Family Practitioner Services (Hansard, 13 December 1983)

§ 9. Dr. Mawhinney
asked the Secretary of State for Social Services if he will make a statement on his plans for the family practitioner services.

§ Mr. Kenneth Clarke
Proposals for changes in the general ophthalmic services and in the status of FPCs are included in the Health and Social Security Bill now before the House. My right hon. Friend announced on 17 November the planned level of expenditure on the family practitioner services in 1984–85.

§ Dr. Mawhinney
I thank my hon. and learned Friend for that answer. Is he aware that the Government's determination to improve the cost-effectiveness of the family practitioner services is welcomed? In that regard, is it at least a possibility that the drug-prescribing habits of general practitioners will be audited annually?

§ Mr. Clarke
We certainly intend to try to improve the drug-prescribing habits of general practitioners. We continue to encourage economy in the quantity of drugs prescribed and a greater use of generic prescribing. I agree that we must continue our efforts, because there is still considerable potential for savings to be made.

§ Rev. Martin Smyth
I thank the Minister for his answer to the hon. Member for Peterborough (Dr. Mawhinney). Does he agree that the lists could be further reduced by a process of directives for doctors when dealing with patients who need drugs?

§ Mr. Clarke
There has been a steady increase in the number of practitioners and a reduction in list sizes, but 825 that must be judged as part of an overall policy for general practice, mainly determined by the interests of the patients and the improved service which we want to provide.

§ Mr. Colin Shepherd
Will my hon. and learned Friend maintain the greatest possible pressure to achieve accountability in the family practitioner service? Does he agree that every time family practitioners overrun what might be called projected expenditure the rest of the Health Service, such as the hospital sector, suffers and we experience problems of the kind facing us today?

§ Mr. Clarke
With respect to my hon. Friend, that is not so, although some people interpreted the changes in July in that way. What happened in July was that cash limits for all programmes, not just the Health Service, were reduced to bring planned public spending within previously agreed levels. Part of the reason was that at the same time non-cash limited programmes were running ahead of the budgetary estimates. That included the family practitioner services.
On balance, within the Health Service we acquired rather more money than we lost by that process, and overall spending on the Health Service has not been reduced. We are avoiding any fixed relationship. When deciding on spending on one or another part of the Health Service, we must judge the level of spending for both services in the light of economic conditions and the needs of the Health Service.

§ Dr. Roger Thomas
Will the Minister come to the assistance of those committees that run deputising services and tell them exactly what he means by "excessive" use? Why is he now so pessimistic about deputising services, compared with when he spoke in Committee in March of this year on health services?

§ Mr. Clarke
I hope shortly to come forward with our proposals for improving the monitoring of the deputising services. I find it difficult to divine the hon. Gentleman's views from his question, but there is widespread public and parliamentary concern about the way in which the present guidelines are being applied. I believe that there is general acceptance in the medical profession that there is some room for tightening up the deputising services.

§ Mr. Couchman
My hon. and learned Friend will be aware that much of the administration of family practitioner services involves routine clerical work and that progress towards computerising patient records has been painfully slow. Will he undertake to speed up that process, because that would have a beneficial effect on expenditure on administration in the family practitioner services?

§ Mr. Clarke
We have engaged the consultants Arthur Andersen and Co. as advisors on improving methods of administering all the family practitioner services. We have asked the consultants to look especially at the way in which we can speed up the application of computerisation and modern office techniques. I take my hon. Friend's point. It is important that we act promptly once the report from Arthur Andersen and Co. is at hand.

§ Mr. Meacher
On what grounds does the Secretary of State justify arrogating to himself in the Health and Social Security Bill the right to appoint all the members of each of the 90 family practitioner committees? Is he not content with sacking all the non-compliant chairmen of the regional and district health authorities and packing the 826 membership of those bodies with his own placemen? Is it not a monstrous perversion of patronage that he should reserve to himself the power to hand-pick all of those 2,700 appointees so that he can steamroller through his policies and blot out further resistance?

§ Mr. Clarke
The hon. Gentleman has as ready a source of adjectives as of bogus statistics, but he is getting overexcited about a fairly simple change. The Secretary of State must represent the public interest and cannot just accept nominees. It is important that the family practitioner committees, which dispose of enormous sums of money, should be answerable to the House, amongst other places, through my right hon. Friend the Secretary of State.
It is untrue to suggest that we have changed the leadership of any health authorities on party political grounds. I could cite regional and district chairmen who are or have been active members of the Labour party. Contrary to the hon. Gentleman's belief that patronage exists, we are appointing the right people to run the services efficiently.