§ 8. Mr. Duncan Smith
To ask the Secretary of State for Health how many fundholding general practitioners there are in Redbridge and Waltham Forest district. 
§ Mr. Dorrell
There are currently 86 general practitioners who are fundholders in the Redbridge and Waltham Forest family health services authority area serving an estimated 44 per cent. of the population.
§ Mr. Duncan Smith
I thank my right hon. Friend for that information. Does he agree that one of the great success stories of fundholders has been the fact that they have helped improve standards across the board for all general practitioners by the use of innovation and best practice, not only by driving down the cost of the drug budget, but by bringing areas of medicine into their practice? Will my right hon. Friend undertake to do two things as a result: first to make it even easier for other 1442 practitioners to become fundholders as fast as possible, and secondly to expose the nonsense of the Opposition, who seek to level downwards to get rid of best practice and innovation and to crush the whole idea of improvement among general practitioners?
§ Mr. Dorrell
I entirely agree with both my hon. Friend's propositions. He will know that we are developing fundholding by extending the concept to include the total purchase of health care for a particular resident population and by extending it down the patient list size. There is now a fundholding scheme for relatively small general practices. Both of those are welcome developments which follow through the Government's policy of giving real budgets to doctors to allow them to make real choices. That is in preference to Labour's policy, which is to give notional budgets to doctors to allow them to make notional choices.
It is an extraordinary commentary on the Labour party that, when it is given the choice between regional health authorities and fundholding practices, it chooses to keep regional health authorities and to abolish fundholding practices. That, of course, is before we have heard the word from Hayman Island about where the policy should go next.
§ Mrs. Beckett
Surely the Secretary of State must be aware that, although there is no evidence to justify the statements just made by the hon. Member for Chingford (Mr. Duncan Smith)—there is no proper evidence and no evaluation behind those statements—there is growing evidence that GP commissioning is both more effective and less expensive than fundholding. As the Secretary of State seems to have overlooked them, I draw to his attention the recent remarks by Duncan Nichol, the former head of the health service executive. He said that he preferred GP commissioning and then said:You don't necessarily need the budget in your hand but you need to influence it.As the evidence is on the side of GP commissioning rather than fundholding, why are the Secretary of State and his colleagues trying to discourage commissioning? Why are they wasting money and risking fragmenting the health service by forcing people to become fundholders?
§ Mr. Dorrell
The right hon. Lady says that there is no evidence; that is not true. The efficiency with which fundholders use their resources has been assessed at between a 3.5 and 4 per cent. improvement year by year. The total cost of the administrative element of the fundholding budget is between 2 and 3 per cent. Even if one assumes that the total cost is extra cost, it is actually paid for by the efficiency achieved by fundholding doctors. In terms of the choice between notional commissioning and hard budgeting, I should like to hear the right hon. Lady explain why she thinks that a doctor is better able to deliver value for his patients if he is given a notional budget than he is if he is given the opportunity to commit real money to buy real care from real health service providers.