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Mr. Chris Mullin (Sunderland, South) (Lab):
What would my right hon. Friend say to the GPs from the local medical committee in Sunderland who came to see us last week? They welcome the extra investment, but
believe that the money could be spent more efficiently if it were spent via existing doctors surgeries. When asked why, they say that some of the previous reforms, such as independent treatment centres, have proved quite wasteful.
Alan Johnson: I would tell those GPs that this is not the only investment being made in primary care. About £500 million is going into primary care this year from one source or another. In Sunderland, as well as in my city of Hull, GPs will have their own plans, but we will ensure that nowhere in the country is there a single patient who cannot gain access to primary care seven days a week, 365 days a year, between 8 am and 8 pm. God forbid that I should make the link between Newcastle and Sunderland, but people who work in Newcastle and live in Sunderland will now be able to go to a GP-led health centre in Newcastle. This is about patient convenience and patient choice.
Dr. Stoate: May I play devils advocate, and suggest that my right hon. Friend is not going anywhere near far enough? While I support his plans for super-surgeries that will be open seven days a weekI think that that will really help patient caremy real desire is for them not just to provide GP care seven days a week but to provide visiting consultants, X-rays, physiotherapy and occupational therapy. I want patients to have access to a whole range of services that people in smaller towns and rural communities currently have to travel many miles to receive. I want the centres to provide those services so that patients will not have to travel 20, 30 or more miles to major centres to receive services that they could receive far more efficiently and cheaply in their local communities.
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Before the Secretary of State replies, may I just remark that the interventions have been getting steadily longer? I ask everyone to remember that the list of Members wishing to take part in the debate is quite long.
Alan Johnson: My hon. Friend the Member for Dartford (Dr. Stoate) is right. I am concentrating on primary care because of the attack that these proposals will somehow diminish primary care. Bevan, at this Dispatch Box in 1946 as the National Health Service Act was passing through the House, saw the integration of primary and acute care as one of the fundamental principles of the creation of health centres around the country, and we have an opportunity to revisit that.
Mr. Eric Illsley (Barnsley, Central) (Lab): We in Barnsley are looking forward to having a super-surgeryor polyclinic, or whatever it will be called. We have traditionally had too few GPs, to the point where one GP practice currently has a patient list of 8,000. Nobody can tell me that that is ideal. We are therefore quite looking forward to the extra capacity that will come with these super-surgeries.
Alan Johnson: It is stated that the Tories claim that 608 practices may close in 58 PCTs. [Interruption.] Well, I apologise for initially saying will instead of may. Also, the procurement guidance that was discovered hidden away on our website was actually launched by Ministers in December at a public meeting.
Barnsley is cited as one of the Conservatives examples; it is said that, because there are all these GP surgeries around the area where the GP-led health centre will be placed, somehow they will all close. However, my hon. Friend the Member for Barnsley, Central (Mr. Illsley) is absolutely right. Barnsley has 49.3 GPs and 25.4 nurses per head of population and all the resultant health problems, while Cambridgeshirethe hon. Gentlemans part of the worldhas 74.6 GPs and twice as many nurses per 100,000 head of population. That is why, as another major part of this proposal, we are putting 130 new GP practices in under-doctored areas, which I presume the Conservative party also opposes. [Interruption.] Well, I am sorry, but it signed up to a petition saying that GPs should be allowed to set up where they want to set up, and if we want them to work in poorer areas, they should get more money. Not even the Brazilian Health Minister, who was talking to me the other week and who is introducing health centres in the favelas in Rio de Janeiro, was saying that the GPs who work there should get more money, but that is what the Conservatives are saying for towns such as Barnsley and Hull.
Many PCTs are looking to provide other services in these health centres, such as diagnostics or pharmacy services. However, that is a matter to be decided locally in consultation with patients, GPs and the public. We have no plans, no intention, no desire, no aspiration and no ambition to force a specific model of primary care on GPs or patients. These new services are designed not to replace existing GP surgeries, but to provide additional access and extra choice for patients.
Nor is this an attempt to get rid of single-practice GPs, which will continue to be an essential part of primary care, particularly in rural areas. However, there has undoubtedly been a general trend in recent years for GPs to come together to work in larger teams so that they can provide a better range of care and more integrated services. There are now more than 500 practices with nine GPs or more. This has been led and encouraged not by Government, but by GPs themselves, who increasingly find that it is more practical to work together in larger, more suitable premises, providing a greater range of integrated services.
Therefore, having invested heavily in primary care and increased the number of staff and improved their conditions, the Government now propose to expand primary care capacity, including in the 25 per cent. of PCTs with the poorest GP provision, thereby addressing a major cause of health inequalities.
What have Her Majestys official Opposition got to say? Last week, they claimed that there was a £1.6 billion black hole in our plans for GP-led health centres. I note that that ludicrous claim is missing from the catalogue of ludicrous claims masquerading as a motion for todays debate. Yet again, they mistakenly assume that what has been proposed for London will be transposed to the rest of the country, and there will be 25 GPs in each of the new health centresin actual fact, the expected number is five not 25.
Greg Mulholland: I think the Secretary of State gave a rather one-sided view of the Age Concern briefing that he mentioned. Does he acknowledge that older people have real concerns about these plans, particularly because, as we know, they are most reliant on family doctor services? There are real concerns that the relationship will be lost. There are also concerns about access during the day; people hope that the extended hours will not mean fewer opportunities to see family doctors during the day, because they are the sort of times on which older people are particularly reliant.
Alan Johnson: The hon. Gentleman is right to say that the elderly, who use health services more and, as Age Concern points out in the briefing, use primary care services much more, would be worried by any indication that their GP services were to be diminished. As Age Concern points out, the advantage of the polyclinic and the health centre for elderly people is that even if they have to go a little further to get to the polyclinic, they do not have then to go somewhere else to go to the pharmacy, to go somewhere else to get diagnostics and to go to the hospital for other services. That is a very important point.
Incidentally, we have been absolutely stringent in saying that increased access, which the Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw) has mentioned has now reached 21 per cent. across the countrythat is an 11 per cent. rise since we introduced the policymust not be at the expense of existing hours. The pay that goes to GPs is only for their giving additional hours; it is not for putting in a Saturday morning and taking away a Thursday afternoon. The hon. Member for Leeds, North-West (Greg Mulholland) is right to raise the point.
Mrs. Maria Miller (Basingstoke) (Con): Perhaps the Secretary of State can clarify something for me. He is at pains to say that his proposals do not aim to replace GPs surgeries, yet the proposal put forward by the Hampshire PCT to locate a polyclinicor whatever he wants to call itin my constituency talks about building
capacity to absorb a growing population.
The allegation is made by the Conservative party that every one of these GP-led centres will have 25 GPs, and that is wrong, because we expect them to have, on average, about five new GPs. That rather silly misrepresentation is less pernicious than the way in which many patients are being deliberately misled by some in the profession about what our proposals to improve primary care actually mean.
I have here a leaflet produced by a group of GPs on Teesside entitled Save our Surgeries. It has an NHS logo on it, when it should not have, it contains no address to which to write and it makes several unsubstantiated claims about what our proposals will mean. It is, by no means, an isolated leaflet; such leaflets are going right across the country. It says:
This initiative will be the first stage in dismantling of traditional general practice in this country.
You will have to de-register from your local surgery in order to register and be seen in a new one.
People will not have to do so, although, of course, anyone who chooses to change their GP, as is their right, will have to register with a new practice. That is the case for any patient now who chooses to change practice, but the same will not be true for those who use the new GP-led health centres. As I have explained, patients do not have to leave their existing GP to gain access to the new service.
This funding is only for a very short time. When it runs out, the PCT will have to use other funding to continue the new services.
The proposals will eventually force doctors to leave traditional general practices and work for private big companies like Tesco or Virgin...Doctors who work in these practices will have to follow company policy and protocols regarding prescribing expensive drugs and making referrals to hospitals.
This borders on hysteria. In the first instance, we expect many of the new contracts to go to GP-led consortiums, not private companies, and any GP practice, whoever runs it, has a professional duty to provide the best possible care for its patients and will already work to sensible protocols on prescribing and referral. In fact, Virgin has made it clear that it is not interested and will not even be bidding for these new practices. It will seek to get GPswho are already, I remind hon. Members, in the private sectorto come into consortiums with it, and it will provide the building. That is nothing to do with the Government or the 150 new GP-led centres.
Such scurrilous leaflets ignore or patronise the central player in this debate: the patient. While the vast majority of GP practices provide an excellent service, it must be acknowledged that many patients cannot access the services they need and that there is a very real need to improve the quality of primary care in some parts of the country, especially in London.
We have many examples of patients being dragooned into signing the BMAs petition, but when patients understand our proposals, they realise that we will not be taking away their GP services and that the relationship between the family doctor and the GP is sacrosanct and will be protected by this Government.
The Government believe that adding more than 270 new GP practices and GP-led health centres across the country, with the majority in under-doctored areassome of which have been under-doctored for the past 60 yearswill add extra capacity, provide more convenience and choice for patients, and allow the expansion of more preventive work such as vascular checks to proceed successfully. As we will not be removing existing GP surgeries, the time for the Opposition to criticise these proposals will be when and if these new facilities remain empty and unused once they have been established. I confidently predict that that will not be the outcome, and that historians of the health service will look back on this peculiar spat as the time when producer capture killed off the little credibility that the Conservatives ever had on health issues. I commend the amendment to the House.
Norman Lamb (North Norfolk) (LD): It is surely a spectacular achievement by the Government to have taken a concept that is clearly worthy of consideration and development and, in the space of nine short months, turned so many people against it. The reason for that is the central imposition from Whitehall, which will require every PCT to introduce a GP-led health centre.
The Secretary of State draws a distinction between GP-led health centres and polyclinics, but the Kings Fundwhich is entirely independent of the BMAsays that they involve a model of care that is not dissimilar. GP-led health centres are, at the very least, embryonic polyclinics. They look to most independent observers very much like the same thing. As the hon. Member for Birmingham, Selly Oak (Lynne Jones) and my hon. Friend the Member for St. Ives (Andrew George), who is no longer in his place, made clear, surely the decisions should be made by local commissioners, who are accountable to the communities they serve.
The review, the first of its kind, will directly engage patients, NHS staff and the public. I have written...to all NHS staff to explain the importance of this new approach. The success of the review will depend on gaining access to those relationships and stimulating a range of lively, local, provocative debates. Public services cannot be transformed by going against the grain of public service, or without support from the professionals who know the NHS best.
That was the stated ambition at the start of the process, but three short months later, when the interim Darzi report came out, it announced the 152 GP-led health
centres, one for every PCT. Was that really the outcome of that great conversation with the NHS, or was it the imposition of a blueprint that had already been determined long before the launch of the review?
Mr. Lee Scott (Ilford, North) (Con): Does the hon. Gentleman share my concerns about the fact that Lord Darzi said in his report that many polyclinics would take the place of the care provision formerly provided by district general hospitals? Does he agree that that would be a detrimental step? We have all been fighting to save our district general hospitals, and anything that threatens them will be of great concern.
Norman Lamb: That might be a concern, but my argument is that these new mechanisms for delivering care should be piloted. They should be tried in various parts of the country so that we can learn the lessons, both positive and negative, and see what the implications are for district general hospitals and community hospitals. We ought to be developing a lot of these services in local community hospitals, which often serve very rural areas. For many communities, that would be a much better way forward than the Governments proposals.
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