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against local health needs and requirements.
What is the evidence? There is little evidence. Most decision making in the national health service could hardly be called evidence-based. On the contrary, it is often a matter of wetting ones finger, putting it up in the air and seeing which way the wind is blowing. This is the first time I have said that, but it is a true representation of how decisions have been taken for the past 59 years.
The hon. Member for Peterborough (Mr. Jackson) mentioned Kaiser Permanente in California. Studies in the US have shown that where there are more primary care practitioners on the groundnot just GPs, but other health professionals as wellthere are healthier communities. That may be an international finding and it may not be specific to east Yorkshire or south Yorkshire, but in general, it is likely that by expanding the number of primary care health professionals, not just GPs, better health care will result for the people in that area.
against local health needs and requirements
The BMA acknowledges that there may be a case for establishing a polyclinic in some very specific circumstances, such as where local patients and clinicians agree on a proven need in their area.
I represent an area with very high disease burdens. Fifteen years ago it had the highest patient to GP ratio
in England and Wales. It is a little less now because of the action that this Government have taken, but are GPs flooding into south Yorkshire to come and work alongside the hard-working GPs dealing with massive problems at every surgery, because of the difficulties that we have, sadly, with smoking, drinking, eating and the scars that industry has left on individuals? If it were not for the Government changing the GP contract, we would have the same patient to GP ratio that we had previously.
I should like to knowI say this to those on both Front Benches and to everyone in the debatehow we measure the needs of communities, if not by looking at the disease burden that they carry and taking the action proposed by the Government to put GP services into those communities? What other way of measuring need is there? I do not know another way. If it is true that in America more primary health care professionals lead to healthier communities, the Governments proposals should be endorsed by everybody, including the medical profession.
Most of the Governments proposals in recent months relating to family doctor services have been grudgingly accepted. One doctor turned up at my constituency surgery to discuss the issue of doctors hours, which went to ballot. The rest of them get on with doing a very hard job under difficult circumstances because of the size of their patient list and the disease burden that those patients carry. The BMA badly misrepresents GPs, as it did on the issue of extending practice opening by a few hours in the evening and on Saturday. The BMA and the GPs within it are badly led.
If we dont agree to this, the government has threatened to take this money away from patient services anyway and give it to local Primary Care Trusts (PCT) to fund large town centre Superclinics, probably run by private companies for profit. This could be the first stage in privatising all family doctor services and then the whole NHS.
The hon. Member for Peterborough said that the Labour party always harks back to what happened 60 years ago when the national health service was created. It was on precisely the matter of GPs that Nye Bevan fell out with many people, and I suspect with those on the Labour Benches in the Chamber, although at the time the Chamber had been knocked down for a few years. It was agreed that GPs would not work for the state, although there are some in my constituency and in all other constituencies who work on a salary, and thank goodness they do. That has enabled us to bring down the patient to GP ratio a little.
I have had only two letters on the matter, but leaflets such as the one that I quoted are outrageous and do the profession terrible harm. A similar one was being circulated in neighbouring Doncaster. I am pleased that my right hon. Friend the Secretary of State stuck to his guns and said that, under the new contract and its treatment of doctors, it is reasonable for us to expect that doctors surgeries should open on a Saturday morning. They always used to do so when I worked in
industry, before I came to the House, and sometimes in the evening, to make it easier for people to attend.
I am dismayed at the lack of professional leadership that the BMA provides to general practitioners. Dr. Laurence Buckman wrote an article on family service access. I have met him a couple of times and he is obviously an independent-minded person. In the Royal College of GP News in February 2008, he is quoted as saying:
If there is a boat Ill rock it...I dont shy away from confrontationpeople need to hear our point of view. I first got involved with the BMA because I was an angry young man with something to say and I still feel the same way now.
The last trade union leader to say that was Arthur Scargill, and look what happened to the coal mines. I do not think that the GP surgeries in Rother Valley will suffer the same fate as the coal mines, but that is not good, sensible and responsible leadership. Dr. Buckman went on to say:
Politicians arent primarily interested in the health service; theyre out for what will be good for themselves and their constituents.
That is absolutely right. After 59 years of being dictated to by those who work in the health service as opposed to those who need to use it, I could not agree more. If that man were representing me, I would be going along to the next branch meeting.
Is this the same gentleman who has one of the highest rates of exempted patients in the country when it comes to calculating QOF points? He
has the nerve to say that we are in it for what suits us, but he may be in it for what suits him.
Mr. Barron: I do not know the detail of his QOF points, but the Select Committee will be looking at QOF points later in the year in relation to health inequality. I expect that the debate will be ongoing for a long time, but I come back to how we can assess local health needs other than by measuring the disease burden in communities to determine whether we need more health practitioners, perhaps for preventive reasons or to enable people to be seen more quickly. How do we measure such needs other than by taking such action? Rather than destabilising or closing local GP surgeries, it will give them the opportunity to bid for and to work in the new centre in Rotherham.
The Government seek to take the health service to those who need it so that they can make better use of it than they can at the moment because there are fewer doctors in their areas than there should be and those who are there are working hard with a difficult patient work load. The sooner this is sorted out collectivelyit does not look as though we will reach a decision on the matter todaythe better it will be for the NHS and our constituents.
Madam Deputy Speaker (Sylvia Heal): I have now to announce the result of the Division deferred on the question relating to immigration. The Ayes were 265, the Noes were 65, so the question was agreed to.
Mr. Peter Bone (Wellingborough) (Con): It is a great pleasure to follow the right hon. Member for Rother Valley (Mr. Barron), who is always worth listening to. He is the Chairman of my Select Committee, so I must be nice to him.
This has been an interesting debate. I come to it from the Northamptonshire perspective, but there are variations around the country, which worries me when it comes to the top-down approach of saying that every area must have a health centre or a polyclinic.
I asked my staff to trawl through all our letters to see how many people wanted a centre that was open 12 hours a day, seven days a week, but I have not had a single request for that by telephone or e-mail or at my advice surgery. However, I have had a number of letters from constituents stating their concerns about polyclinics. My staff summarise it as follows:
Worried about loss of patient-doctor relationship. Seems to be older generation that are particularly concernedvalue relationship with doctor, see same one frequently and they trust and are at ease with the same doctor.
I have had a number of briefings from doctors on this subject. I went to a town hall-style meeting in the village of Great Doddington that was attended by 100 people, where the local GP spoke with great passion about her worry that the result would be that the village surgery would close. I can see the appeal of having many services on one site, but there is a real concern that centralising provision and making facilities bigger may result in the loss of village practices, which would be to the detriment of my constituents.
I tried to intervene earlier on the Secretary of State. I think that he said that no practices would close as a result of this initiative. The Guardian said that there would be a substantial loss of surgeries if the policy was to proceed, so when the Minister replies will he say whether I understood the Secretary of State correctly? That is an important issue.
My second detailed explanation from a GP occurred last Tuesday, and I should explain the circumstances. Last Monday during the recess I did what every good Conservative should do and went out campaigning for Boris for the election, and I got a very good reception on the doorstep. Unfortunately when I had finished that electioneering I fell flat on my face, did my leg in and cracked my ribs and I was covered in blood. I finished up at the GPs surgery, and while she prodded and poked me she had a great opportunity to explain her concerns in some detail. In all the time that I have been a Member of Parliament, when I have been told something by those who are highly respected in the community, I have always taken on board their concerns. In that regard, I have a slight worry about the hon. Member for Dartford (Dr. Stoate). He must have a split personality. Being an MP he is not trusted by anyone, but being a GP he is trusted by everyone.
In Northamptonshire, we have already arranged GP out-of-hours availability at two sites. The one that most of my constituents go to is Keydoc, so there is no
problem about seeing a GP out of hours, although one could not see ones own GP. No one seems to want to see a change in that system.
Sandra Gidley: The hon. Gentleman raises an interesting point, because precisely that situation has arisen in many areas other than in Northamptonshire. It works well and there is a service there if people want it. I have been surprised by the number of GPs locally who have written to me saying that they can make a provision, but they object to being told exactly what to do, for how many hours and in what format.
Mr. Bone: That is exactly the feeling in my area. Despite the fact that we have one of the worst ratios of GPs to population in the country, we have made rather a good fist of our arrangements, and our GPs are highly regarded.
My constituents real fear seems to be the loss of the relationship with the family doctor. Hon. Members say that that will not happen, which is good news if that is so, but I want to give a very real example that affected my family. My wife went to see her local GP, but saw another instead who said she had nothing to worry about. She did not get better, so she saw her own doctor, who knew her history intimately. She had liver cancer; she was immediately referred to the acute hospital and, thanks to the NHS, she was saved. This happened five years ago. My concern is if that situation had involved a polyclinic where she did not know the doctor, I am not sure whether she would have bothered to go back to get a second opinion.
Dr. Stoate: I am interested to hear the hon. Gentlemans examples and am sorry to hear about his cut leg and cracked ribs. If the hon. Gentlemans GP had decided that he needed an X-ray, or if his wifes GP had decided to order a liver ultrasound scan, it would have been far better to have that X-ray or ultrasound scan then and there in the same clinic, rather than waiting for two or three weeks for provision in one of the local hospitals, which might be 20 miles away. Surely it is better to have the ultrasound scanner and the X-ray machine on the same site to deal with such matters as one-stop events?
Mr. Bone: I am grateful to the hon. Gentleman for his intervention, because it takes me to my final point. Everybody in my constituency wants a hospital in the Wellingborough and Rushden area. I have found no one who does not want this. We must travel miles to get to a hospital, and we are in an expansion area where 52,000 new homes are about to be built. We want a hospital. Listening to this debate, my fear is that somebody will say, They can have a polyclinic, because then we will not have to provide them with a hospital, which would be totally and utterly unacceptable. There are significant variations around the country, so I do not believe in one centrally imposed system. There may be great merit to those health centres, but they should not be centrally imposed everywhere.
Mark Simmonds (Boston and Skegness) (Con):
At times, the debate has been stimulating, and it has been interesting and necessary throughout. Many well-informed contributions highlighted the concerns in
many different parts of the country. The key issues to come out of the debate are the disparity in existing provision, the nervousness about future provision and the potential for a break in the important GP-patient relationship. Any decision to improve provision and services should be taken locally and should not be imposed centrally.
My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) opened the debate. He provided a thorough analysis and a detailed, comprehensive and authoritative explanation and understanding of the issues. He was right to highlight his support for family doctors, the importance of GP contracts, the need for GPs to remain as independent contractors and the tensions between primary and secondary care. He was also right to highlight the concerns about the imposition of polyclinics or GP-led health centresit is whatever the Government have chosen to call them todaywhich will be centralised, top-down structures that will be unresponsive to local needs in some circumstances and undermine access in rural areas. The issue is about centralising primary care. The Opposition do not oppose polyclinics or GP-led centres, when local needs desire and require them.
Mark Simmonds: Sadly, the Secretary of State is not in his place. Unusually for him, the issue has clearly rattled him. He did not set out how he will explain to his constituents that the PCT that covers his constituency has admitted that it sees the imposition of a polyclinic as an opportunity to reconfigure GP services, thereby possibly closing existing practitioners. He did not support the family GP, and, interestingly enough, he did not defend the imposition of health care centres or polyclinics.
In response to my interventionit will be interesting to see whether he confirms this laterhe stated that primary care trusts do not have to have a polyclinic or a GP-led health centre and can therefore use the resources that would have been allocated for other, locally driven services. We will wait and see whether he substantiates that point outside this House.
The hon. Member for North Norfolk (Norman Lamb) once again explained how his party plans to politicise PCTs expenditure decisions by direct, local political interference. He rightly highlighted low morale among GPs and the need to review the quality assessment framework. He was also right to highlight the importance of preventive health care and the link to health inequalities. We need greater emphasis on public health. The PCTs with the greatest level of deprivation often spend the least resources on public health.
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