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The UK’s almost unique system of family doctors is envied throughout the world. Most of us need and expect our GPs to be there for us when we need them, but in repeated patient and other public surveys the public have told us that they do not always find it as easy as it should be to see a GP quickly or make an appointment in advance and at a time that suits them. That is why the Prime Minister, when he took over just over a year ago, said that he wanted at least half of GP surgeries opening in the evenings and at weekends. Earlier this week we announced that that target had been met three months early.

Mr. David Drew (Stroud) (Lab/Co-op): If my hon. Friend examines the matter carefully, he will see that Gloucestershire sits alongside two other authorities in not having negotiated any improvements in GP access so far. I am assured by my primary care trust that that is historical data and that a lot of practices have now come on board, but will he ensure that there is not a huge disparity across GP practices? They should all offer some out-of-hours provision. Although many do so, the problem is how it has been reported. It was a bit of a shock to see that not one practice in Gloucestershire could qualify as part of the long-awaited improvement.

Mr. Bradshaw: My hon. Friend is absolutely right to draw attention to PCTs’ so far variable performance in delivering on the target that more than 50 per cent. of GP practices should offer evening or weekend openings. It must be frustrating for him, as a Gloucestershire Member of Parliament, to note that his is one of the areas that still has some catching up to do. I am confident that Gloucestershire will catch up and that every strategic health authority in the country will hit the target by December.

Of course, the more GP surgeries that offer extended hours, and the more patients decide they like them and vote with their feet, the more likely it is that there will be a snowball effect. In that case, probably far more than 50 per cent. of surgeries in most areas will end up offering extended hours.

Mr. Stewart Jackson (Peterborough) (Con): Despite the Minister’s words, does he not understand the cynicism that many general practitioners will have about the policy of getting rid of the minimum practice income guarantee? Some will feel that that means a move towards a capitation-based, quantitative approach to family primary care rather than a quality-based approach. The real effect will be to close many small surgeries up and down the country.

Mr. Bradshaw: No, I do not accept that. I think that the minimum practice income guarantee is one area of consensus in the House, and I shall say a little more about it in a moment. I welcome the fact that the British Medical Association has now signed up in principle to phasing it out, and we want to work with the BMA to ensure that we do that in a way that does not have the impact that the hon. Gentleman describes. The very problem with the guarantee is that it does not reward performance and quality. It makes a significant proportion of payments based on what has historically been paid, and I do not believe that anybody in 2008 thinks that that is the right way forward.


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Mr. Lansley: The Minister will no doubt have seen that last week GP magazine reported the Department’s director of the GP access programme as saying that one option that the Department was considering was to replace the directed enhanced service for extended opening hours with a local enhanced service. Can he confirm that that is one of the options that the Department is considering, and that in effect it would bring us to the situation that should have obtained under the contract introduced in 2004?

Mr. Bradshaw: No, I cannot comment on those remarks. I can say that we would not want to do anything that was in danger of reversing the marked and welcome progress that has been made on extended hours over recent months.

Norman Lamb (North Norfolk) (LD): The Minister says that he cannot comment, but is he saying that the report is not true? Do we face another change, on top of the one that was introduced earlier this year?

Mr. Bradshaw: If it would help the hon. Gentleman and the hon. Member for South Cambridgeshire (Mr. Lansley), I shall write to them with clarification on the matter.

Mr. Peter Bone (Wellingborough) (Con): The Minister has been extremely gracious in accepting so many interventions. Before he leaves the issue of getting access to a GP within 48 hours, I want to ask him about something that happened in my constituency. A rather poorly elderly lady went early in the morning to get an appointment at the doctor’s surgery, only to be told that it was full for that day. When she asked whether she could have an appointment for the next day, she was told, “No, you have to come back and try again tomorrow.” Presumably that did not register as her not being able to get an appointment within 48 hours, and surely that cannot be the way in which the Government want GP access to operate.

Mr. Bradshaw: No, that would not comply with the standard that someone should be able to see a GP within 48 hours. Some surgeries operate a walk-in, non-appointment service, whereas others offer appointments only. However, if someone is not able to see their GP within 48 hours, that would not comply with the current standards. That lady would, therefore, have every right, aided by her able Member of Parliament, I am sure, to complain to the practice concerned and to the primary care trust.

The people who are taking advantage of these new extended hours are not the people whom the Leader of the Opposition recently described, so disparagingly, as executives who

Neither are they the people whom some doctors’ leaders have described as the “worried well”. They are the hard-working people who pay for the national health service, and they welcome the fact that they do not have to take time off work any more, in some cases losing wages as a result, just to see a doctor. The new evening and weekend opening hours are proving extremely popular with the public and with the doctors, nurses and other practice staff who are implementing them. I hope that
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the Conservative party will soon perform another U-turn and abandon its pledge to reverse evening and weekend opening—perhaps the hon. Member for South Cambridgeshire will assure us now that it will abandon its pledge to reverse extended opening.

Mr. Lansley: The Minister will doubtless be aware that I will have an opportunity to say something after he has finished, but may I ask him a question now? Has he seen the report on extending opening in this week’s Pulse? It says that its survey of 398 GPs found that

So, the hours are not necessarily being used by people who are in work, and that is what one would have expected. He must know from his own patients survey that the people who most wanted to be able to attend on a Saturday morning were the elderly, not those who are in work. Of course we can respond to patient choice, and to do so is Conservative policy, but we need to be aware who is seeking this system.

Mr. Bradshaw: That was exactly the point that I was making. I was citing the suggestion by the right hon. Member for Witney (Mr. Cameron) that the only people who would use extended hours were yuppies getting their jabs before going to Asia, and making the point that a cross-section of patients are benefiting from these hours. This week, I visited a surgery in west London that has introduced extended opening, where I was told that the patient profile of the people using the service was almost exactly the same as the surgery’s overall patient profile. It included not only people who welcomed the fact that they could attend before or after work on a week day, but elderly people, who liked the fact that the surgery was quieter, and parents, particularly mothers, who found that they could use the evening opening—their child care arrangements were looked after because their partner, husband or spouse was already home. We should not be sniffy about the fact that extended opening is being used and welcomed by a cross-section of patients, because that is exactly why the Government introduced it. I hope that the Opposition will abandon their pledge to reserve it.

Helping patients to fit a doctor’s appointment into their busy lives does not just mean making available evening or weekend appointments; it also means patients being able to be seen quickly and to book appointments ahead. Some of the media today have said that the Healthcare Commission’s report shows that just 31 per cent. of primary care trusts are giving patients an appointment within 48 hours. That is not correct. The Healthcare Commission’s own patient survey and the much larger national GP patient survey, which questions 5 million patients, both show the same thing: last year, 87 per cent. of patients said that they could see their GP within two working days of asking for an appointment. That is a further improvement on the year before.

The Healthcare Commission has its own separate measurement to judge how effectively primary care trusts are performing. It is that far more stringent measurement that has led to some of today’s misleading headlines. While 87 per cent. is good, it is not good enough. Every patient should be able to see their GP within 48 hours. If any of the hon. Members present, or their constituents, think that local GPs are not providing that service, they should take the matter up with their local primary care trust.


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Norman Lamb: The Minister referred to the fact that the assessment by the Healthcare Commission is much more stringent, and I have read the relevant section of the report. None the less, the results are alarming, suggesting that patients often cannot get an appointment within the defined period. When the surveys do their mystery shopping, they make three calls, because in real life people often cannot make specific times, especially if they are working. The commission report should therefore give rise to considerable concern and demonstrates how much further we still have to go.

Mr. Bradshaw: I agree, and I wish to put on record my admiration and respect for the work of the Healthcare Commission. We established that independent health watchdog and its work has helped us to drive up standards across the NHS. It is also right to highlight in its report the relatively weak performance at primary care trust level. There has been significant improvement across the NHS, as Sir Ian Kennedy, the chairman of the commission acknowledged, both in his foreword to the report and in his media interviews, but acute hospital trusts are performing much more strongly than primary care trusts. That is partly because primary care trusts were massively reorganised only two or three years ago and have been settling down since. There has been improvement, but the Healthcare Commission is right to focus the criticisms in its report towards primary care trusts, and especially their management of GPs.

Mr. Lansley: It is important to be clear about what the Healthcare Commission is saying. Will the Minister therefore agree that it was unhelpful for the Secretary of State to wander around studios this morning insinuating—and sometimes even stating—that there was a difference between the commission’s survey and the Department’s, because the latter asked about the chance of seeing “a” doctor within 48 hours, and the former asked about the chance of seeing “your” doctor? That is irrelevant. In fact, the Healthcare Commission incorporated the result of the GP patient survey fully into the measure that it has published. In that sense, what the Minister has said is true, and not what the Secretary of State said.

Mr. Bradshaw: It would be unwise for me to comment on media interviews that I did not hear or see. I do not think that there is any difference between us and the Healthcare Commission on the surveys. Indeed, the commission used our survey as part of its report. The difference, as the commission acknowledged, comes in its interpretation of some of the data, which has led to headlines claiming that two thirds of people cannot see a GP within 48 hours, so millions of people are deprived of access to GPs—to misquote the splash in The Daily Telegraph today. That is not the case, and the Healthcare Commission has been happy to put it on record that that is not its view.

Mr. Bone: What the report actually said was that two thirds of primary care trusts were failing to get everyone in their area seen within 48 hours. If that is the case, it is quite a failure to meet the Government’s target.

Mr. Bradshaw: It is not a target, but a standard; let us get our terminology right. The hon. Gentleman is right, but it would be wrong to imply from that information that millions of people were being deprived of access to
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a GP—that is not the case—or to give the impression that the vast majority of people in both surveys were unable to do so: 86 or 87 per cent. said that they could get to see their GP within 48 hours.

Mr. Lansley: I am sorry to intervene again, but if we are in the business of clarifying we should clarify properly. There are two surveys, one of which is the primary care access survey conducted by the Department through primary care trusts. The other is the GP-patient survey conducted by Ipsos MORI. That survey says that 87 per cent. of patients say that they can access a doctor within 48 hours. The national primary care access survey says that 98.93 per cent. of patients can access a doctor within 48 hours. Part of the issue is how the Healthcare Commission has constructed its measure. It has done so partly to incentivise improvement on the patient access survey, and partly to penalise the gap between the two surveys, which on average across the country is approaching 12 per cent. The measure has taken some PCTs below 80 per cent. overall achievement—below a mark of 80—which means that they are held not to have achieved the level. I know that that is complicated, but it does not mean that it is true that the two surveys deliver the same result.

Mr. Bradshaw: We are dancing on the head of a pin. I agree completely with what the hon. Gentleman just said, and I am not quite sure what point he was trying to make.

One way in which we have achieved the improvement in GP access is using incentives in the new contract. An ever-increasing proportion of the payments made to GPs is based on a patient’s ability to get an appointment within 48 hours and to book appointments ahead. More than £38 million is now available through the quality and outcomes framework to award those practices whose patients are highly satisfied with the speed and efficiency of the appointments system.

Providing incentives for practices to open for longer, and making it easier to see a GP quickly and to book appointments ahead, are only part of the story. We are also expanding primary care through new and additional GP practices. We have already replaced and refurbished nearly 3,000 GP premises and built more than 650 one-stop primary care centres. We have invested nearly £1.5 billion in primary and community care facilities since 2003 under the LIFT—local improvement finance trust—initiative.

In order further to improve access to GP services and to tackle some of the persistent health inequalities, we need to do more. We are investing £500 million over the next three years to provide a new GP-led health centre in every primary care trust in the country. Any member of the public, regardless of which local GP practice they are registered at, will be able to walk in and use those services or book an appointment in advance. Every centre will be open from 8 o’clock in the morning to 8 o’clock in the evening, seven days a week, 52 weeks a year.

Tony Baldry (Banbury) (Con): The Minister has talked about carrots and incentives for GPs to improve access, and I am sure that we all welcome that, as it is good news. However, there is one thing that I am at a complete
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loss to understand. In the whole area covered by the Oxfordshire PCT there will be just one Darzi centre in one bit of the county, so how will that help everyone else all over the rest of Oxfordshire? Would it not be better to put the money that will go into that Darzi centre into the general pot of incentives and carrots to help all GPs improve their services? Effectively, what will happen is that one Darzi centre in one bit of the county will be competing with the GP practices there, while the rest of the county will not benefit at all from the centre. I do not understand the public policy imperative of all that. It is very confusing.

Mr. Bradshaw: What happens in Oxfordshire is a matter for Oxfordshire PCT. The hon. Gentleman might want to make representations to the PCT. If he does not want the new walk-in centre in his constituency, in Banbury, perhaps the trust would be better off putting it in Oxford, where students could benefit from it.

As I said earlier, one thing that has come top of the public’s concerns on the further improvements that they want in the health service is the ability to see a GP at a time that is more convenient to them. As we have discussed already, more than half of GP surgeries now offer appointments in the evenings and at weekends, but it may be that only half or 60 per cent. of GPs in Oxfordshire do so. It is right that a service should be provided so that people whose surgeries are not open in the evenings or at weekends, or at a time that is more convenient for them, can make use of them on a Saturday or Sunday or a weekday evening. I must tell the hon. Gentleman that those facilities that are already up and running are incredibly popular.

Earlier this year, the proposals were subject to a campaign of opposition led by the British Medical Association. I am afraid that that campaign was supported by both the Conservatives and Liberal Democrats. The claim was that the proposals posed a threat to existing GP services and would lead to the wholesale closure of GP practices. I believe that both Opposition parties are pledged to scrap them, and that is another area in which I confidently predict U-turns by them.

Norman Lamb: What we opposed was the central imposition on every PCT. The Minister responded to the intervention from the hon. Member for Banbury (Tony Baldry) by saying that the decision was up to each PCT, but that is not the case. It was imposed from Whitehall. Will he confirm that every PCT had no choice but to go along with the decision, and also that the time scale was very tight?

Mr. Bradshaw: I do not know whether the hon. Gentleman has misinterpreted my remarks accidentally or deliberately, but I said that the decision on the location was entirely up to Oxfordshire PCT. He is entirely right to say that we are insisting that every PCT in England establishes one of the new facilities, but I have never met anyone who is 100 per cent. satisfied as to the current level of access to general practice in their area. The new facilities will be a big improvement, and as I said, the ones that have been set up already are extremely popular.


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