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The hon. Members for Dartford (Dr. Stoate) and for Wyre Forest are both GPs, and they have made the point that GPs work exceptionally hard. If we ask GPs
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to work in the evenings, they will take time off in the daytime to compensate for that—it has to be that way. A local GP from Finedon in my constituency came to see me and told me that the new system was absolutely nuts. He has a surgery during the day and anyone can come along. He sees patients during the day, but now he has to open his surgery one night a week and sit there with his practice manager while nobody comes to see him. It is a pointless exercise.

If I have learned one thing from this debate, it is that there is a huge difference around the country and that one idea or size does not fit all. When I grew up, if I needed to see a doctor, I saw one whom I knew. We could ring up, make an appointment and we would get seen. If I needed to go to the dentist, I would make an NHS dentist appointment, and I would be seen. If I needed to go to hospital, it would be arranged through my local doctor. If I was ill in the evening, the local doctor would come out. I remember that I once needed to see a doctor on Christmas day, and the senior partner in the practice came out to see me. All that was under what many Labour Members like to portray as the wicked old days of the Tories, but it seemed to me to work well. What we should do is build on a system like that rather than apply top-down approaches. I understand that the Minister has adopted those approaches for the very best motives, but I just do not believe that they will work. Why not let existing GP practices expand and develop services that are relevant to their areas?

Dr. Stoate: As I have said, the answer to the question is that there is great variation. The good practices will no doubt pick up the baton and provide everything that the Government could possibly dream of. However, the hon. Member for North Norfolk (Norman Lamb) has pointed out on the basis of surveys in his area that there are far too few practices—sometimes as few as 1 per cent.—able or willing to do that. We must try to reduce the variation.

Mr. Bone: I am grateful for that intervention, which adds to my point that there are big differences around the country. My argument is that imposing one GP-led health centre in every PCT is not right.

This morning, three hon. Members who are currently in their places were sitting in the Health Committee. We heard that the Government have found £250 million of taxpayers’ money to inject into primary care. However, £150 million is going into a minimum of one health care centre per PCT, and we do not know how the other £100 million will be divided up. I was trying to understand the best way of allocating that money so that it was focused on the areas that needed it most, and I suggested a very simple system.

The Government devote a lot of time, concern and expense to working out—on the basis of deprivation, growth and other factors—what each and every PCT needs as a minimum, but they do not fund every PCT to that level. Because some areas are overfunded, others are underfunded. My Northamptonshire PCT happens to be the worst funded in the country, so I declare a certain interest in finding a solution. Surely it would be better to take this £250 million and give it to the PCTs that are underfunded according to the Government’s own criteria, and then let them develop local solutions to their problems.

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I have another idea for raising some extra money to put into the pot. Why not get rid of the strategic health authorities? I cannot see that they do anything other than push pieces of paper about and tick boxes. The only criterion that an SHA takes into account as making for a good PCT is ticking all the boxes; it does not take local need or local decision making into account. What we should do is get rid of all those pen pushers, take this money and put it into primary access.

Dr. Richard Taylor: Towards the end of this morning’s Health Committee meeting, we were all convinced of the value of SHAs, because they carried out the consultation for Lord Darzi’s review and canvassed the views of patients, citizens and staff. I changed my mind about the SHAs at the end of that meeting.

Mr. Bone: I certainly did not. My opinion was the same at the end of the meeting as it had been at the beginning. The witnesses confirmed all my thoughts about bureaucrats wasting time and money.

Talking of surveys, I run a tracking survey in my constituency. It is called the listening survey. One of the questions is “What concerns you most?” Health is always one of the two top issues. There are so many other issues—council tax, pensions, education, immigration, which is a huge issue in my area, and overdevelopment—but health is always first or second.

Mike Penning: Does my hon. Friend think that if he asked his constituents whom they respected most, GPs would be quite high on the list—higher than Ministers or Members of Parliament in general?

Mr. Bone: I should hate to include that question in my survey. If I asked “Do you value your GP or me?”, it would be like the election return in an African republic: 100 per cent. would value the GP and none would value me. So, with all respect to my hon. Friend, I do not think that I shall include that question.

The question “Why do people put health first or second?” leads to another question. A number of Members have said that many people make their local hospital their first call, because they can obtain primary care in the accident and emergency department, and they are not sure where they should go or cannot see their GP. I only wish that we had that option in my area. We do not have a hospital, although an area of that size should obviously have one, and if my PCT were funded correctly, it would have one.

As for access to GPs, Wellingborough has one of the worst GP-patient ratios in the country. Because the town is expanding, people coming into it cannot get on to GPs’ lists. They have to be forced on to them through the PCT. Again, the position varies considerably around the country. I feel that rather than there being all these plans and targets, money should be found to provide more GPs. We are lagging behind the rest of Europe when it comes to GP numbers. We are asking GPs to do more—to work longer hours, or to work at weekends and take time off during the week to compensate—which is not at all helpful.

On average, a GP sees 34 patients a day. Goodness me! I shall sit down at 9.30 tomorrow morning, and after I have seen 12 of my constituents, I shall be
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completely worn out. The fact that our GPs see 34 people who are really ill in a single day is an extraordinary testament to them.

Out-of-hours access is never an issue in my constituency. The doctors—or the doctors and the PCT—have worked it out. Many surgeries stay open in the evenings, but, as was mentioned earlier, there are doctors’ co-operatives running night-time services. I have a seven-year-old. He was ill one night—not ill enough for us to dial 999 and take him to a hospital, but ill enough for us to ring NHS Direct, which told us that we should use the out-of-hours service. When we went to the out-of-hours service, we were seen very quickly and it was a first-class service. In my area, there is no demand for polyclinics or GP-led health centres, but the Northamptonshire PCT had planned to put three in the county. Sense has prevailed and that has been knocked back to one, which no one seems to want.

The hon. Member for Dartford made a strong case about how GPs in his area were embracing the scheme and bringing it forward. That is the way in which it should happen. If people want to do it, they should do it. In my constituency, there was a doctor’s surgery that was already planning to move to a bigger location and to add services. That is the sort of thing that is evolving and should be encouraged, but local doctors are concerned about funding.

The Minister will probably pull me up on this, as I will not use the right terminology, but, as I understand it, if there is a polyclinic or a GP-led health centre in the town, it will attract people because of the out-of-hours service and the seven-days-a-week service. People will register with that centre, which is how it will be funded in due course, and move away from existing surgeries. It is rather like cherry-picking. The people who tend to be healthier will go to the GP-led health centre and my surgeries will be left with the more difficult cases—namely, the elderly and the young. Those surgeries have to spend more time on them, but because it is a per capita funded system, their income will go down. Therefore, they will spend longer with the patient for less money and not be able to develop their services. That cannot be what the Government planned. If I have that totally wrong, I would like the Minister to tell me in his winding-up speech. That issue really concerns local doctors in the area.

I want to move away from GPs, because, in many respects, the problem is not as serious in my area as it is elsewhere. What is fundamentally wrong and driving people up the wall is NHS dentistry, or should I say non-NHS dentistry? Like thousands and thousands of people in Northamptonshire, I have had to take out private insurance to continue to see my dentist. When I talk to my dentist, he makes a powerful case. Admittedly, he is standing over me with a drill at the time, but he makes the case strongly that the Government have forced him to do what he has done. Here am I and thousands and thousands of others paying through taxes for an NHS dentist, yet there are no NHS dentists in the area and I am paying £48 a month extra for insurance. That cannot be right. That cannot be how NHS dentistry should work.

The Minister said nothing about dentistry in his opening remarks. I am sure that that was not an oversight. I think that he wanted to avoid a hugely embarrassing situation. The one thing that I can say
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with certainty is that NHS dentistry is worse now under this Labour Government than it was under Margaret Thatcher.

Many things may have improved in the health service—if funding for the health service is increased in real terms by 82 per cent., things should improve. The fact that most of that money has been wasted and that we have seen only a 23 per cent. increase in outcomes is down to the Government's inefficiency. The fact that the median waiting time is still longer under Labour than it was under the Conservatives is a minor point when we are talking about access, but the Minister has to answer this question: why is it that my constituents and others in Northamptonshire cannot see an NHS dentist? If one rings up and says, “I must see an NHS dentist,” the reply is, “If you do not mind going out of the county, you can see one.” That is the reality of NHS access in my county.

5.39 pm

Mike Penning (Hemel Hempstead) (Con): It is a pleasure both to wind up on behalf of Her Majesty’s Opposition in this important debate, and to follow three members of the Health Committee. Having left the Committee myself only just over a year ago, I know how diligently they work. The Health Committee is one of the great Committees in this House, and I do not hold back in my praise of it—although I wonder whether the Minister might drag himself away from his notes for five seconds and listen to a contribution this afternoon? [Interruption.] I may tease him a bit more, as I have now got his attention.

Interestingly, the Minister was, I think, referring to spin when he complained about the coverage of the Healthcare Commission report in this morning’s press. That is astonishing coming from a member of a Government who have welcomed back into their ranks Lord Mandelson, a man who got his reputation from practising the black arts of spin in the 1990s.

Perhaps I can tease the Minister a little more? On page 68 of that report, reference is made to an access to a GP indicator. The report is not as definitive as it might have been because some areas refused to return any data. One such area was Devon, which is run by the Minister’s own primary care trust. It is a shocking indictment of the Minister that he cannot even control his own PCT by getting it to give data back to the commission, let alone understand what is going on. The Healthcare Commission report is timely—although I am sure the Government were not expecting it to be published at this time when they timetabled this debate for this afternoon.

I will try not to go over the points raised by the shadow Secretary of State, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), but instead I shall cover some areas I have a personal interest in and some responsibility for. I will come on to urgent care and dentistry, which my hon. Friend the Member for Wellingborough (Mr. Bone) referred to, and polyclinics.

However, I must first highlight something. If Ministers come before the House and make commitments to Members and to the country that they will address certain matters, the public have the right to expect that to happen. Therefore, given that the former Health Minister, the Under-Secretary of State for International
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Development, the hon. Member for Bury, South (Mr. Lewis), came to this House and promised he would address the 0844 number issue—which is leading to our constituents being ripped off when they phone their GP surgeries—and that that practice would stop, it is astonishing and unbelievable that, in this later debate, Labour and Opposition Members have highlighted the problem of patients still paying these charges.

We must also address the fact that the Government have gone to war with the GPs. I do not understand why, as the Government brought in the new contract in 2004. It was not written by the GPs or the Opposition; it was a Government contract for better health care in GPs’ surgeries. The GPs took it and delivered it to their patients, but then the Government started to attack GPs throughout the country. The hon. Member for Dartford (Dr. Stoate) was absolutely right: morale is not great. For the first time since I have been involved in politics, all the GPs in my constituency have come together with the community to complain about what is going on in health care.

We should briefly address the polyclinics issue—although I know the Government do not like to call them that. The Prime Minister stood at the Dispatch Box and said there will be 150 polyclinics in London. The Darzi report said that, and the Prime Minister said it would be imposed in London. Rightly, London is revolting against that, and areas of London say they are not going to have them. In some areas in London and the country a polyclinic might be a good thing. I listened to the comments of the hon. Member for Dartford; if he has an expanded area and there is no existing provision in it, a polyclinic might well be a good way forward in that part of his constituency. However, it is clear from other Members’ comments that in the other parts of the country where they are being imposed, it is not right that they will be plonked down in the middle of an area regardless of whether there is a need.

I am sure the Minister is aware that I will raise the issue of the polyclinic that is being imposed in the middle of Hemel Hempstead town centre. Every GP surgery has signed an open letter to the PCT, along with myself and the patient groups in the town, saying, “Please do not impose this on us.”

Not one GP surgery in that part of my constituency has a full list. The other evening, I purposely made a 7.30 pm appointment with my GP at one of those surgeries, just to see what demand there was. I could have gone at another time of day, but I booked online and went at 7.30 pm. How lonely I was. I got there five minutes early and was seen five minutes early, because there had been no patients in for the previous half an hour. There was no one booked in after me either. There were two receptionists on duty—quite rightly, because they should not be left alone in that situation at that time of night. The pharmacy attached to the surgery was open, and my GP was there. I saw my GP, and we then left and had a conversation about a lot of other things. The demand is not there. If it were, the surgery would be open at that time day in, day out. The polyclinic is to be only 200 yd to 300 yd away from there.

There are parts of Hertfordshire, in the same PCT area, that might well need such a clinic in future. Some 80,000 homes are being imposed on Hertfordshire, not
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least 18,000 in my constituency. If those homes are to be built, a polyclinic might well be the right vehicle for delivering primary care to my constituents, but to say that one size fits all around the country is wrong.

I was interested to hear the hon. Member for Dartford, who brings his expertise to the subject, say that GPs have got together to run clinics, but in most parts of the country they are being prevented from doing so. Two of the GP surgeries in my constituency would probably like to join together to run a clinic rather than compete, but they are being prevented from doing so.

I shall touch on a couple of points that hon. Members have made before turning finally to dentistry. The hon. Member for Walthamstow (Mr. Gerrard)—I know that part of the world well, having grown up there—rightly said that there are good GP surgeries and bad, and that some offer more services than others. I am sure that he is aware that because of how the funding formula works within PCTs, some GP surgeries get double the money that others get.

I was interested by the Minister’s saying that one reason for the problems in delivering primary care was the reconfiguration that had taken place around the country. There may be an argument for that, although I have not heard that one before, but in London there was no reconfiguration. The PCTs were left in situ as they were before, so that argument does not stack up.

I agreed enormously with the hon. Member for North Norfolk (Norman Lamb), the Liberal Democrat spokesman, when he talked about his own surveys. We are all doing that type of survey—I am sure that it is not just a Liberal Democrat thing. We all try to make contact with our constituents and find out their concerns. GPs are not happy, and they feel as though they are being persecuted even though they are delivering front-line services to our constituents in a most professional way. Where there are problems, they are for the PCTs to address in their commissioning. That is their role in life.

I was slightly concerned when the hon. Gentleman talked about the Liberal Democrats’ policy that if patients are not treated in a timely fashion, they should be able to go off to the private sector. I would like to see the costings for that, if the Liberal Democrats would like to publish them. It sounds as though they must be quite phenomenal.

Norman Lamb: I mentioned earlier that that policy was based on the Danish system. The evidence from Denmark is that it has massively increased efficiency in the state sector, thereby saving money.

Mike Penning: We examined the methods in other countries in the Health Committee, but a completely different type of health care is provided in Denmark, Sweden and other countries.

As always, it was a pleasure to listen to my friend the hon. Member for Wyre Forest (Dr. Taylor). He is renowned in the House, and particularly in the Health Committee, for his expertise. It is very important that we all understand the type of care that our constituents want. They do not want to go and meet a stranger, or see a different GP every time they need some care. They want the relationship provided by years of work together, often down the family line. Although GPs in Worcestershire were pressed, it is a crying shame that GPs from other parts of the
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country are coming down to Worcestershire, because Worcestershire GPs probably understand the hon. Gentleman’s constituents much better and would represent the way forward.

We are pressed for time, but I want to make a couple more comments. The hon. Member for Wyre Forest alluded to the fact that we must address the out-of-hours urgent care system. So many people are frightened and need help, and they do not know the myriad numbers involved. I know that NHS Direct has tried desperately to get its number into the public’s perception, but people still do not know it. The branded number that people know, 999, is sadly being abused on a daily basis. We must get another number branded quickly, before these numbers disappear—the European Union is progressing with these 116 numbers as we speak. He also mentioned the important NHS pathways software, and I have seen it working brilliantly in the north-east.

My final point is about dentistry, which is the part of primary care missing from the Minister’s speech. It is crucial that this Government address the mess that they have created by imposing the dentists’ contract on this country. So many people cannot see an NHS dentist, but they deserve to do so, because that is what they pay their taxes for, and so it is about time that this Government scrapped their ludicrous contract.

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