HC Deb 04 May 1966 vol 727 cc1629-35
The Prime Minister (Mr. Harold Wilson)

With your permission, Mr. Speaker, and that of the House, I should like to make a statement about the latest Report of the Review Body on Doctors' and Dentists' Remuneration, covering the next two years, which is being published today.

I should like to express the Government's gratitude to the Review Body for the sustained and intensive work they have put into the conduct of this particularly difficult review.

The Government accept all the Review Body's recommendations in principle and are at once making arrangements to implement those for hospital doctors and dentists, and for general dental practitioners, in full, with effect from 1st April, 1966, at an estimated cost in the current financial year of about £12 million. The average percentage increases in net remuneration are 13.4 for hospital doctors and dentists and 10.6 for general dental practitioners.

For general medical practitioners, it is estimated that full implementation of the recommendations would cost some £28 million this year and would involve an increase of about a third in aggregate net income. The Government agree with the Review Body that special considerations of workload and manpower in general practice justify an exceptionally large increase in remuneration for general practitioners. In the light, however, both of current economic difficulties and of their general policy for prices and incomes, the Government have decided that they would not be justified in implementing an increase of this magnitude in a single immediate step. They accordingly propose that the Review Body's recommendations should be implemented in two stages. The first stage would apply retrospectively from 1st April, 1966, and would be designed to increase net income by about half the full amount, or rather more than 15 per cent. The second stage, completing the implementation of the Review Body's recommendations, would take effect from 1st April, 1967. The. Government are willing to discuss with the profession how this can best be achieved and are putting forward their own proposals.

A third and final Report on the negotiations between the Health Departments and the profession about the proposed new contract for family doctors is also being published today, and my right hon. Friend the Minister of Health is today writing to the Chairman of the General. Medical Services Committee to convey the Government's proposals as regards both the contract and remuneration.

Mr. Heath

Is the Prime Minister aware that we shall, naturally, want to study these two Reports before pressing him with questions of detail? In the meantime, is the Prime Minister aware that we believe it is right that the Government should themselves take the responsibility for this decision in view of the importance of the Review Body and its status, rather than that they should refer it to the Prices and Incomes Board, as they did in the case of serving officers and the higher Civil Service?

I should like to ask the right hon. Gentleman two broad, general questions. First, does the additional cost take account of what was said in the Budget. Statement made to us by the Chancellor of the Exchequer yesterday?

Secondly, what will be the effect on the finances of the Health Service under the National Plan? Will there be a reduction in the resources which have been placed at the disposal of the Health Service under the National Plan, or will this mean an addition to the 3.9 per cent. of the gross national product?

The Prime Minister

I thank the right hon. Gentleman for what he has said. I think that the whole House will need time to study this very intricate and full Report. I agree that although it is difficult, it is right that we should have a straight decision on this case and not refer it to the Prices and Incomes Board.

With regard to cost, in respect of which figures have been quoted, I understand that these figures are not included in the current Estimates before the House, which were presented in February. With regard to resources for the National Plan, those were expressed in real terms, not in financial terms, and allowed something for increases in remuneration, though I would judge—but I should like time to consider this matter further—that they would not take account of quite so large an increase in remuneration as this.

Dr. David Kerr

Will my right hon. Friend note that the work of the Review Body, which has always been admired by the profession, will gain added status by virtue of the apparent generosity of this award? Will my right hon. Friend say something about the distribution of this award, which always seemed to be implicit in the reference to the Review Body of the projected contract between the Ministry of Health and the profession?

The Prime Minister

As my hon. Friend knows, the job which the Review Body had to do this time was a particularly difficult one because it involved the Review Body considering an entirely new contract and a new deal for the whole of the family doctor service, as well as doing its normal work. I made it clear that the question of distribution is one which my right hon. Friend will be discussing with the profession. As I think the House knows, I saw leaders of the profession this morning, and while they have fully reserved their position and the position of the profession on our decision to break the award into two separate years, I think they feel that, if they accept the Government's decision, they should press very strongly the right to have discussions as to the method of implementation within the overall figures which I have quoted, and indeed we have given a pledge that this will be done, largely at the request of the leaders of the profession.

Dr. Winstanley

May I ask the Prime Minister whether if it is necessary to phase the award to general practitioners over a period of two years, he will consider phasing it on a regional basis so that doctors practising in under-doctored areas can receive the whole award at once, thereby doing something to correct the maldistribution of doctors, which is adding to the overall shortage?

The Prime Minister

As the hon. Gentleman will see when he is able to study the Report in detail, this problem has been taken into account by the Review Body, but I have said that the method of implementation is a matter for discussion. The point mentioned by the hon. Gentleman, particularly the question of those doctors who, in areas where there is a shortage of doctors, have very large lists, was one of the points mentioned to us this morning by leaders of the profession, and is one reason why a certain elasticity will be required in the method of implementation.

Mr. Selwyn Lloyd

When using percentage figures, will the Prime Minister always give them in terms of annual increases in order to avoid giving a false impression?

The Prime Minister

The figures which I gave when I referred to the 10 per cent., 13 per cent., and rather more than 33 per cent. increases are overall average figures, and they cover—I think that this is the point which the right hon. and learned Gentleman has in mind—a two-year review and not the figure for a single year.

Mrs. Lena Jeger

Can my right hon. Friend assure us that the increases for family doctors will be on a general basis, and that there will not be any element of invidious or discriminatory so-called merit awards at a time when we are trying to develop the concept of group practice and health centres with a sharing of responsibility between doctors working together?

The Prime Minister

I think that the Review Body was very much alive to the new developments going on in the profession, but the exact implementation between doctors in very different circumstances, and also the point raised by my hon. Friend, are matters for discussion between my right hon. Friend and the profession.

Mr. Orme

Will my right hon. Friend take note that this award will cause grave concern among many manual workers and trade unionists throughout the country? I recognise the necessity for some increase, but these increases are quite extortionate. Can the Prime Minister say whether the basis of treating the professional classes differently from manual workers is to be continued by the Government?

The Prime Minister

In the first place, there has been no question of discriminating between the professional classes and manual workers. Recently there have been a number of cases in which the Government have played a leading part, both as employers and in other cases, where increases for professional workers have been well within the norm, and a good deal lower than the average wage increases for last year, so there is no general discrimination of that kind.

With regard to my hon. Friend's first point, I am sure that the House will realise the difficulties with which we were faced, taking into account the problems within the Health Service. This problem has been growing for five years, and it had to be settled. Taking all that on the one hand, and on the other the whole position of the prices and incomes policy, it was a very difficult decision, but, having regard to the acute shortage of doctors, and the work load on other doctors as a result—it is a pity that more doctors were not retrained earlier; it takes seven years or more to train them—we felt that this was a reasonable recommendation to accept.

Mr. Farr

Will the Prime Minister state the reasons which prompted him not to publish this Report some weeks ago, and whether or not he had these recommendations in his possession well before polling day?

The Prime Minister

I suppose that to satisfy an hon. Member with a mind like that—[Interruption.]

Mr. Farr

On a point of order. I protest. I merely asked the Prime Minister that question because a number of my constituents who are doctors understood that the Prime Minister was in possession of this Report well before polling day. I merely asked whether or not that was so.

Hon. Members


The Prime Minister

There is nothing to withdraw. I am going to answer the hon. Gentleman's question in the spirit in which it was put. If the hon. Gentleman's doctor constituents understand that, they obviously do not know the facts as put out by the Review Body, which said that it intended to publish its Report as close to the end of March as possible. The Review Body felt, and it was its responsibility, with no pressure from the Government, Opposition, or any political party, that it would prefer the Report not to be bandied about in the middle of a General Election. That was the Review Body's decision. The Report reached me a day or two before Polling Day. This was well understood, and I had announced, I think in the House, but certainly a month before, that this was the programme to which the Review Body was working, and that we should need time to study its Report. The House will recognise that in several previous cases there was no question of immediate publication. Apart from the fact that the Report had to be printed, the Government had to consider their attitude to it, and in every previous case there has been a considerable delay in publication. We have brought it out with reasonable dispatch. We have had it for just over a month. It has been printed, we have considered it, and we had some consultations this morning, and any suggestion to the contrary is rather unworthy of the hon. Gentleman.

Miss Pike

In his consultation with the medical profession, will the Prime Minister bear in mind the work load on the general practitioner and on his wife, and also the great importance of maintaining a good career structure both in the hospital service and in general practice?

The Prime Minister

This was mentioned by the representatives of the profession when my right hon. Friend and I met them this morning, and I am sure that this will be taken into account by my right hon. Friend and the profession. These are important features in the discussions, and so, if I may say this because it was stressed this morning, is the position of younger doctors and, not least, young hospital doctors, of whom there is a great shortage. They are carrying a heavy load, and their numbers have been subject to considerable erosion for many years by emigration as a result of dissatisfaction with the present position.

Several Hon. Members


Mr. Speaker

Order. We must get on with the business of the House.