General Practitioners (Contract) (Hansard, 25 July 1989)

§ 4. Sir Bernard Braine
To ask the Secretary of State for Health how the new general practitioners' contract will affect the chances of night visits being made by a patient's own doctor.

§ 9. Mr. Bellingham
To ask the Secretary of State for Health how the new general practitioners' contract will affect immunisation and screening policies.

§ 10. Mr. David Nicholson
To ask the Secretary of State for Health how the new general practitioners' contract will affect the assessment of the development of young children.

§ The Secretary of State for Health (Mr. Kenneth Clarke)
The new contract will introduce a higher visit fee for those doctors who visit patients themselves, or who arrange night cover in small rotas of no more than 10 doctors. I believe that this will encourage general practitioners to carry out more home visits themselves or ensure that their patients see a doctor whom they know.
The new payments for the achievement of specified levels of childhood immunisation and cervical cytology will offer GPs a powerful incentive to raise protection against diseases for their patients.
The new contract will introduce for the first time a fee for GPs who provide services to monitor the development and well-being of their child patients.

§ Sir Bernard Braine
Although a deputising service clearly has its uses, does it not make sense for general practitioners to have an incentive to visit their patients rather than to encourage the attendance of deputies, who may have had absolutely no contact with the patients, particularly elderly patients? If anyone had any doubts before, does this not clearly show that the function of the new contract is to improve the quality of service to the patient?

§ Mr. Clarke
I am grateful to my right hon. Friend. His point will be endorsed by his constituents who much prefer, wherever possible, a visit by a doctor from their own practice or one in close contact with it. I am glad to say that the majority of GPs do not use commercial deputising services. It is fair that they should be paid a higher reward for that. I regret to say that, at the moment, the general medical services committee is seeking to reopen discussions with me on the higher fee. I see no basis for that. We must remember the patients' interests and the public interest in settling the contract.

§ Mr. Bellingham
I am grateful to my right hon. and learned Friend for that reply. Does he agree that good doctors have nothing to fear from the new contract? Will he confirm that, in future, in places such as west Norfolk, where there is a large retired population, people will get even better service from their GPs and will not mind them receiving extra rewards?

§ Mr. Clarke
We are very conscious of the increasing number of elderly patients and the increasing needs of elderly patients, particularly those beyond the age of 75. That is a growing feature of the population of Norfolk. Patients would welcome the introduction of a new higher fee for GPs in return for keeping at least in annual touch with all their patients over the age of 75.

§ Mr. Nicholson
My right hon. and learned Friend will be aware of my concern that the National Health Service should cope with the needs of patients of all ages, particularly young children. Does he agree that his earlier replies give the lie to claims that the new contract would 840 work against patient care? What can he do to bring home to GPs the considerable benefits to patients from the new contract?

§ Mr. Clarke
I am glad to say that the new payment for child surveillance, which is monitoring the development and health of children under the age of five, was put into the contract at the request of the medical profession and the GMSC. It is one of many features of the contract that should encourage much better service to patients. Many GPs have still not altogether understood all the details of the contract on offer. They should realise that the resulting contract must be on a balance between the legitimate interests of the profession and the legitimate needs of patients to ensure that general practice maintains the highest international standards.

§ Mr. Foot
As the right hon. and learned Gentleman was originally appointed to his post because of his great powers of communication—we might call him the "Kenneth Baker of yesterday"—can he give the House an estimate of what would have been the response from doctors to the new contract without his great clarity and vision?

§ Mr. Clarke
I remain a colleague of Kenneth Baker today. I have certainly communicated with doctors. I and my negotiating team have had 19 meetings with the GMSC negotiators, spent 110 hours in negotiation and produced 38 papers as bases for discussion. We eventually reached an agreement that the GMSC recommended to the profession.
Obviously, I regret the fact that GPs have decided to reject the recommendations of their own negotiators, but at least it was not by the nine to one vote that greeted Aneurin Bevan when he tried to persuade the British Medical Association to accept his terms of service when the NHS was founded.

§ Mr. Duffy
The hon. Member for Norfolk, North-West (Mr. Bellingham) referred to the elderly. Is the Secretary of State aware that in Sheffield the most freely expressed fear about the new contract is that it will prejudice the dedication of services and resources to the elderly, especially in respect of night visits? Will he comment on the effect of the new contract on Sheffield's elderly population, especially as it is expected that the number of those over the age of 85 will increase by 82 per cent. during the next decade?

§ Mr. Clarke
I do not accept the interpretation that the hon. Gentleman claims has been put upon the contract by some doctors in Sheffield. As I have already said, we are introducing a new, higher payment in exchange for regular contact with patients over the age of 75. The new contract will benefit the elderly, who would much prefer that, whenever possible, night visits are made by someone from their own practice whom they are likely to know.

§ Ms. Mowlam
Will the right hon. and learned Gentleman make it clear that doctors will not be paid for immunisations and screenings if they do not achieve a minimum target of 70 per cent. of their patients? In an area such as Teesside, doctors, however hard they try, will have great difficulty in reaching that high target. It is a question not of good or bad doctors but of a target that is unattainable.

§ Mr. Clarke
Vaccination is part of the ordinary duties of every GP. I am sure that they all accept that they must strive to raise the level of immunisations. The 70 per cent. target is already being met by the majority of practices, certainly in England, and it can be achieved regardless of the social status of an area. It is important to try to secure a National Health Service that meets the highest international standards of patient care. The target that we have set is that recommended by the World Health Organisation, and none of us should recommend second-rate or lower standards for the NHS than those regarded as reasonably attainable in developed countries.

§ Mr. Cormack
Although it may be true that, as my hon. Friend the Member for Norfolk, North-West (Mr. Bellingham) said, the majority of doctors have nothing to fear from the new contract, does my right hon. and learned Friend accept that some excellent doctors are apprehensive? Despite his efforts through meetings, papers and discussions, does he agree that there is a need for a concerted effort during the next three months, when Parliament is not sitting, to talk to doctors throughout the country in as conciliatory and constructive a manner as possible, in the hope of persuading them that they have nothing to fear?

§ Mr. Clarke
My two ministerial colleagues and I hold meetings with hundreds of doctors each week, and they have been successful and productive. One of the main actions that we can take is to explain the impact of the contract to individual GPs, many of whom are labouring under unreasonable and unnecessary fears about a possible loss of income in their practices. In fact, the best doctors will gain under the proposals, but some will have to improve their performance. Many doctors are labouring under a misunderstanding because they have not absorbed the detail of the new contract. I shall take my hon. Friend's advice and I shall almost certainly communicate in writing with all GPs, setting out the terms on offer.