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Michael Jabez Foster (Hastings and Rye) (Lab): The GPs of Hastings and Rye are not persuaded that the BMA has got it right. Not one has complained. They are delighted with the £15 million that my right hon. Friend has made available for a new health centre in the town centre. Patients are not compiling petitions, either.
Alan Johnson: My hon. Friend’s experience is replicated throughout the country.
We are supposed to have three ulterior motives. All that is arrant nonsense. It is possibly the most ludicrous misrepresentation made in the House since the equally ludicrous attempts to distort the principles behind the establishment of the NHS 60 years ago, and it derives from exactly the same source.
The motion refers to a Government plan to “impose” “polyclinics.” Opposition Members deliberately use that term because of its impersonal and biomedical connotations. There is a perfectly valid argument for polyclinics. There is no argument for imposing them centrally on every locality as a replacement for GP practices—that is why we do not have such a plan. A polyclinic combines primary and secondary care. The only part of the country where a network of polyclinics is proposed is London, where a comprehensive review of health services took place last year, and the Government had no say in its outcome. It was a London consultation, which the NHS in London led.
Joan Ryan (Enfield, North) (Lab): The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned north London. In my constituency, the chairman of the local medical committee, who is a local GP, made it clear that premises are limiting the advantages that GPs can offer patients. A plan that provides GP centres is therefore important. It is likely to give us a GP centre in Enfield Lock and in Enfield town—exactly what Sir George Alberti, a leading clinician, said that we need. The people of Enfield, North will not be deprived of that huge investment by the Conservative party’s propaganda.
Alan Johnson: My right hon. Friend makes an important point about health services in London. We had no role in the outcome of that review; however, like the population of London, we support NHS London’s proposals. I want to take a minute to explain to the House why the proposals, which those on the Opposition Front Bench oppose, are right for London.
Mrs. Jacqui Lait (Beckenham) (Con): If the footfall of a centralised primary care centre is 50,000 people, that adds up to about 50 per cent. of all the GP practices in any one constituency. As a south-east London MP, I should be grateful if the Secretary of State said whether he is seriously proposing that 50 per cent. of our constituents go to one place for their primary care?
Alan Johnson: I am suggesting that the hon. Lady, like her colleagues on overview and scrutiny committees throughout London, participate in the London consultation, the outcome of which has shown wide support from both the public and politicians of all political persuasions for what is being proposed in London, and well it might.
We hear the trite comments from the Opposition Front Bench, but people in London do not have access to the quality of primary care that they deserve. There are particular problems with access in this city. An Ipsos MORI poll of Londoners revealed significantly lower satisfaction ratings than the national average, and that 54 per cent. of GP practices in London have only one or two GPs, compared with 40 per cent. elsewhere, that nearly 20 per cent. of GP practices in London are unable to offer an appointment 48 hours in advance, that demand for longer opening hours is even higher than in the rest of the country, that 50 per cent. of all patients who attend A and E departments in London can be better treated elsewhere, and that more people clog up A and E in London than in any other city.
Angela Watkinson (Upminster) (Con) rose—
Alan Johnson: I give way to the London MP.
Angela Watkinson: One of the justifications for polyclinics is the extension of GP availability. Healthcare for London quotes the patient survey of 2007 as saying that the majority of patients are dissatisfied with their GP’s opening hours. However, the British Medical Association quotes the same survey as saying that 84 out of 100 people are satisfied with their GP opening hours, so is it not better to listen to individual patients and individual GPs? I have not had one GP or patient from my constituency contact me to say that they are in favour of polyclinics.
Alan Johnson: The hon. Lady is referring to the Healthcare Commission report, which was not a London-only survey and which showed a high level of satisfaction with GP opening hours. However, the 84 per cent. in favour left some 6 million people throughout the country who were dissatisfied. When one looked into the figures, one found that people from black and minority ethnic communities, such as the Bangladeshi community, those from poorer backgrounds and, in particular, those from London were much less satisfied than the rest of the country. According to a BMA survey, 60 per cent. of London GPs say that their facilities are unsuitable for current needs, 75 per cent. think that they cannot meet future needs and 36 per cent. doubt whether their facilities could be adapted to meet the access requirements of the Disability Discrimination Act 2005. Those are the problems in London, which London is seeking to resolve.
Mr. Graham Stuart: The Secretary of State is talking to a large extent about London. Can he tell my constituents why he wishes to impose a polyclinic on the East Riding of Yorkshire PCT, where I assure him there is very little appetite for one? This morning, a GP from Beverley told me:
“Polyclinics will lead to the end of personalised care which current patients enjoy.”
That GP, who is nearing the end of his career, also said—perhaps this will rock the Secretary of State
most—that he has voted Labour all his life, but will not do so at the next election, because he has lost confidence in the Government on health.
Alan Johnson: Let us stick to London for a second.
Mr. Redwood: Will the Secretary of State tell us what the total cost will be of this elaborate reorganisation?
Alan Johnson: The total cost is estimated at around £150 million, which will be money well spent and a crucial investment in improving the situation in London.
The term polyclinic has been used in London to describe a range of models that allow primary and some secondary care services, such as diagnostics, to be available in each local community, reducing travelling time and making services more convenient for patients. In some cases, that may involve bringing services together under one roof. In other cases, as my right hon. Friend the Member for Enfield, North (Joan Ryan) mentioned—this is a specific option that is part of the London proposals—it involves having a network of GP practices linked to a hub that provides more specialist services. Both of those are available in London.
Interestingly, in the one part of the country where polyclinics are being proposed, Conservative politicians support the proposals, as, indeed, do the public. Every local authority overview and scrutiny committee, including those that are Tory-led, backs the exciting plans to resolve NHS problems in the capital—problems that probably should have been dealt with 20 or 30 years ago.
Lynne Jones (Birmingham, Selly Oak) (Lab): I certainly welcome the additional investment in primary care, but whatever the problems in London, they are not the same in Birmingham. The report to the PCT on implementing the measures said that there was
“no clear geographical area which warranted investment in an additional three partner practice”
and no real pattern to highlight a need for the GP-led health centre to be located in one particular place. A place was chosen because accommodation was potentially available, even though there are low levels of under-doctoring there. I therefore ask my right hon. Friend please to give this money to the PCTs and to let them decide how to spend it in the interests of the people they serve.
Alan Johnson: I think that that is the Opposition’s policy—give the money to the BMA and it will decide how to spend it. It is also their policy for GPs to be allowed to set up where they want to, for GPs to be allowed to open when they want to and for GPs who work in disadvantaged areas to get more money. I do not agree with that policy. I believe that when we move on from London and talk about other parts of the country, including the west midlands, my hon. Friend will agree that our proposals are the most sensible way forward.
Norman Lamb (North Norfolk) (LD): The Secretary of State accused a Member on his own side of the House of adopting the policy of the BMA, but the hon. Member for Birmingham, Selly Oak (Lynne Jones) actually said was that she wanted to give power to the local area so that decisions could be taken locally. Surely that is what should be done, as it is local people who know what the needs are in any particular area.
Alan Johnson: That is what we are doing— [Interruption.] I am talking about what is happening in London; I will come on to the rest of the country in a minute. London has had its own analysis of problems, which have been the subject of many reports over the last 20 years. Politicians refused to implement the proposals. We are implementing the proposals, with London’s support.
Dr. Tony Wright: Is it not interesting to note that the BMA—when not campaigning and producing petitions—wrote a few weeks ago to all GPs and local medical committees describing the new proposals in what it called a “factual guide”? It talked about the key differences between the health centre proposals and the polyclinic proposals; and of the polyclinic proposals it said, “mostly in London”.
Alan Johnson: I have not seen that particular circular, but that is exactly what I am trying to explain. In London, there is a specific proposal about polyclinics. That is opposed by the Conservative party, despite the fact that the project has been worked up locally by people in London and has been the subject of full consultation with the public and GPs.
Clive Efford (Eltham) (Lab): In my constituency, we are about to rebuild a new local hospital which will be a 24/7, GP-led urgent care centre with 40 respite beds and diagnostic services that are to be brought right into the heart of our community in Eltham. The hon. Member for South Cambridgeshire (Mr. Lansley) has proposed that any vested interests in the local health economy could scupper that in the face of widespread local support for the scheme. That is not bringing the service back to local people; it is taking it away from them and putting it in the hands of vested interests.
Alan Johnson: My hon. Friend makes a very powerful point. The Minister of State, my hon. Friend the Member for Exeter (Mr. Bradshaw), will be visiting the area next week.
Unlike the proposals for London, the 150 GP-led health centres that my Department has asked the NHS to develop across the country are not, and have never been, designed to alter the way in which existing GP services operate. The London proposals are so designed, for all the reasons that I have discussed. The proposals for the rest of the country are not seeking to change GP services at all. They are designed purely and simply to increase capacity. The average primary care trust has around 55 GP practices that will continue to provide services to their patients as they do today. In addition to those practices, each PCT will also now have a GP-led health centre, funded from ongoing additional investment, attached to which are only three conditions. No. 1 is that the centre should be in a central location; it should be accessible. No. 2 is that it should be open from 8 am to 8 pm, 365 days a year. The third is that any member of the public must be able to use the centre either to book a GP appointment or to turn up to see a GP or nurse without the need to be registered at the centre—in other words, people can continue to be registered with their local family doctor and benefit from the continuity of care that is provided.
Mr. Lansley:
The Secretary of State says that those are the only requirements, but surely it is a requirement that the Department has laid down that these centres—these
clinics—should register patients. By extension, therefore, patients will no longer be registered with other GP surgeries.
Alan Johnson: I just mentioned that— [Interruption.] I did. I said that the third condition allows patients to be registered or to walk in and receive GP services because they are in a more convenient location. Let us consider the logical extension of the hon. Gentleman’s argument. Yes of course members of the public can decide to leave their existing surgery and register at this GP-led health centre. It is called patient choice. They are perfectly entitled to do that. What we expect is that this additional resource will be used to mix and match, as I mentioned. Most patients will want to stay with their existing GP because of the particular benefits that gives them, but they will also want to use the GP-led health service on Christmas day or on a Sunday afternoon knowing that they do not have to be registered there to use its services.
Mr. Mark Francois (Rayleigh) (Con) rose—
Alan Johnson: I give way to the hon. Member for Worthing, West (Peter Bottomley).
Peter Bottomley: The Secretary of State is trying to share as much information with the House as possible. Is it not true that there are two other conditions? One is that no primary care trust can say, “No, we don’t want to do it.” The second is that there is a rule that no existing GP-led health centre—that is to say, a wide practice—can turn itself into one of these new GP-led health centres.
Alan Johnson: It is absolutely the case that we are saying that in the interests of greater capacity, greater patient choice and the public being able to access primary care, this is not a zero-sum game. There will be a greater need to access primary care in the future, particularly with the plans that we have for prevention being as important as diagnosis and cure, and there must be one of these centres in each location.
I have set out the three conditions. Beyond those, it is for local GPs and the PCT to discuss exactly how the service is provided.
Mr. Francois: I thank the Secretary of State for his courtesy in giving way again. I suspect that hon. Members on both sides of the House would agree that many patients are naturally very loyal to their general practitioner. That being the case, does the right hon. Gentleman accept that if there were to be any attempts by financial mechanisms or otherwise to compel general practitioners to move into polyclinics against their will, that would be resisted by the GPs, very likely by their patients, and not least by local Members of Parliament as well?
Alan Johnson: I accept that point entirely. That is not part of our proposals.
Andrew George: Further to the point raised by the hon. Member for Birmingham, Selly Oak (Lynne Jones), if the Secretary of State looks at areas such as Cornwall and the Isles of Scilly, he will see that there is a geographical problem. If he is simply imposing a top-down restructuring of the type that he is describing, a single polyclinic in just one area in a place the shape and size of Cornwall will clearly have a destabilising and destructive impact. Why does he not allow that local community to design services that best meet its needs, rather than imposing this top-down, centralised restructuring? Why will he not allow the local community to design its own services and achieve the aims that I think he desires?
Alan Johnson: We have specified three conditions. The centres must be centrally located, must be open from 8 am until 8 pm seven days a week, and must allow people to use their services on a drop-in basis as well as to be registered if they wish. The money that will be invested is additional money, provided not by the local primary care trust but from the centre, to improve access throughout the country. I think that that is the right thing for a Government to do.
Harry Cohen (Leyton and Wanstead) (Lab): Members of the BMA are not the only people to comment on the proposals. The Royal College of Midwives, of which I am an honorary vice-president, tells me that it is interested in the potential of polyclinics and larger health centres to provide better midwifery services—better antenatal and post-natal care. That means, however, that the centres should provide accommodation for midwifery. Will Ministers and local NHS chiefs encourage the decision makers to provide such accommodation?
Alan Johnson: My hon. Friend has reminded me why the proposals are so exciting for London. It will be possible to provide services such as diagnostics and maternity care, and to achieve a fundamental advance in primary care in the capital. My hon. Friend has also reminded me that we should listen to the views of Age Concern. The hon. Member for South Cambridgeshire said how dreadful the new arrangements would be for elderly people. This is what Age Concern said in a briefing for today’s debate:
“For many, especially carers and those with mobility issues, the super surgery or polyclinic could be preferable to what they currently have on offer. For those without transport, it can take a whole day to get to the doctor and back, via the pharmacy. If then, they are required to visit the hospital for blood tests, x-rays or anything else, that will take them another day. There is a tentatively enthusiastic welcome to a super surgery or polyclinic that will allow them to do all these things on one day, under one roof.”
When we talk to the public and to patients, they see the attraction. Obviously they listen to the horror stories that are being peddled, because they trust their local GPs, as well they should, but when what we are proposing is contrasted with what Her Majesty’s official Opposition are suggesting that we are proposing, it can be seen that what we are doing is improving primary care throughout the country.
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