GP Fundholding (Hansard, 31 October 1995)

§ 8. Mr. Hinchliffe
To ask the Secretary of State for Health if he will make a statement about the future of general practitioner fundholding. [38218]

§ 10. Mr. Hanson
To ask the Secretary of State for Health what percentage of general practitioners in the United Kingdom are currently fundholders. [38220]

§ Mr. Dorrell
General practitioner fundholding is central to our plans for the future of the national health service. We expect more than half the GPs in the country 90 to be fundholders from next April and I recently announced a further extension of the total purchasing pilots.

§ Mr. Hinchliffe
Can the Secretary of State explain why my constituents who are waiting for certain treatment at Pinderfields hospital, Wakefield, are asked whether they are the patients of fundholding or non-fundholding GPs? Why does it appear that fundholding patients are able to get certain treatments, which are being denied to patients of non-fundholding GPs? Will he join me in welcoming the fact that the Labour party is committed to ensuring that patients are treated on the basis of clinical priority and, as a consequence, will get rid of fundholding once and for all?

§ Mr. Dorrell
As we are in the business of welcoming hon. Members to different parts of the House, I begin by welcoming the hon. Gentleman to a position on the Opposition Back Benches—one of his own choice. It no doubt allows him to tease out some of the differences about fundholding among those on the Opposition Front Bench, which he previously had to obscure from the world.
The hon. Gentleman asked whether I welcome the fact that those on the Opposition Front Bench are committed to ensuring that care in the national health service is available on the basis of clinical need. He will have seen that precisely that commitment is given by the Government Front Bench. In terms of the hon. Gentleman's constituents, that commitment was given to the hon. Gentleman by both Wakefield health care trust and the Wakefield fundholders in exercising choice in the use of their funds.

§ Mr. Hanson
Will the Secretary of State confirm that the two-tier system—the inefficient, bureaucratic system referred to by my hon. Friend the Member for Wakefield (Mr. Hinchliffe)—also costs an additional £200 million in bureaucracy? Will he welcome the Labour party's commitment to abolish fundholding and put that money back where it belongs, into patient care?

§ Mr. Dorrell
I shall certainly make no commitment to abolish fundholding because to do so would put back the cause of patient care. The evidence is clear. The Opposition keep calling for extra research because they do not like the results of the research that has already been carried out. It shows clearly that, for a small increase in transaction costs, we deliver substantial savings and improved patient care. That is the result not of the Government's assessment but of repeated independent assessments of the effect of fundholding.

§ Mr. Key
My right hon. Friend will be aware that the majority of fundholders in my constituency provide a better service for their patients. However, will he now look at a problem that has arisen and advise my national health service trust? Where that trust literally runs out of money, it is beyond doubt and political banter that patients suffer because non-fundholders cannot have equal access to the national health service trust.

§ Mr. Dorrell
With respect, my hon. Friend must face the fact that the resources available to treat patients, whether of fundholding practices or not, are exactly the same. The assurance given to patients of fundholding GPs, by both trusts and GPs, fundholding and non-fundholding alike, is that access to urgent and 91 emergency care is dealt with from a single waiting list. The availability of non-urgent care within the health service reflects different purchasing decisions taken not merely by different fundholders within the health service but by different health authorities within the health service. That is part of the exercise of local choice, exercised in the interest of all patients of the NHS.

§ Mr. Congdon
Does my right hon. Friend agree that firm evidence now suggests that devolving financial power to GPs has enabled them to deliver improved care to their patients? Does he agree that the best means of improving the position of all patients would be to extend GP fundholding to them, thereby levelling up rather than levelling down, as espoused by the Labour party?

§ Mr. Dorrell
I entirely agree with my hon. Friend's desire to take the benefits that come from fundholding and generalise them. I entirely agree that that is surely how, in practice, one continues the rate of improvement of patient care within the NHS. Those who argue that we should abandon fundholding must explain to what is now a majority of GPs in the NHS why it is in their interests and those of their patients to abandon a scheme that has been shown by repeated analysis to deliver better value care and better quality care not merely to fundholding patients but to all NHS patients.

§ Ms Harman
Is the Secretary of State aware of the situation in his own Minister of State's constituency? Although the patients of GP fundholding practices get their hip replacements in less than 10 months, the patients in non-fundholding GP practices have been told by the Winchester and Eastleigh Health Care trust that they will have to wait 18 months or more. What does he say to those patients who are in pain and have been told that they have got to wait more than 18 months, while other patients are treated in less than 10 months? Is that not evidence of a two-tier system and of the unfairness of Tory health reforms? Will he join me in thanking Dr. Andy Coates, all the local GPs and the local NHS hospital trust for working together to try to mitigate the unfairness of those Tory health reforms?

§ Mr. Dorrell
One of the things that the Labour party must get used to about its new health spokesman is that she cannot see an elephant trap without walking into it. What has happened in Winchester blows sky high her theory that fundholders do not work for the benefit of all NHS patients. The deal to which the hon. Lady referred clearly reveals that the GPs of the district, fundholders and non-fundholders, are working together to deal with a problem that has emerged in the district, and was caused by an 8 per cent. increase in accident and emergency admissions. I do not remember that the hon. Lady predicted that. What has happened in the constituency of my hon. Friend the Minister of State is evidence that the case of the Labour party is wrong—fundholders do not desert NHS patients. All the GPs of that district have worked together to look after all the local patients, as the hon. Lady had the grace to admit in the closing sentence of her question.

§ Mr. Day
Does my right hon. Friend agree that, if the Opposition were correct in their assumption that patients registered at fundholding practices benefit far more than other patients, surely the obvious answer is for the Opposition to see to it that that successful mode of GP practice is extended throughout the NHS?

§ Mr. Dorrell
My hon. Friend is not only right, but echoes the views of the majority of GPs operating in 92 the NHS. That is why the predecessor of the hon. Member for Peckham, the right hon. Member for Derby, South (Mrs. Beckett), found herself faced with a rather hostile audience when she recently attended the fundholding doctors conference. She had to explain to those doctors why the Labour party is committed to abolishing a scheme that allows the majority of GPs in Britain to improve the health care available to their patients.