HC Deb 25 April 1989 vol 151 cc795-7
9. Mr. Adley

To as the Secretary of State for Health when he next intends to meet the British Medical Association; and what he intends to discuss.

Mr. Kenneth Clarke

I have no plans to meet the BMA, but I have arranged to meet representatives of the medical profession through the joint consultants' committee tomorrow to discuss the implementation of the NHS White Paper "Working for Patients".

Mr. Adley

While thanking my right hon. and learned Friend for that reply, may I ask him please to obtain from the BMA an apology for the distortions with which it is frightening patients? Does he agree with me that if the purpose of its campaign is to persuade Ministers and Conservative Members of Parliament by the mindless barrage of propaganda that it is putting out, it is singularly unsuccessful? The main beneficiary of this propaganda appears to be the advertising agency handling the account. Will my right hon. and learned Friend accept from me that, he and I having been in the House together for more than 19 years, I am more than happy to recommend his advice rather than that of the BMA to my constituents?

Mr. Clarke

I have written to all GPs under contract in England, setting out why we disagree strongly with the five principal assertions made in that leaflet, and why we say that they are all untrue. I have invited GPs to consider whether they want to carry on putting the leaflet in their surgeries, and I am glad to say that I think that many of them do not. I look forward to having sensible negotiations with the BMA, if it will return to constructive proposals, about how to improve general practice in this country. Some of the campaigning on which it is spending such money is not really helping to improve the atmosphere, or the prospects for patient services either.

Mr. James Lamond

When the Secretary of State meets the consultants, as he has said he will, will he ask them if the people appointed to the new consultant posts that he intends to agree to—the 100 posts that have just been mentioned—will accept that they must devote 100 per cent. of their time to the National Health Service, and not, as at present, be permitted to devote as much time as they like to private medicine, using National Health Service facilities, and charging old people, who cannot wait in the queue any longer, exorbitant prices for operations that should be performed free?

Mr. Clarke

Consultants are able to enter into contracts on the present basis with the National Health Service. They can be full-time, and maximum part-time, and so on. What we have ensured in the White Paper is that district health authorities will agree a job description with each consultant each year and will act as the agents of the regional health authorities in ensuring that that job description is, indeed, fulfilled by the consultant. So the consultant will be paid according to the extent of his commitment to the National Health Service, and the district health authorities will be able to ensure that that commitment is carried out.

Mr. John Greenway

Does my right hon. and learned Friend agree that much of the confusion in the minds of the public in relation to the proposed reforms of the Health Service stems from a mixing of aspects of the general practitioner contract with proposals set out in the White Paper, and that this misinformation is largely perpetrated by some GPs who do not understand the differences themselves? Will my right hon. and learned Friend take the opportunity for further negotiations to get the GP contract settled, so that discussions about the White Paper reforms may continue, and the beneficial ideas in the White Paper may be discussed and put into practice?

Mr. Clarke

I agree entirely with my hon. Friend's analysis. My experience in discussions has been the same as his. I sent to all general practitioners a copy of the White Paper on the National Health Service review and the relevant working papers that related to the White Paper. I sent out separately the proposals for a new contract, in which I described the stage that we had reached in our discussions and negotiations. I asked all general practitioners to read whichever parts that interest them but to keep them apart and made it quite clear that discussions on the contract—where we hope to reach a reasonable conclusion, if people will accept the aims of the new contract—are one thing and that the evolution of the Health Service review is quite another. A great deal of discussion still has to take place on that while we are getting the details in place. The sooner that we can settle the contract and stop this protracted negotiations battle, the sooner we shall get on with implementing the NHS review.

Mr. Galbraith

When the Minister next discusses the general practitioners' contract with the British Medical Association and the general medical services committee will he deal with the concessions that have been made in the tartan contract—the concessions on basic practice allowance, the retention of the rural practice allowance and the lowering of screening targets? Will those concessions be offered throughout the United Kingdom so that they become the basis for a United Kingdom contract?

Mr. Clarke

I discussed the details of the tartan contract, as the hon. Gentleman described it, with my right hon. and learned Friend the Secretary of State for Scotland before he issued it. That contract reflects in part our reactions to the submissions that we had received on the contract and expresses Scottish conditions. Average list sizes in Scotland are smaller so doctors have, on average, fewer patients. The average level of vaccination is lower and targets are adjusted accordingly. Moreover, doctors serve many scattered rural areas. I shall be interested in the reactions of the general medical services committee and of anybody else to the provisions in the Scottish contract. The Government sought to react to the representations made to us. We have tried to meet local conditions in order to ensure that good practice is encouraged.