HC Deb 16 May 1995 vol 260 cc140-2
7. Mr. Gunnell

To ask the Secretary of State for Health what research her Department has undertaken into the administrative costs of general practitioner fundholding; and if she will make a statement. [22857]

Mrs. Virginia Bottomley

The management costs of general practitioner fundholding are kept under regular review. In the first three years of the scheme, general practitioner management costs were about 2 per cent. of budgets, which represents excellent value for money for the very real benefits to patients resulting from the scheme.

Mr. Gunnell

I am sure that the Secretary of State is aware that the magazine Fundholding, which can hardly be said to be unsympathetic to fundholders, has estimated that the amount spent on setting up the scheme and on administration was £98 million, and that the average cost per fundholding practice is more than £80,000. There is also plenty of research to show that this is a much more expensive way of purchasing for district health authorities. Does not she think that the money should have been put into patient care and not into creating an expensive administrative system?

Mrs. Bottomley

I do not agree with the hon. Gentleman. I believe, as does the King's Fund, that fundholding has been one of the most exciting aspects of our health service reforms. I recommend to the hon. Gentleman the words of the National Audit Office, the Organisation for Economic Co-operation and Development and Professor Howard Glennerster. They have all confirmed that fundholding has made care much more responsive to patients. The amount spent on management is modest compared with the substantial improvements in patient care and the better value for money that has been achieved by the scheme.

Mr. Quentin Davies

Is my right hon. Friend aware that in Lincolnshire well over 50 per cent. of patients are now treated by fundholding general practitioners? Is not that a remarkable tribute to the popularity of fundholding among GPs and patients, and does not it vindicate the Government's decision to go ahead with this proposal despite the consistent opposition of the Labour party?

Mrs. Bottomley

I commend the example of Lincolnshire, but perhaps the most interesting example is to be found in Derbyshire. In Derby, South, 78 per cent. of the population have fundholders. That shows how persuasive is the Opposition spokesman on health with her local general practitioners, all of whom totally disregarded her words and decided that there were benefits for their patients by taking up the fundholding option.

Mrs. Beckett

Is the Secretary of State aware that managers in some parts of the country are said to be insisting that general practitioners become fundholders and are refusing to provide financial or administrative support to groups of GPs who want to become commissioning GPs although that is a much less expensive and more effective system? Those managers claim to be acting on instructions from the Department of Health. Why?

Mrs. Bottomley

Let me make it clear that fundholding is and will remain voluntary. Undoubtedly, fundholding offers much more direct control to the general practitioner for securing, commissioning and monitoring services than joint commissioning. Joint commissioning clearly has a part to play, but in our view it is not as effective as proper GP fundholding. As the right hon. Lady will know, we have now set up 51 total fundholding projects which are being carefully evaluated to see what further lessons can be learned.

Mr. Evennett

Does my right hon. Friend agree that GP fundholders are delivering a clear benefit to all patients in their areas? Does she further agree that the waiting time for the patients of GP fundholders tends to be shorter and that the opportunity for a better and more varied service in the surgery is greater?

Mrs. Bottomley

I very much agree with my hon. Friend. I hope that he agrees that waiting time for all patients is shorter. Before the reforms there were 200,000 one-year waiters and he will know that there are now only 31,000. That affects all patients, irrespective of whether they have GP fundholders. It is right to say that the Opposition do not care. They do not want to know the facts because they might get in the way of the rhetoric. I agree not only with my hon. Friend but with the OECD that GP fundholders have been more prepared to challenge hospital practices and demand improvements. The National Audit Office states: the direct involvement of general practitioner fundholders in health care purchasing has led to improvements in the service provided for their patients".