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It is a state of total confusion [Interruption.] The hon. Member for Wolverhampton, South-West (Rob Marris) talks from a sedentary position about denying centralisation, but we know that there is a central imposition of a GP-led health centre in every primary care trust. There is no option; all trusts have to introduce them. I had discussions with the East of England strategic health authority, which made it clear that every PCT must have such a centre. In the case of Norfolk, for example, I was told by the GPs I met last week that the PCT has not yet even completed its review of its estatethe buildings it ownsto ensure that it makes the most effective use of
that estate. Suddenly, however, because the Government told the trust to do so, it has stopped doing that work and is now having to focus on the introduction of a polyclinicsorry, a health centrein Norwich.
Introducing a centre of that sort in Norwich does nothing for rural disadvantaged people who have no access to a car and have poor public transport. It also does nothing for the greatly disadvantaged community in Thetford, which has a low income level and has a great need to improve primary care services. The imposition from Whitehall of a GP-led health centre in the centre of Norwich will do absolutely nothing for those people. That is what frustrates so many.
lack of empirical and clinical evidence for... polyclinics.
Does the hon. Gentleman hope, as I do, that the Minister who replies will provide more substantial evidence of where the concept has worked? Countries in eastern Europe and elsewhere that have used it are retreating rapidly towards our own model in order to retain doctor-patient relationships and put a distance between doctors and specialists, and to deal with other issues on which polyclinics have foundered.
Norman Lamb: The hon. Gentleman makes a good point. I believe that policy should be based on evidence. The hon. Gentleman, who is familiar with north Norfolk, will know about rural disadvantage. In disadvantaged parts of Norfolk, a polyclinicor health centre, or whatever it is calledin Norwich will have no impact at all. As the hon. Gentleman says, we should also try to learn the lessons of experiences overseas.
Although this policy may be a partial solution in London and other major cities, I do not think it will translate to rural areas and suburbia in anything like the way that the Government imagine. The same has been true of policies on, for example, housing and trust schools.
Norman Lamb: The hon. Gentleman makes another good point. I want to say more about the concept of the health centre, or polyclinic. It seems to me that such schemes should be piloted to establish how they work in given settings, so that the lessons can be learned. I think that there is something in the concept for certain communities.
Last summer I visited the Arches centre, in a very disadvantaged part of Belfast. People in the Province have the benefit of health and social care trusts, which the Liberal Democrats support. That health centre combines various services. It brings together health and social care, and makes available to the community services that would normally be in a more remote acute hospital. That is a very attractive model. Surely we
should let these centres develop and grow, and then analyse their successes and, in some cases, their failures empirically before rolling them out across the country. What I find both extraordinary and frustrating is that, without such empirical evidence-gathering, the system is being imposed throughout the country on a ludicrously tight time scale. The Government should be condemned for that.
Dr. Stoate: I thank the hon. Gentleman for giving way to me again. He is being very generous with his time. Perhaps I can help him. I have a letter from the commissioning lead for one of the primary care trust consortiums in my constituency, who says precisely the same about the need for piloting. He writes:
The intentions of the bids are to encourage a range of pilots that will explore the potential and flexibility of the concept.
existing health facilities which could be adapted or expanded... on-going developments
I do not understand where the hon. Gentleman is coming from when he says that there is no flexibility and no ability to pilot. That letter makes it entirely clear that the flexibility exists. [Interruption.]
Norman Lamb: As my hon. Friend the Member for Southport (Dr. Pugh) observes from a sedentary position, everyone is compelled to pilot. I do not consider it a pilot approach to tell every primary care trust that it must introduce a GP-led health centre.
Mark Simmonds: Perhaps I could assist the hon. Gentleman. It was set out in a press release accompanying the Labour partys local election campaign that the Secretary of State and the Minister launched in Exeter about 10 days ago.
Norman Lamb: I am grateful to the Conservative spokesman for that information. It is of some concern that the Chair of the Select Committee on Health does not appear to know what the Government policy is.
There seems to be a conflict in the Governments approach to the NHS. They talk of empowering patients and responding to what they really want, but when it comes to the crunch they always opt for a model imposed from the centre.
The Phoenix centreI do not know whether it is a medical centre or a health centre, but it is certainly not called a polyclinicis just outside my constituency, and serves some of my constituents. It has been open for about three years, and provides social care as well as health services. It is so popular that, as I said earlier, it is extending its hours and its services. As far as I am aware, that model was not centrally imposed on the excellent Wolverhampton
PCT, but it worked, and it will be more or less replicated elsewhere in the city because it has been so successful locally.
Norman Lamb: I entirely support that approach. As I said earlier, I should prefer a PCT that decided to adopt it to be democratically accountable to the community that it served, but I have no difficulty with the concept. What I have difficulty with is the Governments telling every PCT to complete the process by the end of the year. That appears to be the model that they are imposing.
As I have tried to make clear, I am in favour of examining the principle. It is entirely sensible to trial the idea of taking diagnostics away from more remote acute hospitals and integrating services, and to learn lessons from the experiment. However, as was pointed out by the hon. Gentlemans colleague the hon. Member for North-West Leicestershire (David Taylor), concerns are emerging from the adoption of that approach in other countries, and those lessons should be learnt as well.
One legitimate concern is the eventual loss of the network of local GP surgeries, about which many people will be very anxious. If this kind of model is to be adopted, I think that a rural community hospital should be used as a basis for the development of such an extended range of services. We in Norfolk are in a ludicrous position. We face the loss of a community hospital in Aylsham, a market town, and we are seeing the loss of beds in other community hospitals. Surely we should develop existing, trusted centres of excellence and take the consultants out of acute hospitals, ending the divide between primary and secondary care and providing genuine local care for those who need it.
I want to say a word about the Conservatives. I think there is a degree of hypocrisy in their complaint about central control. They have conveyed the clear message that they dislike the degree of central control exercised by the present Government, yet they propose to introduce a CSA-style unaccountable quango, presumably based in London, to direct the national health service. The Child Support Agency is rather unpopular, and I suspect that when people find that their local hospital is to be closed by a centralised unaccountable quango in London, they will regard it much as they regard the CSA. There is no democratic local accountability in that, and the Conservatives know it. They reject this model, and decide instead to retain the idea of a centralised system. That is even worse than the Governments approach, which at least involves some democratic input in the House.
The Conservatives approach is to opt for a centralised quango that does not even have any accountability to this place. It is supposed to have discussions with the Secretary of State before it decides what to do, but it is clear from the powers of this body that the Conservatives seek to establish [Interruption.] The hon. Member for Mid-Bedfordshire (Mrs. Dorries) may not like to hear what the Conservatives are proposing, but the fact is that a centralised quango will have extensive powers over commissioning and determining what should happen at local level, and people will not like that if they have to deal with it.
The motion is right to address the Governments excessive emphasis on central control. I challenge the Government to provide genuine accountability for
local communities, as the Liberal Democrats propose. I also urge the Secretary of State to listen to the concerns of general practitioners. The model that we should choose is democratic local accountability on the shape of health services serving a community. Alongside that, we should free up GPs and health professionals to do the job that they are qualified to do without overly controlling them from Whitehall.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): I wish to start by paying tribute to GP Professor Dr. Brian McGuinness who retired this week as the chairman of the Society of Medical Writers. He is plain old Dr. McGuinness to me and he epitomises the type of GP that we all talk about. He was the ultimate family GP. I have not seen him for about 20 years, but he established one of the first large GP practices that I was aware of, in a socially deprived area in the north-west. That practice encompassed many of the services that we have been talking about with regard to polyclinics. His practice was not a polyclinicit did not have a fancy titlebut it was a good practice providing a good service to the local community, commensurate with its needs.
The practice had a good patients forum that met regularly and advised the GPsmany GPs do take advice from patients and local patient groups. The practice had seven or eight GPs and provided adequate services to the local community and was well respected. Dr. McGuinness was possibly one of the most highly regarded GPs I have ever known, especially in the socially deprived area in which he practised. He recently received a lifetime achievement award, but it is to his credit that he has vowed to continue to work to encourage GPs and other medics to write about their experiences. I therefore begin by paying tribute to GP Professor Dr. Brian McGuinness, who is one of the best of men as well as one of the best doctors I have ever encountered.
In preparation for this debate, I spoke to some of my local GPs and I want to feed back some of the comments that they made. As their MP, my job is to represent the opinion of all my constituents, and my GPs have some very strong opinions about what is happening and the Governments proposals. They are unanimous in being incredibly angry and they feel undermined and persecuted by the Government. It all stems from the much spun pay rise that GPs received in 2004. It is very rarely mentioned that that pay rise brought GPs pay to an acceptable level, given their training, experience, commitment and hours. Before the pay rise, GPs were one of the lowest paid professions, so it was right to give them that pay rise and bring their pay to that level.
I would not be surprised if the Department of Health had a unit solely devoted to spinning against GPs. We have seen some ludicrous headlines in the tabloids recently, but they did not dream them up. They did not come from GPs either. Those headlines were spun somewhere in the Department of Health. It was preposterous to have stories about GPs earning £250,000 on the front page of national newspapers, and that did GPs no good. As I said when I intervened on the Secretary of State earlier, GPs represent the most cost-effective and efficient branch of the health service. They cost £20 per consultation, even for long consultations.
As I said, the 2004 pay rise brought GPs pay to a reasonable level. Since then, they have had a 0 per cent. pay rise for three years. Which other profession would put up with having a pay rise that just brought them back into line with what they should have been earning, followed by a pay freeze in the next three years?
Mrs. Dorries: I have absolutely no idea where that figure comes from. My GPs have had no pay rise for the past three years, at the same time as their staffing costs have increased by an average of 5 per cent.
Mr. Lansley: For the sake of accuracy, I wish to point out that the NAO said that there had been a 58 per cent. increase over three years from 2002-03 to 2005-06. My hon. Friend is making a point about what has happened since 2005-06. The return of doctors to general practice has remained the same, but costs have risen. The position has changed since 2005-06, and we do not have the figures yet.
Mrs. Dorries: I specifically referred to the past three years. Staffing costs have increased for general practice, and the front of this weeks GP, the GPs magazine, reveals that some GP practices could face a 10-year pay freeze. So not all GP practices finances are rosy, and GPs are feeling persecuted and undermined by the Government. Morale is very low.
One result of the pay rise was a rebalancing of GPs morale, but there was also an easing in recruitment. It became easier to recruit on to the GP training scheme and to recruit new GPs. However, over the past few years, that has suddenly and dramatically changed and it is again becoming difficult to recruit. Just in my constituency, I know of GPs who are leaving general practice to go to New Zealand or the US, because of the demoralisation and confusion about the future of the service that GPs are beginning to feel.
Patients want, above all else, the stability and continuity of having access to a GP whom they know and with whom they have built up a relationship. They want to have confidence in their GP, especially if they have a difficult illness or are elderly. GPs work on the relationship with their patients because they know the value of having a good relationship with them, including an element of confidence. Polyclinics will probably include Australian or other antipodean doctors, or Polish doctors. They will come and staff the clinic for six months, probably as part of their travels, and then move on. The relationship that patients have with their GPs will no longer exist.
GPs are leaving the service at the moment, so I would like to know how the polyclinics that the Government propose will be staffed. Where will the GPs come from? Many GPs want to retain the service that they provide to their communities, because that is what patients want. Patients do not want polyclinics. As the end users of the service, patients must have a voice in deciding
what will be provided. GPs must also have a voice in what they are going to provide. By and large, they do not want large polyclinics.
In rural constituencies such as mine, with a high elderly population and poor transport links, it is preposterous to suggest that people will be able to get on a bus and travel to a polyclinic. Bus services have been cut dramatically in the past two years, so they will be unable to get a bus to a polyclinic, wherever it might be. It is also likely that such a clinic would be in Bedford or the outer areas of that town, but only 12 per cent. of my constituency is built on, as it is a rural area. It would be extremely difficult for my constituents to get to a polyclinic.
Another problem is staffing. More GPs are leaving the profession than are arriving. Which services will be offered in the polyclinics? If radiography services and other physiotherapy services are to be carried out in polyclinics, who will carry them out in hospitals? Hospitals are already finding recruitment difficult. If a radiographer is out in a polyclinic, who will be in the hospital?
Mr. Stewart Jackson: My hon. Friend is making a compelling case. Surely the logical corollary of her argument is that any general practitioner in a family practice that is doing well will not want to move to a polyclinic. As there are shortages of fully trained medical practitioners in many parts of the country, will not the system embed second-class health care at polyclinics for some of the most vulnerable people in our communities?
Mrs. Dorries: My hon. Friend is absolutely right. The polyclinics will take off in the areas of higher social deprivation where, because of the transient nature of those who will work in those polyclinics and the problems in various hospitals, such as Peterborough, we will see a lesser service on offer rather than a better one. GPs who can combinelike those in the example from Macclesfield that we were givenwill do so if it is what the community wants, desires and needs. If it is cost-effective and serves the community better, nothing stops GPs getting together now to provide such services. Many GP practices already do that so there is no barrier to the essence of a polyclinic; GPs can provide that service if their patients need it.
I hope that the Minister will clarify those services that a polyclinic will provide better to a community than those that GPs have the freedom to provide now. What is this magic bullet represented by a polyclinic? What will it do that GPs cannot do today?
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