HC Deb 26 October 1993 vol 230 cc676-8
2. Sir Roger Moate

To ask the Secretary of State for Health what further plans she has to spread the benefits of fund holding to other practices.

Mrs. Virginia Bottomley

The GP fund-holding scheme has empowered family doctors to improve services for patients. We wish to see more fund holding and more fund holders and we are pursuing several arrangements, such as consortia, to fulfil our manifesto commitment to extending the benefits of fund holding to all GPs.

Sir Roger Moate

Does my right hon. Friend agree that GP fund holding is proving to be one of the great success stories of the health service? Does she agree that the best way to nail the lie that there is a two-tier service, so often put about by the Opposition, is to extend GP fund holding and the benefits thereof to all practices, including the smaller ones, as soon as possible? Will she confirm her support for consortium arrangements and the multi-fund applications that she is now receiving?

Mrs. Bottomley

My hon. Friend is exactly right. We want to extend the benefits of fund holding to all GPs. We welcome the number of groups that are forming consortia. Of the 800 fund-holding practices that are coming forward for next April, about 350 are precisely for those smaller schemes. We are looking particularly to see further development in London, where the energising effect of GP fund holding on primary care in general could play an important part.

Ms Lynne

Can the Secretary of State tell the House how she intends to fund the initiative that she announced last week whereby non-GP fund holders' patients will receive urgent treatment within six weeks? I welcome the announcement. I believe that it means that the Secretary of State has accepted that she created a two-tier health service. How does she intend to fund it?

Mrs. Bottomley

Fifty per cent. of cases are now seen within five weeks. We must make sure that those are the most urgent cases. All emergency cases are, of course, seen immediately. It is clear that GP fund holding is leading to improvements in primary care generally. GPs are funded on a comparable basis for their patients. Any new fund holders who join the scheme will have their budgets arranged on the basis of their referral patterns this year. There is no two-tier system. We are seeing a levelling up.

Mr. Sims

Will my right hon. Friend take steps to contact directly non-fund-holding GPs who may have some doubts and acquaint them with the facts about the advantages of fund holding? That would offset some of the misleading impressions given until recently by the British Medical Association and which continue to be given by those who seem more interested in making party political points than in pointing out the benefits to patients.

Mrs. Bottomley

My hon. Friend has it exactly right. There is no more effective advocate for GP fund holding than the fund holders themselves. GP fund holding is all about empowering the general practitioners. The GP is the most effective advocate on behalf of the patient. A party such as ours, the priorities of which are dominated by the interests of patients, not providers, wishes to see that further advanced. I strongly urge the Labour party to speak to many of its supporters who are active, innovative and energetic GP fund holders. They are showing the way to others.

Mr. Robert Ainsworth

Is the Secretary of State aware of the blatant abuse of the two-tier system in the Coventry and Warwickshire area, and of the consequences of it on the Walsgrave hospital trust? The hospital has refused to operate a two-tier service. The nearby George Eliot hospital offers to fund holders' patients half the waiting time that it offers to health authority patients. As a result, the George Eliot hospital is undermining the Walsgrave hospital trust and is in danger of causing redundancies in the trust. Surely the Secretary of State is aware of this. The blatant introduction of a two-tier service and abuse of the service are causing redundancies within the system that would otherwise be unnecessary.

Mrs. Bottomley

All hospitals are maintaining their patients charter standards. We are seeing a steady downward pressure on waiting times for all patients. The average was previously nine months. It is now down to five months. There has been a 20 per cent. fall in the number waiting more than a year in the past year alone.

I repeat that fund holders are funded fairly and comparably. We want all GPs to come forward and have the benefits of fund holding. It is a voluntary scheme. I commend to the hon. Gentleman the comments of Professor Howard Glenister from the London School of Economics. He said: GP fund holding shifts the balance of power away from hospitals towards GPs and primary care. It replaces a top-down model of the NHS resource allocation with a bottom-up model driven by GPs acting as purchasers on behalf of patients. I commend Professor Glenister's work to the hon. Gentleman.

Dame Elaine Kellett-Bowman

My right hon. Friend will recall that she was good enough to waive the requirement that there should be 7,000 patients for one practice in the southern end of my constituency, when it had already recruited every man, woman and child in its area. That practice is now going from strength to strength. It has extended its buildings and is an example to all others in the area. Will she help fund-holding practices to extend now to the north end of my constituency?

Mrs. Bottomley

I thank my hon. Friend. Those general practitioners with practice sizes that did not reach the 7,000-patient limit are bringing to bear pressure that they should be able to join the scheme. That is why we so welcome the consortia that are developing, which make it possible to push through the preferences of general practitioners in the delivery of care for patients.

Ms Primarolo

When will the Secretary of State accept the evidence that a two-tier system is being created by GP fund holders? The joint consultants committee has handed her a document which demonstrates that 70 per cent. of hospitals are fast-tracking GP fund holder patients. When will she act on that information? When will she make it impossible for GP fund holders to make profits for themselves instead of spending the money in the national health service where it is needed? When will she finally agree to prevent the payment of a £35,000 management fee to every GP fund holder to be spent on bureaucracy and instead give it to practice nurses, who are desperately needed in our community?

Mrs. Bottomley

When a hospital has completed the contract that it has agreed with the district health authority to meet its patients' targets and to ensure that it improves the quality and quantity of care, if it has spare capacity it can give it to another health authority or to a GP fund holder. The hon. Lady should ask why the GP fund holders have been able to use comparable amounts of money so much more effectively. Let us learn from that. Let us level up and have good value for money, rather than look for the lowest common denominator.

The hon. Lady resists no opportunity to take a swipe at any managers in the health service. The management allowance for GP fund holders is enabling resources to be used more effectively; it is about 2 per cent. of the cost. There have been benefits of about 4 per cent. These are ploughed into better patient care. They do not go into the GPs' pockets. They go to physiotherapists, chiropodists and—exactly what the hon. Lady wants—more practice nurses.