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I can help the hon. Lady on that point. One thing that polyclinics will do, for example, is to be open 12 hours a day, seven days a week. Virtually no GP practices are open for such hours. Secondly, polyclinics will provide services such as radiography, blood testing, ECGs and all sorts of facilities that are not available in the vast majority of GP practicesnor are they likely to be. Polyclinics are a model that will, we hope, keep patients away from acute hospitals and prevent long queues forming in accident and emergency made up of people who have no need to be there. They will enable those people to be looked after in a much more comfortable setting much closer to
their home. On the transport issue raised by the hon. Lady, people will travel on average far shorter distances to reach such services than they have to under the district general hospital model.
Mrs. Dorries: The hon. Gentleman makes a number of points. The only reason why we see pressures on accident and emergency services at the moment is that cottage hospitals and community hospitals are being closed down. As for 12-hour practices, I have had no letters in my postbag on that subject and no constituents coming to my surgeries to say, I wish my doctors surgery was open for 12 hours a day. It is unreasonable to expect GP surgeries to open for 12 hours a day, if we have good local facilities provided by the PCT.
Let me give the hon. Gentleman an example. A GP recently told me of a PCT manager who got very stroppy with him in his surgery, because the GP had seen a patient who had been out of hospital for 10 days after a post-partum haemorrhage in hospital, and who went to his surgery and complained of chest pains and a pain in the leg. She was a very poorly lady. The GP immediately thought that that could be a pulmonary embolism, did the right thing and sent her to hospital. He was then criticised by the PCT for doing so, when any GP anywhere would do the same in such circumstances, polyclinic or no polyclinic. When a GP sees a patient with acute needs, such as chest pains, he saves the PCT that £3,000 admission fee, because many GPs will diagnose and treat in their surgery as far as possible before sending a patient to hospital.
I do not see polyclinics as filling a need because I do not think that the need is there. GPs provide an excellent service; they save PCTs a huge amount of money; and they are incredibly cost-effective. Patients like the service. They like having a local GP. GPs enjoy building up a good relationship with their patients, so why, if it is not broken, do we need to fix it? That is what I do not understand.
In areas such as Macclesfield, where we need such services, we have provided them. What is the image of the polyclinic? Why are we imposing such a service on communities? Why are we making it more difficult for patients? Why are we imposing something that doctors do not want?
On the point about blood counts, can anyone show me a GP who does not take blood tests and send them on to a hospital lab? A GP who does not do that in his practice should not be a GP. Many GPs provide that serviceI have never heard of one who does not. Can anyone show me a GP who does not refer on for radiography or who does not provide the test? They have those services at their fingertips if they need them.
Mr. Lansley: New technology offers other opportunities. Clearly, the hon. Member for Dartford (Dr. Stoate) might not be aware of the pilot scheme in Lancashire whereby GPs surgeries can send ECGs to a centre in Manchester where trained cardiac nurses interpret them on their behalf. They do not need the patients to go to a single place. Local GPs are perfectly capable of carrying out 12-lead ECGs and sending them off for remote interpretation.
I know many GPs are capable of doing 12-lead ECGs and of reading the results themselves, because they have trained to be able to do so, as well as sending them off to the cardiac nurses. I do not understand
the need for polyclinics, but I do understand that GPs are not happy. Patients do not understand the need for polyclinics. In fact, nobody understands why the Government are doing this. The system is not broken, so why are the Government trying to impose this change unless they are trying to save costs in some way?
In conclusion, I have voiced the concerns of my GPs and patients, who are happy with long-established GPs in my constituency. They do not want a polyclinic. They like what they have at the moment. If they were to have anything, they would want greater resources to be given to GPs so that they could extend the services that they currently offer. They do not want a centralised polyclinic to which they would have to travel, particularly in Bedfordshire.
I was encouraged when the Secretary of State sat down and since then I have become more and more depressed. I was delighted that he acknowledged the quality of our family doctor services, and that he acknowledged the crucial importance of the strong ties between GPs and their patients and their families. I welcome the extra money and his clear statement that there are no plans to herd GPs willy-nilly into polyclinics, whether they want them or not, and that it is not a top-down measure.
We all know from our PCTs that they have been told that they must have a polyclinic. I am sorry that the Minister is not here at this moment, because I want him to confirm that I can go back to my PCT and say that the Secretary of State has said that if the trust can provide the same sort of services that a polyclinic would have provided in the enlarged health centres, which it has planned according to local need and with the money that has been provided for that purpose, the polyclinic will not be imposed on that trust.
Mr. Stewart Jackson: I am grateful to the hon. Gentleman. I was privileged to serve with him on the Select Committee on Health, of which he is a distinguished member. Is his experience the same as mine? My city councils health and scrutiny committee has been given the health centre/polyclinic as a fait accompli, with the caveat that it will be placed in an area of social deprivation in my constituency. Effectively, the committee can do nothing about that decision except rubber stamp it.
Dr. Taylor: I have absolutely no objection to siting these facilities, whatever they are called, in areas where they are needed. I just want to be able to tell my local PCT that it is up to it to decide what is best for the local area.
My real worry about polyclinics is that they could open the door to commercialisation. The hon. Member for St. Ives (Andrew George) touched on that problem in an earlier intervention, but I want to look at it in a bit more detail. People often ask what all the fuss is about, and a letter in my local paper, the Worcester
News, carried the headline Just what point are GPs trying to make? The letter stated:
Let me try to understand. They are, apparently, totally opposed to the privatisation of general practiceyet, of course, the private sector is precisely where they themselves work and earn their crust!
There is concern that opening up contracts to the private sector will have an adverse impact on quality and that there is not a level playing field between the private sector and incumbent GPs. However, this seems to ignore the fact that GP practices are independent for-profit contractors already.
The most effective response to that approach comes from the pressure group Keep Our NHS Public. It is not a rabid, left-wing group: its members are highly dedicated professionals who are passionate supporters of the NHS, through and through, and I shall paraphrase some of the points that they make.
The group accepts that GPs are independent contractors, but asserts that they are crucially different from the large corporations that stand ready to compete for the provision of health services. It says that GPs know their patients and are driven by local prioritiesexactly what the Secretary of State said when he acknowledged the value of the relationship between GPs and local families. The group believes that profits for shareholders drive the private corporations, and that those corporations will decide which patients to treat and which services to offer.
The pressure group believes that professional judgment can be overridden by company policy, and that governance and the monitoring of standards of care could be impeded by commercial confidentiality. It also says that the skill mix may be downgraded, and that NHS pay, conditions of service and pensions might not be retained. I believe that such warnings about the dangers of commercialisation need to be taken very seriously, and in that regard I commend to Ministers two seminal articles that have been published recently.
The first article appeared in the British Medical Journal, and it looked at the US experience of competition in the health care system. It said that the US has long combined public funding with private health care management and delivery. It noted that extensive research had found that the US for-profit health institutions provide inferior care at inflated prices, and that the US experience shows that market mechanisms undermine medical institutions that are unableor unwillingto tailor care to profitability. Finally, the article said that the poor performance of US health care is directly attributable to reliance on market mechanisms and for-profit firms, and that it should serve to warn other nations from following that path.
The extreme failure of the US to contain medical costs results primarily from our unique, pervasive commercialisation ...Medicine...does not lend itself to market discipline.
The article describes in detail the cost-containment tactics and false economies that commercial organisations
plan, and it also looks at revenue-maximisation strategies, the concentration on lucrative procedures and the selection of risk. It even pays a tribute to the British system, saying:
When the British NHS faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialised system seems incapable of producing that result.
Sometimes we Americans do the right thing only after exhausting all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance.
That worry has been reinforced by at least one whistleblower, who was reported in The Guardian on 9 April. I have seen the papers involved, which I think that he probably sent to all members of the Health Committee. They were very long and complicated, so I do not blame any colleague who has not read them through, but the man who provided them has seen the lengths to which organisations that want to break into the market will go to enhance profits. I am reminded of the recent revelations about how a drug manufacturer went to unethical lengths to prolong the life of one of its proprietary drugs that was long out of patent.
I have the marvellous privilege of being able to choose how to vote at the end of this debate, but my problem is that I do not know whether to support the motion or the amendment. That terrible quandary arises because I am not completely sure that the NHS as I have known it for years will be entirely safe under either of the two main parties. I do not yet know how I shall decide to vote, but my voting record would suffer if I did not support either proposition.
I welcome much of what the Government have done for the NHS. I appreciate the extra money that they have provided and the way that they have handled the service, but I hope that they will look very seriously at the warnings that I have repeated about the dangers of opening up family doctor services to commercialisation.
However, I am also worried about the Conservatives. We all know the proverb about how difficult it is for a leopard to change its spots, but it has a corollarythat even when a leopard does change its spots, it remains rather proud of having had them. The changes to the NHS made by the previous Tory Government included the introduction of market forces, the purchaser-provider split and the private finance initiative. I therefore cannot quite accept that any future Conservative Government would oppose the commercialisation that I strongly believe is not welcome in general practice.
Dr. Howard Stoate (Dartford) (Lab): First, may I apologise to you, Mr. Deputy Speaker, for not being in my place at the start of the debate? I had a meeting with the Prime Minister, but one of the issues that I raised with him was the proposal on polyclinics, so at least that was relevant to this discussion.
As many hon. Members will know, I am a practising GP, something that I hope will enable me to make a constructive contribution. It will be of no surprise to the House if I say that I speak to an awful lot of GPs around the country. Many of them are concerned about what the polyclinic model might lead to, and
worried about how it might affect their practices and patients. I therefore think that it will help the House if I set out what I see as the vision for this type of health care.
I envisage a mechanism whereby people can be treated far closer to their own homes, with far less reliance on public transport, far shorter queues and much less reliance on accident and emergency departments, which are often inappropriate places for people to go with many health care needs. They are often not seen by the most appropriate person in the department, and in many cases it is not the nicest place to be. A and E departments simply become clogged up, which often gets in the way of the serious, life-saving work that they need to do. The last thing that they need is a group of patients coming to the A and E who would be far more appropriately treated by their GP practice, district nurse or pharmacist, in a setting that would be far better for their health care.
It is important to set out exactly what the polyclinic model is intended to do. The hon. Member for Mid-Bedfordshire (Mrs. Dorries) said that there is nothing that a polyclinic can provide that cannot be provided by a GP service. I am sorry that she is not currently in her place. The fact is that a polyclinic or such a model could offer a huge number of services that currently cannot be made available in GP services. An obvious example is X-rays. The hon. Member for South Cambridgeshire (Mr. Lansley) made the point that ECGs can be sent online. Of course they can, and of course blood tests can be taken in GP practices. However, it is much more difficult for a GP practice to have an X-ray or ultrasound department with the necessary scanning equipment and range of health care professionals. That is well beyond the scope of current general practice, and we need a radically new way of deciding how those facilities should be produced.
When I ask my patients what they want, they say that they want to be treated as near to their homes as possible, hopefully by people whom they know, trust and have had dealings with before. They do not want to go and sit in a crowded, noisy hospital among patients who clearly have far greater health needs and therefore should obviously take priority. The polyclinic model is a good example of how we can transform the patient experience.
Another obvious example of why the system might work is that it is currently estimated that every time somebody walks into A and E, it costs the health service about £150. A GP consultation costs about £20, so we can immediately see that anybody who attends their GP surgery instead of going to A and E will lead to a dramatic saving in health care expenditure, which could therefore be targeted better than by spending it on A and E. Obviously a polyclinic would have extra fixed costs and there would be other services to consider, but it would still mean a significant cost saving compared with people going to A and E, and it would therefore leave far more money for investment in NHS services and for better use in patient care.
The NHS has moved on. Clinical practice is evolving all the time, and patients expectations are changing. When I first entered general practice, people almost always had surgery as in-patients in hospital. They often stayed in hospital for several days, or even weeks. Now, 70 to 80 per cent. of all surgery is day surgery.
The idea of relying on large, impersonal hospitals is a model that has outgrown its usefulness, and we need to move on to a much more flexible and modern approach. I believe that polyclinics, rather than diminish the range of services and choice, will increase it.
The myth that goes around that if a polyclinic is set up, patients will no longer have a choice of GP, is clearly rubbish. Under the patient choice directive, patients will be able to request a specific GP. Provided that that GP is on duty, that it is reasonable and that he or she has the available appointments, the patient will be able to specify that GP. It does not have to be impersonal. In fact, the model that I read out in an earlier intervention will, in many cases, be based around existing practices, which could be significantly extended or developed to add the extra services that are not currently available, albeit with extra funding and resourcing.
Another advantage of polyclinics is that they will allow GPs, acute specialists and other health professionals such as pharmacists to work together for the first time. General practice can often be isolating, and in small, isolated practices it is often quite difficult to have the mix of colleagues and clinical expertise that is required for personal and professional development.
I am aware that time is pressing on, so I do not wish to go on too long, but I wish briefly to quote Mr. Anthony McKeever, the chief executive of the care trust in Bexley, where my practice is situated. I wrote to him recently to ask what the PCTs model of polyclinics was. He stated:
We do not intend to create polyclinics on the assumption that one size would fit all...A couple of local practices have indicated that they would like actively to explore the possibilities of providing a more integrated care landscape...So, there will be plenty of opportunity to avoid the pitfalls which some anticipate...Certainly, however, the GPs I spoke to direct recognised that the development of primary care hubs or polyclinics could be achieved without damaging and unintended consequences.
As far as I can see, that is the chief executive of a PCT being sensible and pragmatic and understanding that flexibility is perfectly acceptable under the Governments plans, and who actively wishes to work with local GP practices to ensure that what actually happens is a huge improvement in patient care outcomes. Hopefully, that is what we are all aiming for.
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