HC Deb 21 March 1989 vol 149 cc896-8
5. Mr. Livsey

To ask the Secretary of State for Health if he has any plans to meet the British Medical Association to discuss the income of general practitioners in rural areas.

Mr. Clarke

I met the British Medical Association's general medical services council yesterday. We discussed the subject of general practice in rural areas among other issues arising from the discussions that have taken place throughout the past year on proposals to amend regulations for the remuneration of general practitioners.

Mr. Livsey

Is the Secretary of State aware that in the county of Powys, which has the sparsest population in England and Wales, members of the BMA met on Sunday and rejected the NHS proposals as they affected rural areas on the grounds that they abolish choice, reduce income and redistribute money from rural areas to inner cities, without making special provision for inner cities? The proposals will make some rural practices non-viable, so the GPs are unhappy about them as they affect rural areas.

Mr. Clarke

I cannot understand the argument about reducing choice because our new contract proposal is based on a background of making it easier for patients to change and choose their GPs, and GPs will be allowed to advertise to make that choice easier. We are putting forward a new proposal for a rural practice allowance to replace the previous allowance for rural areas. As the hon. Gentleman's constituency is so sparsely populated, I was surprised to hear that his GPs believe that they will lose by the proposal. I will try to ensure that the hon. Gentleman is given further details of our proposals. We have addressed ourselves very much to the fact that in rural areas with a sparse and scattered population it is necessary to weight the basic practice allowance in favour of doctors because they will not have the same opportunity of earning income through patient lists and capitation fees as is possible in more populated areas.

Mr. Maxwell-Hyslop

Can my right hon. and learned Friend tell the House what proportion of the rural practitioners who receive the allowance at the moment will be excluded by the new arrangements? Will he reassure general practitioners that the total on which the percentage target for cervical smears is calculated will exclude virgins and those who have been invited to take the test but have refused?

Mr. Clarke

My proposals for a new contract, based on where I say that we have got to after 12 months of negotiations, were issued after the General Medical Services Committee put its version of where we are at the moment to its members. When we met yesterday we exchanged arguments about rural practice. The GMSC prefers the present system whereby doctors qualify for rural practice supplements if they practise in an area which was served by a rural district council before the local government reorganisation in the early 1970s. I prefer a system based on density of population. We are still discussing the matter. When it is resolved, it will be clear whether practitioners in my hon. Friend's rural constituency are advantaged or disadvantaged.

On my hon. Friend's second point, it is right to set targets. It is no good paying for every smear test because they are part of the ordinary routine day-to-day duties of a GP. We are setting targets for good performance so that extra payments are made to those who achieve levels of screening for which we think good practice should aim. However, I agree that we must define the target group carefully. People who have had hysterectomies, people who have moved off the list, nuns and virgins must be taken into account.

Mr. Foulkes

Is the Secretary of State aware that most people in my rural constituency cannot even choose their doctor, let alone the hospital to which the doctor sends them? Is he aware that that is why, without any encouragement from me, GPs in Ayrshire have unanimously rejected his proposal, including all the GPs in the marginal constituency of the Secretary of State for Defence? Is it part of the Minister's tactics to remove one of his main competitors for the post of Leader of the Opposition after the next election?

Mr. Clarke

For the past 12 months we have been negotiating changes to a contract which was last changed in the mid-1960s. The local medical committees tend to pass resolutions saying that they prefer the contract that they have rather than any changes. If changes are made to determine who receives more or less than the average, it is inevitable that some will be gainers and some will be losers. I suspect that the losers are running along to the local medical committee meetings with more enthusiasm than the others. We are discussing the matter with the GPs and their representatives. The object of changing the contract, from my point of view and from the patient's point of view, is that we must particularly reward those doctors who do most of the work and those who introduce new services and hit performance targets for key services such as vaccinations and screening. Some doctors will do well because that will benefit them, but others will not do so well and will have to improve their practice. That is what a patient-oriented, consumer-conscious NHS is all about.

Mr. Conway

When I meet the GPs in Shropshire on Tuesday night what message would my right hon. and learned Friend like me to give them to assure them that GPs in rural areas will be treated equally favourably with those in the larger city areas at which many of his proposals are aimed? When my right hon. and learned Friend next meets the BMA, will he remind it that the Labour Government cut spending on the NHS, so there is no point in looking to the Opposition for genuine support?

Mr. Clarke

First, I ask my hon. Friend to point out that the only disagreement between myself and the GMSC is about the form of help for those who live in rural areas —the way in which we weight the capitation payment for rural areas. We agree that all the basic practice allowances need to be added to the capitation fees in rural areas to compensate for the sparsity of population. My hon. Friend can also tell his no doubt excellent practitioners in Shropshire that those who can achieve the performance targets that we have set and introduce the new services will benefit under our contract proposals. He might also point out that many parts of the contract are agreed. For example, a new payment for child surveillance services was first put forward by the practitioners representatives four or five years ago. After my meeting yesterday, I think that it is still generally welcomed by those who represent the doctors and by the doctors themselves.

Mr. Galbraith

Is the Minister aware of the statement made by the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), that capitation fees will be banded? Can the Minister confirm that he is discussing that point with the BMA? Can he also explain the further statement by the hon. Member for Stirling that banding will ensure that, irrespective of the number of patients on a list, the income from capitation fees will be exactly the same in each practice?

Mr. Clarke

My hon. Friend the Member for Stirling (Mr. Forsyth) is having separate discussions with the Scottish branch of the GMSC, not about the whole proposition but about certain aspects of it which affect Scotland, and reassurances were given to rural practitioners in Scotland in particular in the White Paper "Working for Patients". I can only ask the hon. Gentleman to refer his question to my hon. Friend the Minister responsible for health in Scotland because I am not party to discussions between him and the GMSC on the subject of the Scottish Health Service or any Scottish variations on the contract that I am negotiating.