HC Deb 23 February 1993 vol 219 cc749-52
3. Sir Roger Moate

To ask the Secretary of State for Health if she will make a statement on progress in the number of GP fund holders.

6. Mr. Jack Thompson

To ask the Secretary of State for Health if she will make a statement on the savings achieved by general practitioners who are fund holders.

Mrs. Virginia Bottomley

Increasing numbers wish to join the scheme. More than 3,000 GPs in 585 practices are now fund holders. A further 600 practices join the third wave this April, when one in four of the population should be covered by fund holding. Overall, fund holders made efficiency savings of between 3 and 4 per cent. on their budgets in 1991–92, which will be ploughed back into patient care.

Sir Roger Moate

Has my right hon. Friend seen the survey reported in Doctor magazine which shows that 70 per cent. of GP fund holders have already managed to cut waiting times for their patients? Is it not extraordinary that the Labour party should seek to abolish fund holding altogether, when more and more GPs are seeking to become fund holders, when there is ample evidence of growing patient satisfaction with GP fund holding and when we need to extend fund holding even more widely?

Mrs. Bottomley

My hon. Friend is exactly right: it is positively bizarre that the Labour party should choose to shun a scheme which is leading to such clear advantages for patients, showing the way in which innovative and pioneering patient care can be organised. I noticed the survey in the Doctor magazine. The same survey shows that more than 60 per cent. of fund holders reported improved follow-up arrangements for appointments, more than 50 per cent. were providing extra services in their surgeries and almost 40 per cent. had introduced consultant visits. All those are real improvements for patients of fund holders which the Labour party—as ever, with its politics of spite and envy—wants to abolish.

Mr. Jack Thompson

Is the Secretary of State aware that 30 GP fund holders have made a profit of about £100,000 by establishing limited companies? Is she also aware that 11.2 per cent. of GP fund holders made a profit of £12.8 million in 1991–92? What evidence can she produce to the House that the money is being returned to the district health authorities for patient care?

Mrs. Bottomley

What I have seen is the most deplorable document produced by the Labour party with the most inaccurate data one could believe possible. The hon. Member for Sheffield, Brightside (Mr. Blunkett) suggested that he wanted the spirit of intellectual renewal in the Labour party. The document on which the information is based has double and treble-counted a great number of the elements. The local element of management allowance is counted three times. Everything else that is covered by the management allowance is counted twice and the Audit Commission component is counted twice. It is the most deplorable document. What I can make clear to the House is that the savings from the GP fund-holding scheme have been ploughed back into better patient care.

Dame Elaine Kellett-Bowman

Does my right hon. Friend recall the quite outstandingly excellent practice in the southern end of my constituency which has done absolutely everything the Minister could possibly want? That practice has every person in the area—there is absolutely no one else that the practice can get—but it has only 6,500 patients. Will my right hon. Friend stretch the limit and allow the GPs in that practice to become fund holders, which they feel is the only way forward for them in already excellent conditions?

Mrs. Bottomley

My hon. Friend, as ever, speaks for a great number of general practitioners and their practices in the United Kingdom. The success of the fund-holding scheme is being admired and emulated by many others. We have been able to find new ways of developing the scheme. Recently, I announced that the scheme would be extended to diagnostic and further surgical techniques. This year, we shall introduce the use of community nurses and it may well be that at a later date we shall be able to reduce the numbers required to join the scheme. I know that that will receive a warm welcome from many hon. Members in the House.

Mr. McCartney

We have just heard a rant from the Del Girl of health economics. The Labour party report on GP fund holders was based on information provided by family health services authorities—information which the Government want to keep secret. The truth is that nearly £100 million in the first wave has been spent trying to bring GPs into line in terms of the fund-holding policy. That money was top-sliced from patient care. Thirty companies have been set up and have raided patient care funds to the tune of over £100,000. At the same time, for example, in Manchester 32 seriously ill children have been turned away from Booth Hall children's hospital since October because it has run out of money. When will the Secretary of State stop top-slicing hospital authorities to give resources to GP fund holders and implement the Labour party policy of joint commissioning, which is much more successful in both funding and care for patients?

Mrs. Bottomley

The overall cost of the fund-holding scheme is about £40,000 per year, which is about 2 per cent. of the budget set. There can be no doubt at all that that has resulted in much better patient care and a great spirit of innovation across general practice overall.

The report to which the hon. Member for Makerfield (Mr. McCartney) referred is positively bizarre. It mentions people such as Dr. Paul Lambden. I quote from him elsewhere: I remain as convinced as ever that GPs should have financial as well as clinical responsibility for their patients … fundholders arc pragmatic and dynamic. As time goes by Trusts will come to understand the value of fundholding … The scheme is undeniably excellent. There is no doubt at all that fund holders have developed excellent services.

The hon. Member for Makerfield referred to the difficulties that some hospitals have had in managing their budgets through the year. Those hospitals need to learn from the way in which fund holders have diligently and shrewdly managed their budgets. Instead of begrudging fund holders, hospitals should admire them. We believe in levelling up, not—like the Labour party—in levelling down.

Mr. Hayes

Does my right hon. Friend agree that it is either incompetent or downright fraudulent for the Opposition suddenly to claim that GP fund holders are getting an extra £44,000 a year—which, of course, is being spent on patient care—when only a few months ago they were saying that there would not be enough money to treat patients?

Mrs. Bottomley

My hon. Friend, as ever, is right. He and I will recall that in Committee the Opposition were always saying that fund holders would be too mean to provide care for their patients. Now they spend all their time saying that the care that fund holders provide for their patients is too good. The Opposition always want to have it both ways. The fact is that the fund-holding scheme—a voluntary scheme—has been a great success. We want all GPs to have the same benefits as the fund holders.