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People wanted that increased access, which is what the GP-led health centres and polyclinics in London will provide, for a wide variety of reasons. One reason that struck me came from working women with young families. Although there is meant to be more equality in society, when it came to taking the kids to the doctor it
was still the woman who had to do it. Generally speaking, she would have to take time off work, and the kids might also have to miss school. That was one reason why those women wanted early morning appointments or appointments later in the evening.
In the Cleethorpes constituency, there are still a number of single-handed GP practices. That was another factor in people wanting more access. For example, if women had an older male GP, they felt uneasy about seeing him about issues to do with sexual health and said that they would prefer a larger health centre so that they could have that choice and have access to the type of clinic that they would not necessarily get in a single or double-handed GP practice. Plenty of people are perfectly happy with that set-up, and no one is suggesting that it will change. However, in my area patients have demonstrated a desire for more than just those single-handed GP practices.
There are now health and medical centres in Cleethorpes and Immingham, just as there are in the area represented by my hon. Friend the Member for Wigan (Mr. Turner). The people who can access those health clinics really appreciate being able to use their services. Immingham is quite isolated from other urban areas in the constituency. The towns GPs came together and relocated to one building. Some people in the area had a bit of a pop, saying, Oh my God, weve got fewer GP surgeries now. Technically that was true, but only because the GPs had all moved out of dilapidated premises and into a brand-new purpose-built primary care centre, where people can use a variety of services. My hon. Friend gave a list of the services, so I will not go through the complete list again. People can have their blood tests and X-rays done there, which means that they do not have to travel to the hospital in Grimsby, which is not easy to do from Immingham.
The British Medical Association was therefore wrong to say that such health centres will always mean that people will have to travel further. That is rubbish; my constituents do not have to travel, because services are being provided on their doorstep. Recently, another GP-led health centrethe Beacon medical centreopened in Cleethorpes constituency, and the people being treated there think that the wide range of services is excellent.
The Opposition are completely out of touch with the public mood on this issue. We are no longer in the days of Dr. Finlay and his sidekick, moody grumpy Dr. Cameron perhaps it is the name that makes the Conservatives so keen on their old-fashioned ideas. Those days are long gone. Peoples lifestyles are pressured. They have many demands on their time, and we have to make sure that primary care evolves and adjusts to meet their needs. If we do that, the NHS will be around for another 60 years after celebrating its 60th year next month.
Mark Simmonds (Boston and Skegness) (Con): The motion is all about patients and the provision of health care for the maximum benefit of patient outcomes. This debate has been very revealing, in that the only speakers who supported the Governments policy came from that diminishing dying breed, the ultra-supporters of the Government.
The debate was opened by the shadow Secretary of State for Health, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who gave a timely and devastating critique, mentioning the potential serious problem and the detrimental impact on patient care. He was right to highlight the problems of potential closures, the potential increase in travel distances, and the danger to the fundamental GP-patient relationship. In direct contradiction of what the hon. Member for Cleethorpes (Shona McIsaac) said, he mentioned the dynamic, strong feelings that patients and GPs have on the issue. He also highlighted the funding uncertainties: where will the money to support the policy come from? Even more importantly, he mentioned the fundamental lack of evidence to support the Governments policy, in relation to quality, access and service.
We then heard the Secretary of States response. He is usually highly polished and has a Teflon quality to him, but today he was clearly slightly over-excited, rattled and very confused. I suspect that he does not really want to have to defend the policy, because he knows that it does not make sense, particularly in the context of localised decision makingan idea that the Government trumpetand clearly he was not enjoying himself. He tried to make a difference in definition between polyclinics and GP health centres, but it was clear from other contributions that they are the same. He quoted a London MORI poll in an attempt to support his policy, but the only recent poll that matters in London is the mayoral election, which was clearly won by Boris Johnson.
The Secretary of State took an extraordinary, uncharacteristic and slightly sarcastic sideswipe at the hon. Member for Birmingham, Selly Oak (Lynne Jones), who made an extremely thoughtful and balanced contribution. Like us and, I suspect, the Liberal Democrats, she is trying to argue for more devolved decision making on how the money is spent. The Secretary of States response to her contribution was extraordinary. Tellingly, he confirmed that primary care trusts would not be allowed to convert and expand existing practices, even if that was in patients interests; there had to be a new polyclinic or GP-led health centre in every primary care trust, and even more in London. He made a bizarre attack on Conservative party policy, which is to try to find ways of improving primary care in socio-economically deprived areas, so that we can reduce health inequalities and improve things for those who do not have sufficient access.
A significant contribution was made by the hon. Member for North Norfolk (Norman Lamb), who rightly confirmed the necessity of local decision making. He made a critical point about the importance of continuity of care, and about the danger that GPs understanding of individual patients medical histories could be eroded by the policy direction being taken. We next heard from the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, let us not forget, is an ex-Secretary of State for Health. The current Secretary of States view is that there is uniformity of opinion in London that polyclinics are a good idea, but that view was clearly shot to pieces by the right hon. Gentlemans contribution. The right hon. Gentleman was right to highlight the fact that the drivers of the polyclinics policy are Ministers in the Department of Health. The
policy is not a response to patients needs, to the NHS in London or to primary care trusts desires elsewhere in the country.
My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill) made a significant contribution. He was right to challenge the idea that the proposals would be the best use of resources in his constituency. In a lucid, considered contribution, my hon. Friend the Member for Basingstoke (Mrs. Miller) highlighted concerns in her constituency. At the time of his speech, the hon. Member for Dartford (Dr. Stoate) was the only Member to have supported the Government line. He is clearly very knowledgeable about the health service as a result of his professional qualification and his career, so it is sad that he always rises to defend Government policy, irrespective of what it is. He does not, perhaps, use his expertise and knowledge to make constructive suggestions for the Government. The hon. Member for Wyre Forest (Dr. Taylor) made a telling contribution, as always. He made one particularly good point: the policy should not be about buildings, but about patient services and pathways. That is one of the fundamental errors in the direction of Government policy.
I will not allow Conservative Members to be painted into a corner and seen as the representatives of the British Medical Association. We are not its representatives; we are here to fight for patients and the improvement of patient services. We are not against polyclinics or GP-led health centres per se. In fact, when they are supported by patients, GPs and the local community, we will be supportive and will facilitate them and enable them to be introduced. However, the decision should be taken locally, and should be based on clinical evidence, and evidence on health inequalities and prevention measures. There should also be a comprehensive understanding of the impact on existing provision.
The House needs to understand that we are not talking about a minor tweak to primary care. The establishment of polyclinics and GP-led health centres will be the largest change to primary care since the establishment of the NHS. In many places, including the Secretary of States constituency, it has been said that the change would act as a catalyst for the reconfiguration of local GP services. It should be for local primary care trusts and patients, not Ministers in the Department of Health, to make the decision.
Of course the Secretary of State is right that there are circumstances in which health centres of polyclinics would have a beneficial impact. He rightly gave the example of preventing multiple appointments and additional travel, particularly for the elderly and the vulnerable. We also recognise that there should be greater access to diagnostics and follow-up appointments, and it may be that such centres are the appropriate place to provide those services, but not everywhere, not uniformly, and particularly not in rural areas.
Very specific criteria were set down by Darzi that the polyclinics and GP-led centres would be both cheaper and more accessible, but some hon. Members contributions have demonstrated that that is not the case. The Government need to answer some specific questions. They do not seem to understand that there is a direct correlation between GPs and patient care and a threat to that relationship. Will the Minister also explain in winding up the debate whether a GP-led health centre means a
GP presence all the time, from 8 am to 8 pm, seven days a week, 365 days a year? Why are there no pilots to produce evidence that the Department of Health can analyse?
The Secretary of State confirmed for the first time that, on average, there will be five GPs per centre outside London. That amounts to an additional 605 GPs. Where will those additional GPs come from, in the context that there were only six more last year, if they do not come from surgeries that are already in place? Why will Ministers not allow PCTs to invest instead, where appropriate, in community hospitals or other GP-led health centresa point made by my hon. Friends the Members for Beverley and Holderness (Mr. Stuart) and for Scarborough and Whitby? Why will Ministers not allow additional facilities to operate in non-spearhead PCTsfor example, outreach services?
The policy is confusing. Lord Darzi said in his framework document that PCTs would not be allowed to reconfigure services until a PCT clinic review has taken place, giving evidence of the benefits. Where is the evidenceI hope that the Minister will explain thisto support the supposed benefits of a centrally prescriptive solution that is odds with locally determined reconfiguration? I suspect that the answer to those questions is that a one-size-fits-all proposal is not really about patient outcomes, but about political outcomes.
There is an inherent contradiction between devolving commissioning responsibilities to a PCT through practice-based commissioning, and proposing a centralised approach to service design, with plans for polyclinics or GP-led health centres in every PCT. The Opposition will not coerce doctors into polyclinics against their will. GP-led health centres should be able to offer additional services, such as physiotherapy and phlebotomy, but they can be provided in other facilities as well in the existing system. This is not just about new buildings. Under the next Conservative Government, primary care will be patient-centric, responsive to local communities and free to innovate, ultimately to drive better patient outcomes.
The Minister of State, Department of Health (Mr. Ben Bradshaw): Our primary care system of family doctors has served this country very well and is the envy of the world, and the Government are investing record sums in it. Funding for GP services has increased from £3 billion in 1997-98 to £7.86 billion in 2006-07. There are 19 per cent. more GPs today than in 1997. Incidentally, there were 273 more, rather than the six more mentioned by the Conservative party, in 2006-07 alone. They are better rewarded than ever before. More doctors are in training to become GPs, and vacancy levels for jobs are the lowest for many years.
The new contract has also brought important benefits for patients: being able to see a GP within 48 hours or to book ahead, longer consultations and better outcomes. But in every recent survey of what the public would like improved in the health service, being able to see a GP at times that are more convenient for them comes top. That is part of the reason why in March we agreed with the BMA that surgeries offering opening in the evenings and weekends will be rewarded. I am pleased to tell the House that today 21 PCTs already have achieved the aim of at least 50 per cent. of GP surgeries opening in
their areas either on a weekday evening or at weekends. We are confident that the rest of England will do so by the end of the year.
Even with more than half of GPs offering extended hours, there may still be some people whose GP, for whatever reason, does not wish to open in the evening or at weekends, and we think it only fair that those people, too, should have the possibility of getting to see a GP at more convenient times. That is why we announced last autumn an extra £250 million to enable the local NHS to establish a new GP-led health centre in every PCT in England and extra GP surgeries in the least well-served areas. That is additional money on top of, not instead of, the record sums already going into existing GP surgeries. No one will lose their current family doctor as a result.
In fact, one of the specific features of the new health centres is that people will be able to remain registered with their own doctors and see GPs in the new centres if they wish. The centres will be particularly welcome for people who work full time or commute, who currently find it hard to visit a GP, and they will also take pressure off accident and emergency departments, which deal with a lot of people who should see a GP. The only requirement we are placing on the centres is that they should be open seven days a week, 12 hours a day, and offer appointments and walk-in services.
The hon. Member for North Norfolk (Norman Lamb) criticised the Government for moving too fast and predicted that we would live to regret our extra investment in primary care services. I suspect that when his constituents begin to enjoy the extended opening hours of GPs in Norfolk and the new 12/7 GP health centre in Norwich, or wherever Norfolk PCT decides to locate it, he will regret his opposition to those improved new services. He quoted the Kings Fund report, which was much more balanced than the impression he gavebut of course, it was an analysis of a policy that is not being proposed.
The hon. Member for Scarborough and Whitby (Mr. Goodwill), like a number of Conservative Members, said he was opposed to the new investment in his constituency. I am sure that other parts of North Yorkshire, such as York and Selby, might welcome it. His local PCT, as he well knows, will have assessed the needs of Scarborough and Whitby, and I understand that a public meeting in his constituency this week supported the proposals. He also said he was concerned about the provision of dental services. He might like to suggest that the PCT considers including extra dental services in the new centre. That is exactly what many PCTs up and down the country are doing. He asked whether the services need to be provided under one roof. No, they need not.
The hon. Member for Basingstoke (Mrs. Miller) also said that she opposed the extra investment, in spite of the very significant population growth in her area. I suggest to her that, as in North Yorkshire, there are plenty of people in Hampshire who would welcome that extra investment. It is also not the case, as she suggested, that the existing GPs whom she mentioned cannot bid to run the new health centre.
My hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) is due to get not only a new health centre but a new GP surgery in her constituency because it is one of the under-doctored areas. Her constituents
do not enjoy the same access as people in neighbouring constituencies in the Heart of Birmingham PCT, which has reached 75 per cent. access for extended hours on behalf of its patients. There is nothing whatsoever to stop the GP practice that she mentioned bidding for the new health centre. It need not be a new building; it can be an expanded existing building, and we have repeatedly made that clear.
I make the same assurance to the hon. Member for Wyre Forest (Dr. Taylor). The new services can be part of an existing system, and there is nothing to stop Worcestershire adopting the kind of model that he favours. If he wants to make that case to Worcestershire PCT, he is very welcome to do so. The current proposal is for Worcester, but if he wants to persuade the PCT that his model is better, I wish him good luck. Of course, I would be very happy to meet him, as I always am.
My hon. Friend the Member for Dartford (Dr. Stoate) made a very strong case in support of the improvements that we are making to primary care, as did my hon. Friend the Member for Wigan (Mr. Turner). He well knows that he will get not only a new health centre but three new GP practices in one of the most under-doctored areas of the country. He also made an important point about the huge public health benefit of investment in primary care.
My hon. Friend the Member for Cannock Chase (Dr. Wright) gave an example of some of the disgraceful and irresponsible scaremongering by the BMA and the Conservatives that has caused unnecessary anxiety to patients, including his constituents. My hon. Friend the Member for Cleethorpes (Shona McIsaac) also welcomed the new investment and improvement in services.
My right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) referred to a procurement that has nothing to do with the extra investment that we are announcing but is an ongoing process of PCTs procuring new GP services. His local PCT says that it is perfectly happy to defend the way the procurement was carried out. If it is not happy with the providers performance, it can terminate or not renew the contract. I understand that the proposal for a new health centre in his area involves housing it in a local hospital because that is an accessible point locally, unlike in some other parts of the country where hospitals are not necessarily as accessible as other places.
this is a big step forward. A large surgery with easy access and in the right location will be ideal. To be open seven days is fantastic.
Labour Members are delighted to have been given another opportunity to defend the Governments record on the NHS and highlight the further improvements under way in primary care. We do not think it unreasonable, given the record sums going to GP practices, that people should be able to see a GP in the evening and at weekends. We will not reverse those improvements or give a veto over health policy to the doctors trade union, the BMA. I recall a similar campaign by the Conservatives this time last year against what they claimed was a programme of hospital closures. That campaign was humiliatingly abandoned when they were forced to admit that they had got their facts wrong. I predict a similarly bruising fall from this bandwagon.
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