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Lord Waddington: My Lords, I am most grateful to the noble Baroness for her gracious and emollient reply. On 20th January, I disturbed the tranquillity of the proceedings by pointing out that the noble and learned Lord the Lord Chancellor had, in recent years, grasped to his bosom a number of new responsibilities. Here is one that he need not have treated in that way. I am saddened by his determination to do so against the wishes of local people. But there it is; I have to accept the position.
Perhaps the noble Baroness could suggest to the noble and learned Lord the Lord Chancellor that both he and she would be showing their respect for history by considering his making of appointments in the Duchy area in the name of the Chancellor of the Duchy. That is a matter that the noble Baroness could consider before Third Reading. I do not think that anything would be gained by pressing the matter to a Division. I beg leave to withdraw the amendment.
The Lord Chancellor (Lord Irvine of Lairg): My Lords, before business begins, I take this opportunity to inform the House that I will be undertaking a ministerial visit to Latvia, Lithuania and Estonia from Monday 19th to Thursday 22nd May, when the House will sit. Accordingly, I trust that the House will grant me leave of absence.
Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply, but my concern is that a situation may arise, as it did in dentistry, whereby the BDA accepted and agreed a contract which has resulted in the total destruction of dentistry in the capital and in many other parts of the country. The Imperial College health practice, of which I am a patient, has 11,000 students and about 1,000 to 1,500 local people, young and old. It runs a model practice. I am told by the doctors there that under the new weighting of young people, which will be greatly reduced in terms of expenditure for each young person requiring health care, they will not find it viable. They claim that the same situation will exist in Bristol, Reading, Southampton, Sussex, York and possibly other areas. What can be done about this?
Baroness Andrews: My Lords, I can give the noble Baroness and the practice concerned solid assurances that there is no question that the practice will not be viable. The noble Baroness is quite right that the formula has been changed. It is now redistributive; it has been driven by the profession and by the NHS Confederation so that the new contract will reflect the real workload of doctors where their patients are more elderly or more sick. University practices, where there are young people, will have a different basis for calculation too, but the minimum practice income guarantee will guarantee that they will not lose out on their current earnings. That guarantee is not time-limited and it will be in place for whatever length of time is necessary. Not only will the guarantee be there and be sound but under the proposed contract, if it is accepted, new practices will be able to organise their workload more flexibly and earn additional money by bidding for additional enhanced services. In the case of universities, that might include sexual health or sports injuries.
Lord Clement-Jones: My Lords, the Minister is implying that this is essentially a communications issue, and that the new GP contract, with its minimum guarantee payments, which is a very important contract, will guarantee existing levels of income. But it was only on 17th April that the chairman of the British Association of Health Services in Higher Education complained that its letters to the negotiators had not been effectively answered and it was concerned that student health practices will remain disadvantaged in the short and medium term, such as that the only option will be cuts in staff, including nurses and doctors. Clearly, communication has not been good enough. What does the noble Baroness say about that?
Baroness Andrews: My Lords, I certainly repeat my reassurances in relation to the issues that the noble Lord has raised. There was some difficulty originally with the communication from the British Medical Association because, in the press of time, incomplete information was given. But I can assure noble Lords that when it is appropriate, we will place a full set of papers in the Library to give everyone as much information as possible. In addition, the BMA website now includes a very full and clear account of the contract and what it proposes.
Lord Walton of Detchant: My Lords, is the noble Baroness aware that these general medical practices on university campuses not only play an important part in offering medical services to university staff and students but many fulfil a vital teaching role as many medical students receive experience of general practice in such practices? Is this not something that must be preserved at all costs?
Baroness Andrews: My Lords, the contract is radical; it puts 33 per cent more money into primary care. Because it is radical and newit is a departure from traditionwe will be watching its progress and it will be under review from October 2004. I predict that every practice will be able to call on that review process.
Baroness Finlay of Llandaff: My Lords, I declare an interest as a doctor practising in Wales. Could the Minister explain why general practitioners in Wales do not have the same concerns as those in England? Indeed, the expansion of academic general practice in Wales is generally being encouraged. What are the Government doing to cope with the anxieties that have been expressed by general practitioners in England and how are they being dealt with?
Baroness Andrews: My Lords, I know that in Wales and in Scotland the professionals have welcomed the new contract. We very much hope that on 14th May, when the BMA has its own meeting, the contract will receive a similar welcome, because we believe that it will bring immense benefits. To reassure practitioners, we are encouraging the fullest possible information about the contract, and that information will be as clear as possible. The NHS Confederation website also offers a very clear explanation of the new contract. I hope that, between the BMA and the NHS Confederationthe two parts of the negotiating arrangementgeneral practitioners will be very well informed.
Baroness Perry of Southwark: My Lords, does the noble Baroness accept that while it is true in the general population that elderly people make bigger demands on general practice than young people, students are in a rather different position, partly because they often live in hostels where infections can spread very fastwe have several examples of thatand also because they often suffer from stress and emotional problems, which take them to their GP? Could not the Government reconsider the formula, particularly in relation to students in university hostels and campuses?
Baroness Andrews: My Lords, I have already said that there will be absolutely no difference in the treatment of university health centres. Indeed, the health centres will be able to contract in to do other sorts of work which will assist the students. In that context, the noble Baroness probably knows the Universities UK report which came out last November. It is extremely positive and has received positive responses from the DfES on student services as a whole. A directory of good examples of innovative practices for student support is about to be published. In addition, the National Service Framework for Mental Health puts a lot of emphasis on the mental health needs of young people.
Lord Trefgarne: My Lords, while welcoming the 33 per cent increase in expenditure in this field to which the noble Baroness has referred, can she say where the money is coming from and how much it is in cash terms? Is it another case of robbing Peter to pay Paul, or is it new money?
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