HC Deb 23 January 1990 vol 165 cc730-2
7. Mr. Bill Walker

To ask the Secretary of State for Health what steps are being taken to allow general practitioners more control over their own budgets.

Mr. Kenneth Clarke

The National Health Service and Community Care Bill currently before the House provides for GP practices which volunteer to do so, and which meet the eligibility criteria, to run their own practice funds. This will give them additional freedom to decide how funds are best used in the interests of their patients and, in particular, to influence the way in which hospital treatment is provided. In December I issued a programme to all GPs in England for the scheme, inviting expressions of interest to regional health authorities. I am pleased that there has already been a very encouraging response.

Mr. Walker

I thank my right hon. and learned Friend for that reply. Can he confirm that GP practices that decide to set up their own budgets will have access to up to £32,000 of the management charge? Does not this make nonsense of all the stories that we have heard about GPs having to spend more time on paperwork than with patients?

Mr. Clarke

There will be £32,000 available to reimburse GPs for expenditure that they incur on the management of the practice budgets. They will use that money to obtain information technology, including software, as well as the staff that they need to make sure that the budget can be run effectively without intrusion on their clinical duties.

Mr. Pike

Will the Secretary of State recognise doctors' genuine worries and patients' concerns about the changes in the Health Service? Today I received from a Mr. Bramald a letter enclosing a letter from his doctor, Dr. Durkin, stating that the change in payment for doctors means that they can no longer afford to keep on their lists people who require more active night calls and weekend calls, and saying that Mr. Bramald and his family were being given 10 days in which to find another doctor. Does this not show the problem, and will the Secretary of State take action to rectify it?

Mr. Clarke

I understand that there are uncertainties among doctors at a time of change, but it is my experience, and that of everybody in the National Health Service, that those uncertainties are diminishing rapidly. GP practice budgets are entirely voluntary, and only GPs who want to take advantage of them will apply to do so. I think that the vast majority of eligible practices will apply.

I will have a look at the letter from Dr. Durkin to which the hon. Gentleman referred, but on the basis of the hon. Gentleman's account I can only say that, under the contract that the doctor has been given, he has no justification for making such statements. I suspect that he is yet another doctor who has been misled by some of the rather over-the-top campaigning that went on last summer about the contract, and that if he looks more closely at the contract he will see that it gives him no encouragement to take such steps against his patients.

Mr. Michael Morris

As all GPs have tight budgets, and inevitably always will do, will my right hon. and learned Friend consider GP practice leaflets? GPs are not allowed to use ordnance survey maps unless, as I understand it, they negotiate directly with the Ordnance Survey. Is not this a case in which my right hon. and learned Friend should knock a few heads together and encourage direct negotiations between the Department of Health and the Ordnance Survey so that GPs may use those maps?

Mr. Clark

GPs must have reasonably tight budgets for their premises and practice expenses, but, as my hon. Friend will know, the amount that has been spent, under this Government, on the improvement of premises and on practices has increased enormously with the huge expansion in the practice staff that GPs employ. I am grateful to my hon. Friend for drawing attention to this problem. I understand the desire of the Ordnance Survey to protect its copyright, but I will look into the possibility of my Department's being able to help to sort out the problem.

Mr. Kennedy

Has the Secretary of State recognised the genuine and legitimate anxiety of patients and general practitioners arising from the changes to the GP service that, in the shape of legislation and contracts, he has forced through this House?

Can he not see that there continues to be legitimate anxiety arising from the peer audit to which GPs are subject, particularly on spending? It makes sense, from the point of view of the Department of Health, only if punitive action is likely to follow supposed or alleged overspending. The injection of that cash element between the family doctor and the patient at the coal face of the Health Service is utter poison for what are supposed to be the principles of the National Health Service.

Mr. Clarke

The hon. Gentleman is muddling a variety of aspects of general practitioners' work. The general practitioners' contract, for which a majority was obtained in the House, will reward general practitioners better than in the past for heavy workload and good performance. That is the point of the contract. The hon. Gentleman is referring to indicative budgets for drugs and prescribing costs, and we have repeatedly made it clear that every patient will be entitled to the drugs which, in the general practitioner's opinion, the patient requires. General practitioners will be subject to penalties under the contract only if they deliberately continue to overprescribe in the face of professional advice that points out their wasteful practices. That is not a serious intrusion into the care of patients.

Mr. Boswell

Has it occurred to my right hon. and learned Friend that the minimum size for practice lists is approximately four or five times the size of the sample drawn by opinion pollsters to represent the population as a whole, so it is highly likely that practice lists will be representative? Will he assure the House that in the event of there being an unusual patient profile, the system will be sufficiently flexible to ensure that general practitioners do not lose out as a result of their introduction?

Mr. Clarke

I can certainly give my hon. Friend that assurance. The funds placed at the disposal of each practice will reflect the make up of its patient list. If general practitioners are not satisfied with the sum provided by the regional health authority, they can refuse to proceed with their application for a practice budget.