HC Deb 25 April 1989 vol 151 cc792-3
4. Mrs. Ray Michie

To ask the Secretary of State for Health what further representations he has received from doctors in rural areas about his National Health Service reform proposals in the "Working for Patients" document.

The Minister of State, Department of Health (Mr. David Mellor)

We have received a number of representations and will take them carefully into account in implementing our proposals.

Mrs. Michie

Will the Minister give details of the people and institutions that he consulted before he produced his White Paper document and proposals, particularly those in relation to rural general practices?

Mr. Mellor

I do not know whether the hon. Lady is referring to the White Paper or the contract. There were considerable discussions of the contract prior to its publication by the Secretary of State after no less than 12 months' negotiations with the doctors' representatives. That document includes most of the material about rural practices. The process of consultation has not yet ended. The Secretary of State has already made it clear that he and his fellow Ministers are meeting regularly with general practitioners, and we shall certainly bear in mind the points that they make on those issues.

Sir Michael McNair-Wilson

General practitioners' income is to rely to a greater extent on capitation. Will this not mean that doctors in rural areas will be rather worse off as a result of the change and, in those circumstances, should not the rural allowance be left in place?

Mr. Mellor

I do not believe that doctors will be worse off, because we intend to pay a rural supplement to recognise the particular problems of doctors in rural areas. There has been some concern because of the aged definition of "rural" used in some cases. Areas that are actually no longer rural have been benefiting from some of the rural payments. We believe that our policy will enhance the position of rural practitioners. All points to the contrary are being borne carefully in mind before we make our final decision.

Rev. Martin Smyth

I welcome that assurance, but is the Minister aware that there is great concern that the small rural practices which have been giving good service believe that they will be penalised under the new system? Will the Minister accept that the consultation time of 20 hours face to face in surgery may not really be a useful basis on which to work, especially when one allows for home calls?

Mr. Mellor

In making that determination, we have borne home calls in mind but, as I have said, all points are being considered. In a number of cases rural practitioners have smaller lists, and to make allowance for that we intend to pay an enhanced capitation fee for practices between 500 to 1,500. In the exceptional circumstances of highly rural communities, where it is justifiable that the practitioner has under 500 patients, it might be possible to pay such a person under the inducement payment scheme, which recognises the exceptional problems of highly scattered areas. I hope that in that respect we shall ensure that rural practice is enhanced and not diminished by our proposals.

Mr. Bill Walker

Will my hon. and learned Friend accept that in the rural areas the quality of medicine, and particularly the motivation of the general practitioners, has been very high, because the quality of life has encouraged good GPs to take up practice? There is nothing to the contrary in the Government's White Paper. Certainly the proposals we have for Scotland show clearly that all this is taken on board and we shall continue to enjoy this quality of service.

Mr. Mellor

I warmly endorse my hon. Friend's remarks.