HC Deb 26 January 1993 vol 217 cc861-2
6. Mr. Garrett

To ask the Secretary of State for Health what guidance she is issuing to provider units concerning preferential access to hospital treatment for patients from GP fund-holding practices.

Mrs. Virginia Bottomley

Guidance agreed with the joint consultants committee was issued to hospital consultants in June 1991. It precluded contracts for general practitioner fund holder patients that disadvantaged other patients.

Mr. Garrett

In Essex and Hertfordshire, and soon in Norfolk, patients of GP fund holders are being admitted to hospital while other patients will have to wait until April or beyond. What is that if not a two-tier health service?

Mrs. Bottomley

I will make the position exactly clear. The GP fund holders are funded on the same basis per head as the district health authorities. It is for each of them to spend that money through the year as they think best. In some areas the districts have placed their contracts and the hospitals have more than met those contracts and are delivering fast, effective patient care. In some circumstances, the fund holders have not yet spent all their funds and can set priorities in a different way. Instead of begrudging it, the hon. Gentleman should see how fund holders have spent their resources to show how better the district could set its priorities for the year ahead.

In the hon. Gentleman's constituency the trust hospital has treated 4,000 more patients than last year. His constituency also has a new renal unit, a new third orthopaedic theatre and a new £1 million accident and emergency department. If we are learning from the fund holders, we should welcome the example and innovation that they set.

Mr. Hayes

Does my right hon. Friend agree that GP fund holding has been a tremendous success? It has improved patient care and choice for patients and it is popular with practitioners–14 per cent. of the population is now covered by GP fundholders. Does she also agree that clear guidelines have been issued by her Department against fast tracking and that they should be obeyed?

Mrs. Bottomley

There are clear guidelines and it is important that we continue to observe them. GP fund holding has been a major source of innovation. For those who profess to support the patients, there is no better way of doing so than to give power to general practitioners. GP fund holding enhances the ability of the GP to act as an advocate on behalf of the patient. A recent survey in Doctor magazine showed yet again the way in which fund holders have been able to provide more efficient and effective care, integrating primary and secondary care in ways from which others can learn.

Mr. Blunkett

Will the Secretary of State tell us, then, why GPs—including fund holders—throughout the country, consultants in the consultants and specialists committee of the British Medical Association, and all who work in and are aware of the health service are up in arms about a two-tier service, the existence of which the Secretary of State refuses to accept? Is she aware of the case spelt out in The Guardian this morning by David Brindle? In view of her statement this afternoon, what action is she prepared to take to stop minor treatment taking precedence over major surgery and to prevent a two-tier health service in Britain?

Mrs. Bottomley

The hon. Gentleman simply fails and refuses to understand the way in which the system works. At long last, we have a health service in which we can focus resources on the priorities set by the districts and GPs through the freedom that is given to GP fund holders. It is the job of the district to talk to local GPs about the priorities that they want set year on year as they place contracts. For 20 per cent. of the work, the GP fund holders have the freedom to allocate their priorities in a different way.

The reason why I could never support the Labour party is that it believes—[Interruption.]

Madam Speaker

Order. These interruptions are a complete waste of precious question time.

Mrs. Bottomley

I could never support the Labour party because it believes in a system of levelling down, whereas we believe in a system of levelling up.

Mr. Jacques Arnold

Are not the facts of the case as given by the hon. Member for Norwich, South (Mr. Garrett) further proof that the fund-holding practices in his area obtain better value for patients than the district health authority does? Is not that further proof that we should extend the fund-holding practices further for the benefit of patients?

Mrs. Bottomley

My hon. Friend is exactly right. We want to extend the benefits of fund holding to all general practitioners, whether they apply, as do 20 per cent. of GPs, to become fund holders by this April, or find other ways of working more effectively with the district. The aim is to reverse the balance of power so that general practitioners, acting on behalf of patients, can have some leverage in the system.