HC Deb 03 May 1989 vol 152 cc169-71
9. Sir Hector Monro

To ask the Secretary of State for Scotland what consultations he has had with Scottish general practitioners with regard to the new Scottish contract of service.

Mr. Rifkind

My hon. Friend the Under-Secretary wrote on 16 March to all general practitioners in Scotland inviting their views. He, I and officials have met representatives of the profession in Scotland on several occasions to discuss the new contract.

Sir Hector Monro

Does my right hon. and learned Friend agree that the proposed contract is very good for rural doctors? Will he also agree that doctors will maintain their income without increasing their lists, and will have adequate time to deal with patients both at home and in surgeries? Will he try to remove the misunderstanding between the general practitioners and the community, perhaps caused by publicity provided by the BMA, and try to reduce the alarm unnecessarily caused to constituents?

Mr. Rifkind

The specific proposals for rural doctors in Scotland have been warmly welcomed by the medical profession and, indeed, by many individual doctors. Of course, there are matters affecting the United Kingdom as a whole that are part of the BMA's negotiations, which are continuing. I certainly agree with my hon. Friend that these matters can best be dealt with on the basis of what is in the White Paper and not by misrepresentation of the White Paper.

Mr. Norman Hogg

How does the Secretary of State explain away the fact that everything that he and his hon. Friend do in the Health Service is greeted with complete disapproval by the Health Service professionals, and the latest episode is just another example? Does he not think that the time has come for him and his hon. Friend to pause and reconsider the Government's actions in the light of opinion being expressed within the medical profession?

Mr. Rifkind

I would be more worried by the reaction from certain quarters if it were based on a clear understanding of what is in the White Paper. So many allegations have been made in documents, such as that issued by the BMA, that have no foundation in truth. There seems to be a deliberate attempt to scare elderly people in particular by implying that in future they would not be entitled to treatment under the National Health Service. It is important indeed that those who represent the general practitioners put their arguments forward clearly and concisely. If they wish to criticise the Government, they are free to do so, but they should not criticise the Government for what is not in the White Paper. That is the weakness in their ultimate position.

Mrs. Margaret Ewing

The Secretary of State will be aware of the enhanced number of women general practitioners in Scotland and of the vital role they often play in preventive medicine. Would it be possible for the Scottish Office to discuss the implications of the White Paper with these women doctors, since so many of them are on part-time contracts and their careers may be damaged if the proposals went through unamended?

Mr. Rifkind

I take the hon. Lady's point; that is one of the considerations we had in mind when proposing, for example, in rural areas that payments from the rural practice fund would be based on average and not on personal list sizes, and we are prepared to consider a similar approach towards practices in urban areas as well.

Mr. Darling

Is it not the height of arrogance for the Secretary of State to accuse doctors of scaring old ladies? Is he not aware of the fact that many general practitioners in Scotland and throughout the whole country are extremely concerned at the prospect of being forced to increase their list size and of having to become accountants and to regard elderly patients, in particular, not as patients to be treated on the basis of need but simply as overheads or non-profit-making units? Does he not understand that general practitioners are concerned about the Health Service? They use it and live with it, unlike Conservative Members.

Mr. Rifkind

As one who uses the National Health Service, I repudiate entirely what the hon. Gentleman has said. He has inadvertently emphasised that he, too, has not read the White Paper.

Mr. Darling

I have.

Mr. Rifkind

If he has read it, he certainly has not understood it, because he began by proposing that general practitioners would be forced to take on more patients in order to maintain their income. No general practitioner will be forced to take on more patients to maintain his or her income and although taking on additional patients might lead to an increase in income, that is a very different proposition.

Mr. Bill Walker

Is my right hon. and learned Friend aware that a substantial number of doctors in my constituency are concerned about the misleading propaganda that has come out of London? Is he also aware that they have pointed out to me that under the provisions of their new contracts and because of the way in which they will be given the opportunity of choice about how to run their practices, they might be able to allocate funds from their own resources to save hospitals such as Blairgowrie cottage hospital and Forfar infirmary because the additional cash could be directed in that way?

Mr. Rifkind

That is entirely true. Of course, additional resources that do not need to be used for one purpose within the National Health Service will continue to be available within the NHS to improve the quality of provision in both general practices and hospitals. That is why the proposals deserve to be welcomed.

Mr. Galbraith

Although the Secretary of State may have read the White Paper, he certainly does not understand it because if he did he would realise that the new GP contracts contain an incentive to increase list size. Will he accept that neither general practitioners nor patients can understand how a GP seeing more patients can somehow improve the quality of care? Will the Secretary of State reconsider his position on list sizes and on incentives to increase list sizes because then and only then can agreements be reached on GPs' contracts for the benefit of all patients?

Mr. Rifkind

There are various ways in which general practitioners can increase their income, sometimes significantly, by providing better and extra facilities to their patients. The point at issue is whether they need to increase their list size to maintain their income. That is the allegation that has been made by the BMA and repeated by the hon. Member for Edinburgh, Central (Mr. Darling), and that allegation is totally unfounded.