§ 11. Mr. JackTo ask the Secretary of State for Health what subjects have been raised with him by doctors making representations on the proposals for their new contracts.
§ 7. Mr. Anthony CoombsTo ask the Secretary of State for Health if he will make a statement on the current situation in the negotiations on general practitioners' contracts.
§ 12. Mr. HunterTo ask the Secretary of State for Health what progress has been made in negotiations on general practitioners' contracts.
§ The Secretary of State for Health (Mr. Kenneth Clarke)Discussions on the new contract have now lasted for more than 12 months. I last met the General Medical Services Committee negotiators on 20 March. In the light of the discussions my officials are now preparing amendments to the relevant NHS regulations and to the statement of fees and allowances, on which they will be consulting the General Medical Services Committee negotiators. A conference of local medical committees is being held this week and the negotiators will no doubt consider whether to seek any further meetings with me in the light of the outcome of that conference.
§ Mr. JackWill my right hon. and learned Friend confirm that in his future negotiations and deliberations on this subject he will take fully into account the representations made by many Conservative Members following meetings with their doctors, who have expressed 788 concern about the contract? Will he also take this opportunity to put at rest the minds of the many patients who have written to me and my hon. Friends about the effects of the contract and assure them that the principles of the National Health Service will be maintained as a service free at the point of consumption with medicine supplied without let or hindrance because of budgets?
§ Mr. ClarkeI am grateful to my hon. Friend and to other hon. Members who have informed me of the views of the practitioners in their constituencies. We have taken on board many of the present representations which have already been made in the course of the discussions and we will certainly take on board all constructive representations now. I agree with my hon. Friend that it is most unfortunate that, in the course of negotiating the contract, some doctors have gone out of their way to cause needless alarm to patients, because no threats to patients will arise from this.
§ Mr. CoombsDoes my right hon. and learned Friend agree that there are 5,000 more doctors than in 1979, they are far better paid than ever before and the number of ancillary workers working for them has doubled, and therefore the disgraceful statements made in a pamphlet by the British Medical Association are often untruthful, alarmist and verging on the paranoid? Will he confirm once again that, under the proposed Health Service reforms, no patient will go without a comprehensive local health service, adequate drugs or appropriate treatment?
§ Mr. ClarkeI agree with my hon. Friend. We now have more doctors than before. They are better paid and their average list sizes have gone down. That is why it is right to concentrate on a contract which rewards fairly those who carry the largest work loads and one which also encourages new services for patients, which we offer in the contract. In contrast, the leaflet produced by the BMA to which my hon. Friend referred, contains scurrilous nonsense. It is a long time since I have encountered a trade union which is prepared to spend millions of pounds of its members' money on spreading untruths among its consumers in that way.
§ Mr. HunterIn the light of a general practitioner telling an elderly constituent of mine that, under the new contract, he may not be able to treat her, will my right hon. and learned Friend emphasise the fact that the elderly will be well looked after under the provisions of the new contract?
§ Mr. ClarkeYes. If such an allegation has been made —and of course, I accept what my hon. Friend has said—it is totally untrue. The contract is so designed to give extra payments to those doctors who take on elderly patients. The contents of the new contract that we are discussing include new services which are expressly aimed at elderly people to ensure that they—particularly those over the age of 75—have more regular contact with their GPs. The contract is designed to improve services to the elderly. It is scandalous nonsense to claim that any elderly patient is threatened by it.
§ Mr. FearnWhat representation has the Secretary or State received from women doctors? Does he not agree that the new contract could harm women doctors' practices, which tend to be smaller?
§ Mr. ClarkeThe contract proposals recognise explicitly the prospect for job-sharing. We also acknowledge the right for someone to have the full status of a principal when taking on part-time obligations. The contract is designed to encourage women doctors in general practice. An ever higher proportion of GPs will be women. The difficulties arise from the changes in basic practice allowance, not from the contract. They stem from the fear of some women that partners will not take on female partners unless the BPA is so constructed as to give all partners a financial benefit when a part-time partner is taken on. Women have no reason to be fearful of their colleagues' prejudice. Nothing in the contract would encourage that.
§ Mr. DalyellAre GPs to be cash-limited?
§ Mr. ClarkeNo they are not.
§ Mr. LoydenDoes the Secretary of State accept that the only reassurance that he could give to National Health Service users would be to cease the stupidity of trying to transform doctors into accountants? The public's clear answer is that they want no part of this crazy scheme.
§ Mr. ClarkeDoctors are independent contractors. It is my duty, on behalf of the patient, to negotiate a contract which rewards heavy work load and encourages good performance. The rest of the population are paid according to the work that they do and the standards that they attain. Many doctors can see no reason in principle why the same criteria should not apply to general practice. The result of the new contract will be an improved service for the patients, because the best and most go-ahead practices will be rewarded. We shall also introduce into the contract up-to-date services in disease prevention, health promotion, and closer surveillance of young children and elderly people.
§ Dame Elaine Kellett-BowmanWill my right hon. and learned Friend accept my thanks for putting at rest the fears of my 84-year-old constituent, who had been informed by his doctor that if this contract went through his doctor would no longer be able to visit him at home in a rural area?
§ Mr. ClarkeThe new contract will place the doctor under an express duty to keep in touch with the elderly patient and keep himself well informed of his home circumstances. By its capitation payments, the new contract will pay the doctor extra to enable him to carry out that new duty. I can only assume that if the doctor in question has put out such information, he has been totally misled by the information from Tavistock square.
§ Ms. HarmanIs it not the case that a patient receives better care if a GP has more time to spend with each patient? Is it not going in completely the wrong direction to give financial incentives to doctors to have as many patients as possible on their lists?
§ Mr. ClarkeI quite agree that patients will wish to join practices that give them adequate time and care and, I hope, offer the new services, for which the new contract is an encouragement. With respect, the arguments about list sizes constitute a complete red herring, which has been put in the forefront of many of the discussions. Under this contract, there is no reason why anyone with an average size list should wish to acquire new patients. A doctor 790 seeking to enhance his income would go for the new services and seek to hit the new performance targets. The hon. Lady and hon. Members on both sides of the House should not be misled by the simplistic argument that this is all about increasing list sizes. The new contract is aimed at raising the standards of general practice to the general public, and the best GPs will respond to that.