HC Deb 19 November 1973 vol 864 cc1093-100

10.13 p.m.

Mr. Patrick Wolrige-Gordon (Aberdeenshire, East)

I am grateful to you, Mr. Speaker, for giving me the opportunity to raise on the Floor of the House a matter of the greatest moment to the people of Longside in my constituency.

The people of Longside have enjoyed the facility of a surgery in Longside and regular consultations with their local general practitioners since 1900. Now the oldest Longside doctor has just retired and that surgery will no longer be available. The remaining doctors of the practice have decided to centralise their facilities in Mintlaw, 2½ miles away. They are absolutely convinced that this is the most efficient way of providing the best possible service to their patients. At Mintlaw they will have ancillary staff. They will be able to operate an appointments system, and they are convinced that this is also the most economic way as well as the most efficient way of serving Longside.

Since the economic argument is the one that is of the greatest relevance to my hon. Friend the Under-Secretary of State for Health and Education, I shall deal with that first. We understand that the present position is that if the doctors centralise their practice in Mintlaw, they will receive a grant of 30 per cent. of the cost, which in this case would simply provide space additional to their existing surgery. They also would receive a loan from the General Practice Finance Corporation. If they did not centralise their surgery in Mintlaw but instead built a new surgery in Longside, as the people there wish, they would not receive any grant and they would have the extra cost of providing a new building as opposed to the addition to an existing building in Mintlaw. The point I wish to emphasise to the Government is that the persuasion of the grant seems to be directed only in favour of the centralisers.

Another point which will concern the Minister in his reply relates to the public services available for the people of Long-side if their surgery is closed and if instead they have to go to Mintlaw. There is one bus, for example, which leaves Longside at 12.30 p.m. and a return bus which leaves Mintlaw at 1.50 p.m. There is also a bus which leaves Longside about 5 p.m. and returns from Mintlaw at 6.30 p.m. The doctors say that under an appointments system system it will be possible for their patients to make proper use of the bus services without undue delay. They also point out that there is a bus stop fairly close to the surgery in Mintlaw—although, incidentally, there is no bus shelter, no car park and no public toilet.

In regard to the provision of drugs, the doctors suggest that a collection system would be simple. They already operate this system for the Maud part of their practice, which is another village in the practice. They would simply invite people to telephone the surgery for their renewed prescriptions and arrange to have them delivered at Longside to some central point in an agreed and arranged fashion. That is the doctors' case as fairly and as briefly as I can put it.

The Longside people see the issue very differently. I remind my hon. Friend of a petition signed by 600 people from the community. They regard the removal of a consultation surgery from Longside as a deprivation of their amenities and their convenience and inevitably feel that it will mean a worse service than that which they have enjoyed hitherto. They say that they see no reason for this practice not to provide a surgery in Longside, such as the surgery which the practice is already providing at Stewartfield. They are concerned that the doctors did not consult their interests before making up their minds and going full steam ahead with a decision to centralise.

There is little confidence among them that an appointments system will work efficiently. They do not feel that there has been any record in the area in the past where an appointments system has operated efficiently. They feel that the bus service is wholly unsatisfactory, as well as expensive. It now costs 18p to make the round trip to Mintlaw. They feel that there is a real danger of patients not being able to get the next bus back from Mintlaw to Longside but possibly having to spend one or two hours—even two and a half hours—in the village where there is no shelter for them and not even a public convenience.

They do not feel that the provision of a purpose-built surgery in Longside should be beyond the resources of a fairly prosperous group practice and they feel that as the population of their village is due to double fairly soon in any event, urgent consideration should be given now to the business of building a new surgery to serve that village, preferably at a site adjacent to the nurse's house, as has been done recently in another village in the vicinity.

My hon. Friend may well say that there is little he can do, since this is obviously in a sense a matter for the doctors and the Health Service Executive Committee which supports the doctors' plan in this area. I believe, however, that my hon. Friend can change his policy on centralisation and that he can exercise direct influence on the doctors through the fact that, as I understand it, the permission of his Department is necessary for the doctors to obtain their improvement grant for providing additional facilities at Mintlaw.

On general policy it would surely be fair to make an improvement grant available for doctors who seek to localise, as well as for doctors who seek to centralise their services. Leaving aside the point whether the Mintlaw-Longside doctors might not be better advised to provide their services either in an urban area where people are well concentrated already, or in a hospital, there is surely much to be said for those doctors who wish to provide as good a service as they can for the convenience of their patients in the country areas by doing so with as wide a spread of surgeries as possible and receiving at least as much help as those doctors who think in the opposite direction.

I know that at this stage in medicine, as indeed in education, unfortunately, it is fashionable to say that the system which makes sense is the one where everybody is brought together in large groups. But there is a lot of reaction against that in the country quite rightly, and it is also very difficult to persuade a layman like myself, who sees a doctor making his initial consultation in a patient's house with very little ancillary equipment to help him except his black bag, that that doctor cannot operate perfectly efficiently with a spread of consulting rooms readily available and convenient for the general public, and only afterwards if necessary bringing them 18 pennyworth or more of travel to enjoy the facilities of the central surgery if that is what they need. That is very much my own view, and I do not see how it prevents the records being written up centrally.

I hope my hon. Friend will give very careful consideration to the general point which I have made. Could he also direct his best attention to further consultations with the Longside-Mintlaw doctors to see whether there is any further way in which they can move to meet the wishes of the Longside people? Progress always means different things to different people, but technical efficiency is never so heartwarming as that desire to serve others, which over-rides personal convenience. The Mintlaw-Longside doctors have to demonstrate that the new arrangements which they make will truly be in the best interests of their patients and of their community. I wish them luck. But they should be under no illusions, and nor should my hon. Friend, that, in the words of the Longside Committee, the arrangements so far suggested for the Longside people mean not inconvenience but hardship. I hope that we can reconsider that tonight.

10.25 p.m.

The Under-Secretary of State for Health and Education, Scottish Office (Mr. Hector Monro)

I am glad that my hon. Friend the Member for Aberdeenshire, East (Mr. Wolrige-Gordon) has raised tonight the provision of surgery facilities for persons resident in the Longside area. He has been in correspondence with and has spoken to me on this matter and has shown a very keen interest in the welfare of his constituents. He has also written to the Executive Council and seen the doctors. However, I am bound to say at the outset that the question is essentially one for them to consider and that the authority of my right hon. Friend the Secretary of State to intervene is strictly limited.

General medical practitioners are independent contractors who undertake to provide general medical services in an area and are responsible for the provision of their own consulting premises, which have to be approved as adequate by the Executive Council. If doctors wish to change the places or the times during which they are available for consultation they must obtain the consent of the Executive Council, which has an obligation to consult the local medical committee, which is the representative body of doctors in the area. There is no obligation to consult any other body. The Secretary of State is involved in this statutory process only if the Executive Council refuses consent and the doctor appeals to my right hon. Friend against the refusal.

The reason for a change being proposed in the consultation arrangements at Long-side now is that one of the three doctors in partnership in that area, Dr. Burgess, retired on 31st October and was succeeded in the partnership by Dr. Clubb who is currently residing at Old Deer. Dr. Burgess lives at Longside, where the consulting accommodation forms part of his residence. Since Dr. Burgess intends to continue to reside there, it will not be available for use by the new partnership after the spring of next year. This has been agreed to by Dr. Burgess to facilitate the carrying out of alterations at the surgery at Mintlaw some two and a half miles away.

As I indicated, the Executive Council has no obligation to consult any particular local body of opinion. However, the constitution of the Executive Council, which contains members appointed by the Secretary of State, by the local authorities in the area and by the local professions, is such that it should be able to reflect informed local opinion.

Moreover, when the Executive Council considered the proposal that consultations at Longside should cease, it had before it a petition from the residents in the Longside area and a letter from my hon. Friend expressing concern on behalf of his constituents, so that the decision that it reached was taken in full knowledge of the views of local residents.

Mr. Wolrige-Gordon

Is it not a fact that that decision was taken by a majority of five, eight against and three in favour—a total number of 11 out of 25 members of that committee? Does that represent a quorum qualified to take a decision of that kind?

Mr. Monro

Speaking without absolute certainty, I feel sure that it represents a quorum. It may be that a disappointingly low number of the Executive Council was present, but this certainly was a democratic decision taken in the light of all the information that I have explained to my hon. Friend.

I can fully appreciate the concern of the people in the Longside area, so eloquently expressed by my hon. Friend, at the prospect of losing the consultation facilities at Longside; but, while it may be cold comfort, a considerable number of villages in this and adjoining practices do not have their own consulting facilities, and a great many patients have to travel considerably more than two and a half miles to their doctor's consulting surgery. Representing a rural constituency, I appreciate this issue.

As my hon. Friend brought out in his speech, I have indeed looked at the bus service between Longside and Mintlaw. I am sure that the doctors will arrange an appointments system to fit in with the timetable, which, to be fair, is not an ungenerous one. I see that there are about six or seven buses a day each way and I am sure that a good appointments system can be fitted in with the timetable. I note, too, what my hon. Friend said about prescription arrangements and the possibility of a collection service between Longside and Mintlaw.

After what might be termed the old partnership was formed in 1963, the partners provided group practice premises at Mintlaw where all three partners consulted and were able to accommodate the practice secretarial and nursing assistance. The extensions of the Mintlaw premises should facilitate the introduction of an appointments system in which due regard can be given to the travelling arrangements of patients.

As regards patients in the Longside area who are physically unable to travel to Mintlaw, the position is that a doctor is required to visit and treat a patient whose condition so requires. The fact that the consultation facilities will cease to be provided at Longside means that the partnership may have to undertake an increased number of home visits in the area. In a long-established practice such as we are talking about, I am sure that the doctors concerned have a great knowledge of the elderly folk in the area and that they will look after them very carefully indeed bearing in mind the difficulties of travel.

As I have stated, the decision where to provide surgery premises is primarily one for the doctors concerned, subject to the approval of the Executive Council. It is clear that the existing surgery accommodation at Longside could not continue to be used, and the choice facing the doctors was where to provide alternative accommodation. I understand that the present population of Mintlaw is 850 and that of Longside about 420. My hon. Friend has mentioned that the population of Long-side may double over the next few years, but I understand that the population of Mintlaw may increase more than three fold during the same period.

It is accordingly understandable why the doctors should choose to develop premises at Mintlaw rather than contemplate providing new ones at Longside, although if the development which my hon. Friend mentioned materialises the doctors are quite free to think again. My hon. Friend mentioned that the economic answer was perhaps the most important to him, but I disagree with him here because what I am most impressed with is the best service within the terms of the National Health Service.

My hon. Friend mentioned the possibility of providing a new surgery at Longside. This is essentially a matter for the doctors concerned in the first place. As far as I am aware they have made no such proposal, and it is perhaps unwise to deal with a hypothetical case. If doctors wish to provide new surgery accommodation and they obtain the consent of the Executive Council to its provision, they are normally responsible for financing it themselves, possibly with the aid of a loan from the General Practice Finance Corporation. There are no grants for the provision of new surgery accommodation, although grants may be available for assisting the improvement of existing surgery accommodation, as is the position at Mintlaw.

If there were accommodation presently in Longside and the doctors wished to improve it, of course it would be open to them to apply for the same grant as they would receive for improving the existing accommodation at Mintlaw. There is no special grant for new surgery accommodation. The grants are available for the improvement of existing accommodation. An executive council may, if so authorised by the Secretary of State, consider the provision of surgery accommodation in special circumstances, but these cases are quite exceptional outside the Highlands and Islands.

My hon. Friend has suggested that doctors are subject to pressures to centralise because of existing financial arrangements. I have indicated to him that this is not so and that the same grants are available wherever the doctors may wish to improve their practice facilities. It is true that an allowance is paid to groups of doctors who work in close association from a common main or central surgery, but this allowance is designed to encourage doctors to make joint arrangements to provide services for patients in an area and to use ancillary staff to help in the efficient administration of their practice. The payment of this allowance does not preclude use of branch surgeries. Indeed, the practice in question has these at Stuartfield and Maud, as my hon. Friend knows.

I listened very carefully to what my hon. Friend said, and I appreciate the strong views that he represented on behalf of his constituents. It is clear that neither the doctors nor the Executive Council have acted unreasonably in the matter, though I appreciate my hon. Friend's wish that they had taken another decision in relation to continuing a branch practice at Longside. But I hope most sincerely that my hon. Friend's constituents will not find the arrangements as difficult in practice as they believe they are likely to be.

Question put and agreed to.

Adjourned accordingly at twenty-four minutes to Eleven o'clock.