§ 7. Mr. David Marshall
To ask the Secretary of State for Scotland what representations he has had from general practitioners in Scotland about the Government's plans to restructure the National Health Service.
§ Mr. Michael Forsyth
Following the publication of the Government's White Papers, "Promoting Better Health" and "Working For Patients—Caring for the 1990s", I wrote to all general medical practitioners in Scotland on 16 March asking for their views on a new contract. Those views are currently being received and studied.
§ Mr. Marshall
Is the Minister aware of the great health problems in the east end of Glasgow, with its high numbers of sick, poor, unemployed and elderly people? GPs there have worked hard for years to reduce the size of their lists. Why is the Minister forcing GPs back into the bad old days? Why is he forcing GPs to provide the cheapest treatment rather than the best treatment for patients? Can he guarantee that that will not happen and that he will alter his proposals accordingly?
§ Mr. Forsyth
I am happy to give the hon. Gentleman the guarantee that he seeks. It is certainly no part of our policy or of our proposals that the standards of primary care and service offered by general practitioners should in any way be reduced. There is much in our proposals to which doctors in inner-city areas, particularly deprived areas, should look forward with optimism. Doctors who continue to have the same list size but offer additional services concerned with preventive medicine, day surgery, and so on, will be able to maintain and enhance their incomes.
§ Mrs. Margaret Ewing
No doubt the Minister would find it embarrassing to give even an initial assessment of the negative responses that he has received. Members of Parliament are receiving copies of letters that were sent by GPs. I have not received one letter from GPs in my area showing broad support for the Government's proposals. Does the Minister accept that the general thrust of the GPs' responses shows that they predict a reversal of 40 years of service by the emphasis on capitation lists? It will be particularly difficult for women doctors, who are often employed on a part-time basis and have an important role to play in preventive medicine. Will the Minister give a commitment that he will not follow the Secretary of State for Health's example but will try to take the medical profession with him on any changes that are implemented?
§ Mr. Forsyth
With regard to the proposals to make the Health Service more responsive to the needs of the patients, the provisions in Scotland will be exactly the same as elsewhere in the United Kingdom. We have already given an undertaking that the contract for general practitioners will reflect the particular circumstances in Scotland. It is slightly surprising to find a Scottish nationalist Member arguing that the contract proposed for England will apply in Scotland. We hope to make an announcement shortly on our proposals for general practitioners in Scotland.
§ Mr. McKelvey
Does the Secretary of State agree that to date at least 191 medical practitioners in Ayrshire alone have written to him indicating their complete opposition to the plans in the White Paper "Working for Patients"? They state categorically that, instead of working for 183 patients, it will work against patients and that it is the beginning of the end of the National Health Service as we know it in Scotland.
§ Mr. Forsyth
I find it difficult to understand how the hon. Gentleman can argue that changes in the doctors' contract and in the method of delivery of service within the National Health Service that will result in an attack on waiting lists, in doctors being encouraged to give more emphasis to preventive medicine and to provide wider services should be seen as an attack on the National Health Service. Proposals that enable patients to change their doctor more easily or to ensure that their doctor is available to visit them at weekends and at night will be widely welcomed by patients and most doctors. The hon. Gentleman is right to say that doctors have expressed alarm, but doctors in Scotland would be wise to wait to see what is on offer before criticising proposals that they have not yet seen.
§ Mr. Galbraith
The problem is that doctors are aware of some of the proposals and they do not like them. Is the Minister aware that I have received copies of the hundreds of letters that he has received and that not one supports his proposals? Does he agree that one of the concerns in those representations is the list size, which is particular to Scotland? Has the Minister had any success in discussions with his counterparts in England and Wales to ensure that any proposals will take into account the special considerations of the list size in Scotland? Is he aware that we will not be dragged along on the coat tail of a huge list size forced on us to the detriment of doctors, patients and the community?
§ Mr. Forsyth
As the hon. Gentleman will know, we have had discussions with the Scottish General Medical Services Committee. As the doctors are organised and negotiate on a United Kingdom basis, they are not able to discuss the particular position in Scotland, but the Scottish Office and Ministers have been addressing that problem. The hon. Gentleman is mistaken about the letters that I have received. There is widespread support among doctors—[Interruption.] Almost all doctors, whether in general practice or in hospitals, support our proposals for medical audit and for putting more emphasis on preventive medicine. The hon. Gentleman said that there was no support at all. As usual, he is using simplistic slogans to attack a policy, when he and his party have no alternative other than to commit themselves to undo everything that the Government achieve.
§ Mr. Steel
Is the Minister aware that the general practitioners in my part of Scotland have written to him opposing those parts of the proposals that relate to general practice? They especially object to his blandishments to increase list sizes to the point where there would need to be group practices covering more than one town and thereby cutting the essential link between a community and its general practice. Will the Minister reconsider that proposal?
§ Mr. Forsyth
I had a very useful and helpful meeting with a number of doctors in the right hon. Gentleman's constituency, who welcomed the broad thrust of the proposals.—[Interruption.] Yes, they did. They expressed reservations about certain aspects of the contract that are currently under discussion. I do not believe that it is right for Opposition Members, who have obviously made no 184 attempt to study the details of the proposals, to argue that there is not considerable agreement with what we are seeking to achieve. However, there is certainly argument about whether the methods that we are using are the most appropriate. That is why we have issued working papers and have entered into discussions with the medical profession.