GP Fund Holding (Hansard, 8 June 1993)

§ 5. Mr. Merchant
To ask the Secretary of State for Health what plans she has to extend the GP fund-holding initiative.

§ The Secretary of State for Health (Mrs. Virginia Bottomley)
GP fund holding has shown itself to be an outstanding success, bringing many benefits to patients. There will be more to come. As the controller of the Audit Commission recently said, fund holding is leading the way, with many imaginative innovations which are good for the health of the population. One in four of the population now benefits from having a fund holder as his or her family doctor. With the numbers preparing to join the scheme from next April, we expect that figure to rise to one in three.

§ Mr. Merchant
Does my right hon. Friend agree that, for the reasons that she has given, the fund-holding initiative has proved to be particularly popular with both doctors and patients, as illustrated by the practice of Dr. Kenneth Scott in my constituency? Does she agree that one of the most important priorities now must be to ensure that the smaller practices are able to benefit fully from the fund-holding initiative? Would she care to tell the House what steps she is taking to enable that goal to be achieved?

§ Mrs. Bottomley
My hon. Friend is right. I am delighted to hear about the progress in his constituency. We should like to see more fund holders across London because they can pioneer new ways of helping patients. The challenge now is to extend the benefits of fund holding to as many general practitioners as possible and to encourage the creation of groups, consortiums and management arrangements. About 70 groups already operate and about 150 are likely to come through for next year.

§ Mr. Grocott
Is it too much to hope that the Secretary of State will consider the overwhelming evidence that the fund-holding system leads to a two-tier system for patients? Will she look at the evidence that I have sent to her on the issue? Even for this Government, is it not indefensible to treat people not on the basis of their medical need but sometimes on the basis of whether their GP is a fund holder or a non-fund holder? As the Government have made so many U-turns on so many issues, is it too much to hope that they will make one on fund holding?

§ Mrs. Bottomley
The Labour party likes to centralise control over all decisions. We believe in devolving responsibility. The general practitioner is the advocate for the patient. Fund holding enables GPs to back their decisions with money so that they can pioneer care that is closest to patients' needs. There are clear guidelines on common waiting lists and a requirement that the treatment of patients of fund holders should not disadvantage the patients of other general practitioners.
The real point is that all general practitioners should have the advantage of fund holding. The task now is for all general practitioners to use leverage through fund holding or by working with the district health authority as the purchaser to achieve continual improvements in the quality of treatment for their patients.

§ Mr. Allason
Does my right hon. Friend see a parallel between the opposition expressed by some general practitioners some time ago to generic medicines and the opposition that was experienced recently to fund holding? Is she aware that in the Torbay constituency the GP who was virulent in his opposition to fund holding is now a fund holder? Does she agree that the opposition that we saw to generic medicines and fund holding has vanished? Is not that an endorsement of the policy?

§ Mrs. Bottomley
My hon. Friend exactly characterises the position. Time and again, I meet fund holders who were initially cautious about the scheme but now say that it has profoundly redressed the previous balance of power in the health service. We believe in a health service in which patients, not institutions, come first. The general practitioner is the advocate on behalf of the patient. Once again, we see the Labour party promoting a sneering campaign of denigration which shows its hallowed principle of equal misery for all. It does not like excellence.

§ Mr. Burden
Would the Secretary of State care to consider the case of Dr. Zuckermann in my constituency, who referred a patient to a local orthopaedic hospital and received a reply that the patient could not be seen until January next year? He then received a telephone call saying, "Sorry, we did not realise that you were a fund-holding general practice. We can see the patient in four to six weeks." The hospital got it wrong because Dr. Zuckermann is not a fund-holding GP. Does not that prove that fund-holding GP systems are about queue-jumping and creating a two-tier health service?

§ Mrs. Bottomley
There are clear agreements with the profession about the way in which fund holding operates. The answer for the general practitioner involved is either to become a fund holder—[ Interruption.] I am pleased that in Birmingham, where there are many singlehanded practices or two-handed practices, there are several schemes to encourage them to form fund-holding practices. Alternatively, the answer for the general practitioner is to work with the district health authority to get the purchasing improvement that the fund holders are establishing.
Once again, the hon. Gentleman fails to recognise the dramatic achievements in reducing waiting times for everyone. We have now established a maximum waiting time for all hip, knee and cataract operations, so the length of time anyone waits for treatment is substantially less than it was in the long distant past when the Labour party was, regrettably, in power.