NHS Reform (Hansard, 27 June 1989)

§ 1. Mr. Day
To ask the Secretary of State for Health whether the intention of the new general practitioners' contract is to increase doctors' list sizes.

§ The Secretary of State for Health (Mr. Kenneth Clarke)
No, Sir. The sole aim of the new contract is to raise the standard of care patients receive from the family doctor service. There is no possibility that it will lead to any increase in average list size.

§ Mr. Day
Is my right hon. and learned Friend aware that, in 1965, the British Medical Association, which was in dispute with the then Labour Government, recommended that general practitioners resign from the National Health Service? Is he further aware that the main point of dispute between the then Government and the BMA at the time was seniority payments, to which the Labour Government were opposed? Does he agree that the Opposition's present position is therefore rather hypocritical?

§ Mr. Clarke
My hon. Friend is right. There was a serious dispute between the former Labour Government and general practitioners on the last occasion when the general practitioners' contract was being revised. Obviously, the attitude of today's Labour party is rather different from that of its predecessor. The hon. Member for Livingston (Mr. Cook) would simply write a letter to the BMA asking what it wants the Labour party to agree to. That was not the practice in former times.

§ Mr. Fearn
Does the Secretary of State agree that a general practitioner should have a maximum number of patients? If there is to be a maximum, is it to be categorised according to elderly, young, indifferent, or what?

§ Mr. Clarke
Nothing that I propose will increase a doctor's average list size. Obviously, patients will join the practice of a doctor whom they think gives them the right quality of care and the right amount of time. I would be most reluctant to contemplate a maximum. It would mean telling patients that they have to leave the list of a doctor whom they think is giving satisfactory service. That is not the way of going about it.

§ Mr. Nicholas Winterton
Does my right hon. and learned Friend agree that increasing the capitation percentage of a doctor's remuneration could reduce the amount of time that a doctor can spend with each patient and that that could be counterproductive for health care?

§ Mr. Clarke
No. Although I do not regard myself as a mathematical genius, I believe that most of those arguments are nonsense. A doctor's average list size is determined by the number of doctors and patients. I have no control over either of those things. Because more general practitioners keep joining the National Health Service, the average list sizes keep dropping, and I imagine that they will continue to do so. Patients will not join the list of someone who has taken on so many patients that he starts cutting the time that he spends with each patient. There is no way that anybody should or will react to the new contract by trying artifically to inflate a practice list over the average size.

§ Mr. Robin Cook
Does the Secretary of State appreciate that the simple and straightforward way by which GPs can increase the average list size is by not appointing new partners? Is he aware of complaints, particularly by women graduates, that since he published his White Paper adverts for new partners have dried up and adverts for part-time partners have practically vanished? How can he possibly pretend that a contract that will make it more difficult for women to become established as general practitioners is likely to encourage more women to come forward for cervical smears?

§ Mr. Clarke
It is an astonishing allegation that, for purely financial reasons, doctors will reduce the time that they can give patients just by not taking on another partner, and thereby willingly taking on more patients for themselves. The financial advantage to a partner in the average practice would be quite minor. I do not think that many doctors would be so irresponsible as to do that, and I do not think that patients would stay with practices that do that. I do not accept that anything in the new contract is any deterrent to women becoming full partners in general practice. I expect many more women to do so. For the first time, we are making provision for part-time principals, job sharing and so on to recognise that more women are likely to go into practice and have family commitments during some part of their careers.