GP Fundholders (Hansard, 5 December 1995)

§ 2. Mr. MacShane
To ask the Secretary of State for Health what is the current percentage of general practitioners who have moved to fundholding status; and what is his estimate for the percentage of GP fundholders over the next two years. [2173]

§ 4. Mr. Hinchliffe
To ask the Secretary of State for Health what steps he has taken to evaluate the impact of GP fundholding. [2175]

§ The Secretary of State for Health (Mr. Stephen Dorrell)
Independent evaluation has repeatedly demonstrated the benefits of fundholding. That is why the Government are committed to further development and expansion of the scheme. Over 39 per cent. of general practitioners in England are already fundholders and this is expected to rise to over 50 per cent. by next April, with more practices preparing to join in 1997.

§ Mr. MacShane
I am grateful to the Secretary of State for his reply, which shows that by next year, half of 123 Britain's GPs will have to operate like small business men. Can he answer a more important question? According to figures that he gave me last week, £66 million is now spent on the bureaucracy of administrating fundholders. That £66 million is almost exactly equivalent to the cost of the 15,000 hip operations on hospital waiting lists. We are all delighted this week that the Queen Mother came out so well from her operation. Will the right hon. Gentleman stop that money being spent on bureaucracy and give people on the hip operation waiting list some hope?

§ Mr. Dorrell
I am certainly not doing anything to undermine the development of the fundholding scheme. All the research that has been done on that scheme demonstrates that the extra administrative cost, which is certainly there, delivers improved value to national health service patients. The question is for the Labour party. Does it agree with its previous health spokesman that it should abolish fundholding, or with the present incumbent of that post that it is not a matter of abolition but replacement?

§ Mr. Hinchliffe
How does the Secretary of State justify ignoring clear evidence provided by GPs in my constituency of a two-tier system arising directly from fundholding?

§ Dame Elaine Kellett-Bowman
The hon. Gentleman is behind the times.

§ Mr. Hinchliffe
Is not it scandalous that 36,000 of my constituents are, according to their doctors, receiving a second-rate service as a result of the status of their GPs? Is not it true, as one GP who wrote to me said—that letter has been seen by the Minister for Health—that those who deny the two-tier system arising from GP funding are talking a lot of twaddle?

§ Mr. Dorrell
My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) was right. The hon. Gentleman is behind the times. First, of the five cases that he mentioned the last time that he raised the issue in the House—I am sure that the hon. Gentleman will welcome the fact—two have had their operations in less than 12 months and the other three are on a waiting list for treatment in less than 12 months at Pinderfields hospital. Furthermore, both the fundholding and the non-fundholding GPs joined Wakefield Healthcare last week to issue a jointly agreed statement which said:
As far as Wakefield Healthcare and GPs, both fundholders and non-fundholders, are concerned there should be no difference in the way patients, whether they go to fundholders or non-fundholders, are treated. That is the policy of every GP in Wakefield, whether a fundholder or a non-fundholder, and it is also the policy of Wakefield Healthcare.

§ Mrs. Roe
Has my right hon. Friend seen a recent interview with the hon. Lady for Peckham (Ms Harman) in Doctor magazine in which she says of the Opposition's plans for fundholding:
We don't call it abolition, we call it replacement. Does my right hon. Friend think that fundholding doctors will be reassured at the prospect of being replaced and not abolished?

§ Mr. Dorrell
No, I do not think that they will be remotely reassured. Every fundholding GP in the health 124 service wants to hear what the Labour party would do if it ever found itself in government. The previous Opposition health spokesman said:
We can live with a whole range and variety of models. She also said that the Opposition are committed to abolishing fundholding. Are they or are they not committed to abolition?

§ Mr. Spring
Is my right hon. Friend aware that an increasing percentage of GPs in Suffolk are in fundholding practices and that that is bringing benefits in the forms of increased personal counselling, chiropody for diabetics, and better diagnostic and physiotherapy services—all very much to the benefit of patients?

§ Mr. Dorrell
My hon. Friend is absolutely right. His experience in Suffolk is repeated throughout the health service. One of the two questions that I have answered jointly asked what steps I have taken to evaluate fundholding. My hon. Friend has offered a local evaluation, but it has also been evaluated by the National Audit Office, the Public Accounts Committee, the Fabian Society, the OECD and the health service research unit at the university of Oxford. They have all published evaluations of fundholding, and the only problem with them is that they have been inconveniently optimistic for the Labour party.

§ Rev. Martin Smyth
Since it is the intention to offer primary-led health care, do the Government intend to change FP10 to allow GP fundholders and others to provide new treatments for leg ulcers in the community rather than in the secondary sphere, which is more costly?

§ Mr. Dorrell
I shall certainly consider that specific proposal. We need to ensure that the maximum range of clinical care that can safely be delivered by practitioners in the primary care context is delivered. Such care has been provided throughout the country as a result of fundholding. If the hon. Gentleman has a specific idea, I should be happy to look at it.

§ Mr. Barry Field
Can my right hon. Friend confirm that the Isle of Wight has one of the highest percentages of GP fundholders in the country? Does he attribute that success to the fact that the Liberal Democrats opposed such a scheme before the election and then, after it, led the charge in forming a fundholding consortium on the Isle of Wight, which has given us such a high percentage of fundholders?

§ Mr. Dorrell
The Liberal party has had just as much difficulty as the Labour party in deciding its policy on the issue. Both parties forecast that there would be no support for fundholding when the scheme was launched. Both have found themselves embarrassed by the fact that, next year, more than half of all GPs in the health service will have opted voluntarily to join the fundholding scheme. My hon. Friend is quite right.

§ Mr. Burden
Can the Secretary of State tell me what the reaction of fundholders and other purchasers of health care in Birmingham will be when they look at the small print of the Budget? They will find that a promised 1.1 per cent. increase in funds will turn out to be equivalent to no more than a half per cent. increase, which will mean around £6 million cuts wherever health care is purchased. When the Secretary of State visits Birmingham next week, will he explain to the local people why their community services will be cut?

§ Mr. Dorrell
This is a question about primary care. One of the best bits of news in the Budget about primary care is that it allows for the continued growth of the family doctor service through the 4 per cent. real terms growth in resources available to it. I would have hoped that the hon. Gentleman might welcome that.

§ Mr. Dunn
Many thousands of people in the Dartford constituency have benefited from GP fundholding. Will the Secretary of State confirm that the Conservative party is the only party that supports that scheme? The Labour party is totally opposed to it now, as it always has been.

§ Mr. Dorrell
My hon. Friend is absolutely right that the Conservative party, and its Government, is the only party committed to the development of fundholding. Every fundholding GP and their patients want to know the policy of the Labour Front-Bench team. When the Opposition appear before a fundholding audience they say that they recognise that the freedoms available under the scheme have produced improvements. They give a soft message to fundholding doctors, but once they get back into the television studios they say that they are committed to abolishing the scheme. What is their policy? We are waiting.

§ Ms Harman
I presume, Madam Speaker, that I am supposed to ask a question rather than answer one. The Secretary of State has acknowledged that one of the effects of GP fundholding has been extra administrative costs. Is not it the case that as a direct result of the Government's NHS reforms the cost of NHS bureaucracy is an extra £1.5 billion every year? That money should be spent on patients, not on paperwork. I welcome the publication of the NHS bureaucracy league tables, which the right hon. Gentleman made available this morning, but can he explain to the House why it is that the worst health authority in the country—the one that spends most on bureaucracy—is Huntingdon, the Prime Minister's constituency?

§ Mr. Dorrell
The hon. Lady might have welcomed the fact that in that same health authority there is to be a 10 per cent. reduction in administrative costs next year. As she raised the subject, she might also have welcomed the fact that the announcements I made this morning represent a shift of resources out of grey suits into white coats of £280 million next year. There will be £280 million extra next year for the treatment of patients. When will the hon. Lady welcome that?

§ Mr. Anthony Coombs
Is my right hon. Friend aware that by April next year 100 per cent. of my constituents will be treated in GP fundholding practices? Does he agree that that is the result of decisions by GPs in order to give their patients the best possible level of primary health care services? In the light of that, is it not an absolute disgrace that the Labour party proposes either to abolish or emasculate GP fundholding?

§ Mr. Dorrell
I could not agree more with my hon. Friend. GPs in his constituency have chosen to operate a completely voluntary scheme because they believe that it will improve care to their patients. In that they agree with the Fabian Society and a wide range of other commentators who have looked at the scheme. We are still waiting for an answer from the Opposition Front Bench as to why they will not support the scheme.