ludicrous if the operation of the GP contract results in financial incentives being greater for practices in the leafy suburbs than for those in disadvantaged areas? Practices in disadvantaged areas receive less pay on average than those in wealthier areas.
Alan Johnson: That is an important point for our health inequalities strategy, which we will publish soon. As Lord Ara Darzi pointed out in his interim report, it is also a major issue for his continuing work.
Rob Marris: I welcome my right hon. Friend’s remarks. May I urge him not to give in to the calls for a free-for-all for GPs? It has not worked in cities such as Wolverhampton. As a bit of an old Labourite—I know that he is, too—I want a bit of planning. I want a bit of planning from the excellent Wolverhampton primary care trust, engaging with local people. However, I also want some accountability on the part of the PCT, because it is not as accountable as it should be. Even though it does an excellent job, we need more accountability by primary care trusts.
Alan Johnson: I am tempted to say that, if a bedpan falls on the floor in a Wolverhampton hospital, I expect it to echo around Whitehall, to paraphrase Nye Bevan’s famous centralising edict. My hon. Friend and the hon. Member for South Cambridgeshire make a fair point about PCT accountability. As part of the review and our attempts to construct a constitution for the NHS’s 60th birthday, we need to introduce greater accountability, especially as we distribute to PCTs a far greater proportion of the central pot than we have ever done.
Tom Levitt: I am grateful for my right hon. Friend’s reassurance about polyclinics. When I first heard the word, I thought that a polyclinic was for treating people who were as sick as a parrot; clearly, I was wrong. Will my right hon. Friend clarify exactly how, in principle, a polyclinic is different from, for example, the three GP practices in Buxton, where five, six or more GPs, practice nurses and other health professionals work in one area in a system that has evolved over the years to provide better health care for people locally?
Alan Johnson: Those definitions of a polyclinic and a health centre—
Mr. Lansley: It would be useful to know.
Alan Johnson:
The hon. Gentleman says that it is useful to know. In the London context, we are considering including services that were previously perceived as secondary in primary care services, thus providing an integrated service, whereby patients can access a far wider range of services than they could traditionally. However, I must say that we have had such services in Hull for years and never called them polyclinics. The chief executive of the NHS said that he went to a place recently and was told that it did not
want a polyclinic. He was speaking in a community hospital, which was, to all intents and purposes, a polyclinic. There is, therefore, a problem with definitions.
Dr. Andrew Murrison (Westbury) (Con): The Secretary of State began to discuss public engagement, and engagement with stakeholders is important, but will he reassure us that there will be no more ridiculous, sham consultations on reorganising primary and intermediate health care? Such consultations happened in Wiltshire, where three of the four community hospitals closed, much against local people’s wishes.
Alan Johnson: The Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), tells me that that horrendous action was supported by the Conservative-run overview and scrutiny committee. However, I accept the tenor of the hon. Gentleman’s points. In the big reconfiguration in Greater Manchester, there was an absence of proper involvement and engagement by the public in the early stages. When the proper engagement took place, we reached an acceptable solution, which everyone supported locally.
There has been a move towards group practices, but that has been driven by GPs as a way to improve services for their patients. In my constituency, single-handed practices are increasingly moving into fabulous new health centres, with an investment of £14.8 million in new facilities, rising to nearly £30 million by 2009 under the local improvement finance trust programme, which is transforming primary health care in our city. However, what works for Kingston upon Hull will not necessarily be right for Kingston upon Thames. It does not mean the end for single-handed practices, many of which provide an excellent service to patients across the country; they will continue where they are right for patients.
Mr. Charles Walker (Broxbourne) (Con): As the Secretary of State knows, I campaigned in my constituency for an urgent care centre as part of the effort to ensure that hospital reconfiguration in the area did not leave my constituents short of services. My constituents want the reassurance of an urgent care centre, but they also want GP practices where there is a familiar, friendly face. Can the Secretary of State give an assurance that people will have a family doctor, who comes out on visits and is there for them?
Alan Johnson: Of course I can. Two central fallacies underpin the Tory party position. The first is that we are imposing a system of polyclinics throughout the country. We are not. The second is that, if an area has a group practice or a health centre, or if GPs decide to move into much better facilities where several practices operate together, people can no longer see their own GP. That is nonsense. It is wrong to suggest that the proposals signal the death of the important patient-GP relationship; they do not.
Individual, single-handed GP practices will continue to operate where they are right for patients. When we talk about developing health centres, or what some local parts of the health service describe as polyclinics, we are not considering a single, fixed model of care. Those terms describe flexible models for bringing
primary care together with a range of other services, be they diagnostic services, specialist care for patients with long-term conditions such as diabetes, or adult social care. It is hardly a novel idea. Health centres featured in the earliest descriptions of the national health service in 1948. Examples abound of GPs, nurses, specialists and other health care professionals coming together to provide integrated care for patients. With advances in new technology and medical science, we can and should do that to a greater extent in much more imaginative ways.
We are also guilty as charged of expanding access both through the new health centres and the new arrangements that we are introducing for extending opening times at GP surgeries in the evenings and on Saturday mornings. The Conservative party appears to have adopted wholesale the distorted view expressed in some quarters of the BMA and articulated by the right hon. Member for Witney (Mr. Cameron), who believes that the cash-rich, time-poor professionals—I paraphrase from his speech on Monday—who need to get their back problem fixed, as well as some jabs for a business trip to India, will be the main beneficiaries. One has only to visit practices that are already open for longer in the evenings and weekends to find that it is not, as so often claimed, a service for the worried well. Those who are most likely to benefit from extended hours are manual workers worried about taking time off, parents balancing child care responsibilities, certain ethnic minorities who are most dissatisfied with current access arrangements, and those very pensioners and mothers with young children, who are said by opponents of extended hours to want only a Monday to Friday service, with a half day on Wednesday.
Mr. Lansley: I am grateful to the Secretary of State for giving way. When we had a debate on the issue three and a half years ago, the precise point made by the right hon. Member for Barrow and Furness (Mr. Hutton), then a Health Minister, was that the Government were planning a new system of what were called walk-in centres, which would give patients greater access and enable them to receive medical care in the evening and at weekends. What has happened to walk-in centres? The Minister here today promised to publish a review of walk-in centres last summer. It has not been published, but simply dropped in some distant part of the Department. Are walk-in centres not the mechanism that the Government said should be used?
Alan Johnson: Bristol university has already conducted an assessment of walk-in centres. It said that they were good on quality and accessibility, but that more work needed to be done on their finances. That work is ongoing and forms part of the Darzi review.
Mr. Neil Turner (Wigan) (Lab):
May I tell the Secretary of State about a new health centre in Wigan called Boston house, which has been open for three or four years? Taking some of the services and moving them there has transformed the lives of many patients living in the area that I represent. We are talking about a health centre outside a general hospital that provides renal services. People in Wigan have always had to go to Bolton, Salford and other places nearby for renal dialysis.
Now we have that in Wigan, located in primary rather than secondary care. Is that not what health centres are all about—transforming the lives of people by taking things out of secondary care and into primary care?
Alan Johnson: That is a perfect example of why we should thank the Conservative party for allowing us to have this Opposition day debate, when we can highlight the important improvements being made throughout the country. We offer better access and improved facilities. What do the Tories offer? They offer a petition for GPs pronouncing on their absolute right to put their own interests before those of the public.
Alan Johnson: So says one of the architects of that petition. It is clear what the petition is about. I have heard the arguments from various quarters. In that petition we hear the hallowed cry of those who ask why they should have to open on Saturday, when their accountant, working in a similar profession, is not open on a Saturday. As one GP down in the west country put it to me in wonderful terms the other week, “If the public are seriously worried about their health, they should be prepared to take time off during the week to come to my surgeries”—at times that suited him, obviously. What we have in the Opposition’s petition is the articulation of all that. It says that GPs should be
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