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Mr. Lansley:
Nobody could responsibly say that “regardless of the quality of care”. The hon. Lady has said that we have suggested that there is a central plan, but I did not make that suggestion. Ara Darzi produced “A Framework for Action” for London, which set out
the specific design for a polyclinic—25 GPs, 50,000 people, £800,000 a year rent, a number of out-patient attendances, the employment of a consultant and the provision of a number of nurses. I did not make that up; the Prime Minister stood at the Dispatch Box and paraded the fact that there would be 150 polyclinics in London. It is absurd that the hon. Member for Regent’s Park and Kensington, North has challenged us on single-handed GPs when the evidence is clear that the best quality and outcomes framework results are achieved by practices with two or three GPs. [ Interruption. ] I know that they are not single-handed practices. Why do the Government propose to push GPs from across London into large polyclinics, when the evidence is clear that accessible local surgeries with two or three GPs achieve the best results?
Tony Baldry (Banbury) (Con): My hon. Friend has said that the situation is absurd, but there is a further bizarre twist. Is he aware that the Darzi clinics will not be subject to monitoring by health overview and scrutiny committees? The Government are introducing a two-tier NHS: parts of the NHS are subject to scrutiny by health overview and scrutiny committees, whereas independent treatment centres and Darzi clinics will not be subject to scrutiny and monitoring by health overview and scrutiny committees, which seems fundamentally wrong.
Mr. Lansley: I agree with my hon. Friend. Pulse recently looked at the proposals in PCTs, and only a tiny proportion of those that it looked at had been subject to even a semblance of a public consultation. The reason is precisely the same as the reason that my hon. Friend gave: the Government are determined that the proposal should not be subject to scrutiny. Why? Because it will not stand up to that scrutiny, it is not locally determined, it does not arise out of the needs and circumstances of the area and, on the quality of care that will be provided, it is not even evidence-based.
Mr. Robert Goodwill (Scarborough and Whitby) (Con): If the aim of the proposal is to force the closure of single-handed practices, why are the Government going to parachute a polyclinic into the middle of Scarborough, where we have a number of good group practices, but not into rural areas, where we have some very good single-handed practices? It does not even follow the logic of the hon. Member for Regent's Park and Kensington, North (Ms Buck).
Alan Johnson: Work it out for yourself.
Mr. Lansley: The Secretary of State says that my hon. Friend can work it out. The reason may be that the chairman of the BMA council is a GP in Scarborough, but there we go. We will see whether the Government’s conspiracy extends even to that. What my hon. Friend says is absolutely true. I have been to rural areas and talked to the head of the local medical committee in north Yorkshire, and it is completely absurd that a town such as Scarborough, which has many health needs but is not under-doctored in terms of GPs, should have money spent on it in that way. Throughout north Yorkshire, it is perfectly clear that access to diagnostics and therapies is required in a range of market towns and centres, not in one centre at the furthest extremities of the area. That is absurd. As it happens, north Yorkshire is technically among the most-doctored areas in the country.
Mr. Graham Stuart (Beverley and Holderness) (Con): May I thank my hon. Friend for supporting my right hon. Friend the Member for East Yorkshire (Mr. Knight) in his campaign to defend health services in Bridlington, and share with my hon. Friend the concern of people along the east Yorkshire coast about polyclinics being imposed on the area? Bridlington, while its hospital services are being devastated, is having a polyclinic imposed and being told that it represents an improvement in its health care.
Mr. Lansley: It is risible. My hon. Friend will know that from his experience, as will my right hon. Friend the Member for East Yorkshire (Mr. Knight), who represents Bridlington. We visited Bridlington and District hospital together, and it is outrageous that the Government appear set on downgrading its services and then, in pursuit of a “care closer to home” philosophy, on undertaking re-provision on the same site—dressing it up as a polyclinic. We live in bizarre times.
Mr. Lansley: No, I shall not give way.
The hon. Member for Regent's Park and Kensington, North was quite right to talk about London earlier, but it is important to understand that, far beyond that, there are considerable implications in rural areas. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill), and my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) in the East Riding, made it clear that there are rural areas where spending such money, so that a polyclinic is established in a place that is already well doctored, is not only wasteful of resources and prejudicial to the GP practices in the area, but, if it threatens other surgeries, could have serious implications for access.
We have done the calculation on access to GP surgeries, and NHS London made a calculation in its consultation document. It says that it has done high-level modelling, meaning that people in London will be on average only 1.5 miles away from their GP surgery. That is quite interesting, because NHS London did not go on to say that, currently, people in London are on average just half a mile away from their GP surgery. So when the Secretary of State says that he is perfectly willing to campaign on the issue, perhaps he would like to tell all the people of London that the distance to their GP surgery will triple. It is quite clear: we have done the calculation and NHS London said that the distance would be 1.5 miles. [ Interruption. ] It is quite clear. It is a good one. Don’t you worry, it is. [ Interruption. ] Actually, Ministers should know that the distance will triple in Hull and in Exeter.
In places such as North Cornwall, the distance to a GP would more than triple, rising to more than 9 miles on average. The Government are parading their belief that they can improve access to primary care, but nobody, anywhere in the country, will be able to believe the Government’s arguments if their access to a local surgery is so prejudiced. There is an enormous difference in London between going half a mile and going a mile and a half. Someone who is elderly, vulnerable, frail or a mother with children, without access to a car, becomes
reliant on public transport. In rural areas, access to public transport over many of these distances is difficult to contemplate.
Andrew George (St. Ives) (LD) rose—
Mr. Lansley: I mentioned Cornwall, so I must give way to the hon. Gentleman.
Andrew George: I agree with the hon. Gentleman in so far as the Government will end up with another independent treatment centre-type fiasco if they continue with the top-down restructuring of the type that he is criticising. He said earlier that these services should be largely designed by GPs. May I seek a reassurance that he is really trying to tell us that patients and local communities should have a big say in how primary care is designed—that it should not be designed by central Government and imposed on the local community or by those who are contracted to provide the service but designed by the local community itself?
Mr. Lansley: I commend to the hon. Gentleman our document, “The patient will see you now, doctor”, published last September, which clearly set out how we would seek to empower patient choice and involvement, the effect of which would be increasingly to design primary care services around the needs of patients.
The Government and primary care trusts have gone ahead without the semblance of a public consultation. Where, in all this, is the evidence to justify the Government’s imposition of this plan? Since they published their proposals, the King’s Fund, which I am sure that Ministers will acknowledge is independent and respected, looked at the evidence for polyclinics under three criteria—quality, cost and access. On quality, it said:
“The co-location of multiple services presents opportunities for delivering more integrated care, particularly for people with chronic diseases. However, the evidence suggests that in practice these opportunities are often lost.”
“Expectations that community-based services will be less costly than hospital-based equivalents are frequently not met.”
“If a substantial centralisation of primary care were pursued, the consequent reduction in access to these services would be a major sacrifice.”
“A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas.”
Dr. Howard Stoate (Dartford) (Lab) rose—
Mr. Lansley: Perhaps the hon. Gentleman can explain how patients will benefit from this centralisation of services.
Dr. Stoate:
I think that the hon. Gentleman is concentrating too much on one particular type of polyclinic. There are many models. There is nothing to say that a polyclinic has to include every local GP. There is plenty of opportunity for hub and spoke models whereby the local GPs can remain and the polyclinic can provide central services such as X-ray, physiotherapy, consultant services and so on. There are also models where individual practices can co-locate into polyclinics and remain as
individual practices. There are many examples around the country of that happening. The opportunity exists for primary care trusts to negotiate and discuss with local GPs and other providers how that type of model can benefit their area, thereby allowing patients to get the benefit of small practices and central services in one locality.
Mr. Lansley: I have heard that before. The fact is that if there were going to be a hub and spoke model in London, why did the framework for action describe a polyclinic model of 25 GPs and 50,000 people? Why did the Prime Minister refer at the Dispatch Box to 150 polyclinics? Why are GPs in north London telling me that the primary care trust is saying that if they do not move into the polyclinic, their rent reimbursement will be stopped? A GP wrote to me and said that he knew what was about to happen to him because the primary care trust published a map of primary care services in his area and he was left off.
David Taylor (North-West Leicestershire) (Lab/Co-op): The official Opposition are coming rather late to this issue. People such as myself tabled early-day motion 1465, which flags up the more fundamental flaws with polyclinics outside London and the metropolitan areas. A fatal flaw of the Conservative motion is that it does not consider the potential of free market competition to inflict serious damage to patient access to general practice and public services. No wonder firms such as Serco, UnitedHealth and Virgin Healthcare are lining up outside the Department of Health just outside this place, licking their lips at the prospect of extracting vast sums from the NHS. Why is that not referred to in the Opposition motion? It deserves to fail because of that.
Mr. Lansley: It is not there because when I have talked to, for example, GPs in Islington who were very unhappy about the way in which a tender was awarded to a commercial organisation, I found that they were willing to enter into competition as long as it was fair, and as long as it was based on a level playing field. I am not opposed to personal medical services or alternative, commercially run, providers of medical services practices, but I am opposed to the top-down system of imposing polyclinics, which is undermining the existing GP structure.
It is interesting that the Prime Minister, when challenged at his press conference last week, retorted that there would be thousands of additional GPs. I think that he said that there are already thousands of additional GPs—[Hon. Members: “There are.”] Of course there are more GPs since 1997, and so there should be. But in the last year for which figures are available, 2006-07, there were only six additional GPs in the whole country, so the Government are not in a position to make much progress on that issue. The predictions from the King’s Fund in its recent document show that we would be short of 2,000 full-time equivalent GPs by 2016. Where is the flow of additional GPs who are to fill the polyclinics?
If polyclinics take over existing GP services, local practices cannot be maintained. If primary care trusts provide the funding for polyclinics, they will, as a consequence, force the closure of many other local GP services because it is not possible to use the same money
twice. The Secretary of State knows that, but he will not admit it. There is a long-term agenda in his Department to undermine the independent contractor status of most GPs and to compel them to become part of a PCT-controlled primary care structure. That is why a GP in London said the other day that the PCT was
“bending everyone’s arms very strongly. Life will be very difficult if we don’t go in.”
It is interesting to note that the Government’s amendment to the motion does not actually mention polyclinics. I suppose that the Secretary of State is going to pretend that they are health centres, not polyclinics. The Minister of State, the hon. Member for Exeter, is constantly saying that people get confused because those centres are health centres, not polyclinics. I received two answers from the Minister of State on this subject. On 15 May, he said:
“‘Health centre’ is a term used to describe a range of health services characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[ Official Report, 15 May 2008; Vol. 475, c. 1666W.]
A month later, on 16 June, he said:
“‘Polyclinic’ is usually a term used to describe a range of possible health service models characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[ Official Report, 16 June 2008; Vol. 477, c. 767W.]
Those definitions are absolutely the same. As far as I am concerned, if it walks like a duck and quacks like a duck, it is a duck.
Mr. Peter Atkinson (Hexham) (Con): Will my hon. Friend give way?
Mr. Lansley: No, I shall finish now, if my hon. Friend will forgive me.
If the structure proposed forces local GP surgeries to close, forces GPs into becoming salaried employees of their primary care trusts instead of independent contractors and turns patients into through-puts rather than people, it is a polyclinic. We should follow the evidence, which says that smaller practices are often of higher quality. We know that they are more accessible. We know that patient choice and preference show that they value continuity of care even more highly than rapid access to care. We know that integrated care is about a lot more than putting all the services in one large building. How can access and care closer to home be improved if hospital services are closed down while polyclinics are built on the same site? Why are the Government so obsessed with the ideology that they have brought in, when they should understand that primary care in Britain is one of our comparative strengths? We should develop and strengthen our structure of primary care, not replace it with a German or a US-style polyclinic system.
All hon. Members should be aware of the concern raised throughout the country because of the Government’s top-down imposition of polyclinics. There is a better way. We can strengthen access to community services and strengthen the existing GP structures. We can extend GPs’ commissioning and their responsibility for providing integrated care for their patients. We can use those additional resources to improve access to community services while maintaining access to GPs locally. We can empower patients to choose their general practice and
to drive up quality and access improvements through their choices. That would be a better way. The Government should reconsider their polyclinic plans. The motion would require them to do so, and I commend it to the House.
4.14 pm
The Secretary of State for Health (Alan Johnson): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“welcomes the Government’s support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population.”
We are delighted that the hon. Member for South Cambridgeshire (Mr. Lansley) has used up another of his party’s Opposition day debates to allow us to reiterate our commitment to primary care, set out our record of investment and reform, and explain in detail our exciting plans to expand capacity in primary care.
No previous Government have more clearly demonstrated their commitment to primary care and those who work in it. Let us examine the record since 1997: investment in primary care has more than doubled; there are more than 5,000 more GPs and more than 4,400 more practice nurses; GP pay has increased by around 55 per cent. in real terms; GP hours have reduced by 17 per cent., and the time spent on each patient is up by 50 per cent. That is hardly the record of a Government who are hostile to the role of primary care in the NHS.
I want to set out as clearly as possible exactly what the Government propose throughout the country, what the NHS is seeking to do in London, and to mention briefly other separate developments that clinicians, patients and managers in local PCT areas, including—I am pleased to say—Hull, are leading.
Let me begin by stating firmly what we do not propose. According to the BMA and its political wing opposite, the Government have not one but three evil ulterior motives: to privatise primary care by allowing companies such as Boots to run GP services; to nationalise primary care by making GPs state employees; and to destroy family practices by breaking the GP-patient link.
Alan Johnson: Conservative Members claim that the accusation of privatisation comes from behind me, but it appears in every BMA leaflet that I have read, at the same time as that of trying to make GPs do what Bevan could never make them do—become state employees. So we are trying to privatise and nationalise simultaneously.
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