HC Deb 03 December 1991 vol 200 cc132-3
5. Mr. Knapman

To ask the Secretary of State for Health whether he intends to relax the patient numbers criteria so that smaller general practitioner practices can apply to be fund holders.

Mr. Waldegrave

I know that many general practitioners who are not eligible to join the scheme recognise the benefits of fund holding and wish to take part. I hope to be able to open the scheme to more practices soon. At present, small practices may group together to become fund holders.

Mr. Knapman

My right hon. Friend is aware of the clear advantages to patients of fund-holding practices. That is being increasingly recognised, not only by doctors but by the British Medical Association and, possibly, by some Opposition Members. Does he appreciate the keen desire of many small practices to join these excellent schemes?

Mr. Waldegrave

My hon. Friend is right. There is a growing consensus about the success of the scheme, and that runs right across the general practitioners taking part in it. The hon. Member for Livingston (Mr. Cook) is not exactly clear about his policy on these issues. I hope that that unclarity means that he is moving towards us.

Mr. Loyden

Does the Secretary of State agree that there is a danger that the number of patients per doctor might have an effect on the eventual standard of treatment that patients receive? Is he carefully watching the changes that are taking place to ensure that the number of patients per doctor conforms with the ability to supply a good service?

Mr. Waldegrave

Yes, we are assessing the whole fund-holding scheme jointly with the general medical services committee, the relevant committee of the BMA. The hon. Gentleman might recall that one of our successes has been to bring down average list sizes markedly since Labour was in power.

Mr. Wolfson

Does my right hon. Friend agree that general practitioners, whether fund-holders or not, as a result of the new contract—which initially was often bitterly opposed—are now giving patients a much better service than they had in the past?

Mr. Waldegrave

My hon. Friend is right, and that is not just his opinion. A recent independent poll on exactly that matter showed that already, within the first year, a significant number of patients of general practitioners recognised that they were getting better services than a year previously. The level of opposition that existed when my predecessor brought in the contract will be shown by history to have been wildly overstated. It has been a success.

Mr. Rooker

In the context of smaller practices, I wish to raise with the right hon. Gentleman a subsidiary but related issue, that of the single-practice general practitioner. Does he believe that, even with massive commitment and dedication, it will be possible for the large number of single-practice GPs in this country to measure up to the demands of the community care programme in 1993?

I cite as an example the urban areas of the city which I partially represent—[Interruption.] I speak for all of Birmingham when I speak on this issue, and I am trying to raise an important matter in which there may be some common cause. There are 586 GPs in 270 practices, over a third of which are single practices. Even with their dedication and commitment, one must feel concern about their ability to measure up to the infrastructure needed for a viable community care programme.

Mr. Waldegrave

I respect the hon. Gentleman's commitment to those matters, and he is right to point to one of the problems. In recent years there has been a move to much bigger primary care teams, which has generally been welcomed. Many dedicated single-handed practitioners remain, and we must ensure that that option remains so that GPs are free to practise how they wish. One of the strengths of the fund-holding scheme is that general practitioners can group together to use the benefits of the scheme. Therefore, the scheme can provide some of the back-up for single-handed practitioners without their losing the independence that they rightly value.