§ 4. Mr. Chisholm
To ask the Secretary of State for Health what recent monitoring he has undertaken of GP fundholding. 
§ The Minister for Health (Mr. Gerald Malone)
Throughout the country, general practitioner fundholders are improving services to patients through effective management of resources. Health authorities monitor them monthly, in accordance with the accountability framework; and the national health service executive monitors both health authorities and fundholders through its regional offices.
§ Mr. Chisholm
What assessment has the Minister made of the recent Audit Commission report on GP fundholding? Can he confirm that the report vindicates the long-standing criticisms that Labour has made of the scheme, and does he agree that fundholding involves massive duplication of bureaucracy without any significant benefits to patients?
§ Mr. Malone
No, of course not. Unlike the hon. Gentleman, I have read the report from beginning to end. It shows that every fundholder has brought benefits to patients. It also says that some, who have not brought as many benefits to patients as others, should be encouraged. I would expect the hon. Gentleman to support that idea.
This is an investment in patient care which has brought about a better quality of patient care for more than 50 per cent. of the population in England. In the interests of his own constituents, I hope that the hon. Gentleman will ensure that that is emulated in Edinburgh.
§ Sir James Hill
Does my hon. Friend agree that the difference between a single GP and a group of fundholding GPs is the collective amount of money available? I already know of several individual GPs in Southampton who have run out of funds long before their group counterparts. Would it be possible to send teams to the new unitary authorities—now in the middle of the reorganisation—to advise GPs and social workers of the benefits of GP fundholding?
§ Mr. Malone
It is never very gracious to disagree with a knight of the realm—I congratulate my hon. Friend on that distinction—and in any event I do not disagree with the substance of his question. We certainly expect health authorities to work with fundholders and non-fundholders to build better care for patients. I am sure that that is happening in my hon. Friend's local health authority.
§ Mr. Milburn
Does the Minister agree with the Audit Commission's conclusion that GP fundholding has added to management costs in all parts of the NHS? How does he justify wasting £260 million a year on red tape for fundholding when it produces no gains for patients? Will he now accept that the replacement of fundholding by GP commissioning will not only give all family doctors a say in shaping hospital services for their patients but will shift NHS resources from back-line bureaucracy to front-line patient care?
§ Mr. Malone
The hon. Gentleman makes exactly the same mistake as his hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm)—not reading the report or understanding its conclusions. The report clearly points out that, for an on-going payment of some two per cent. of total budget, there is a four per cent. gain in patient care efficiency. The hon. Gentleman persistently refuses to understand that that is a benefit for patients. I am glad that he and his hon. Friends have now clearly told the world that that is an advantage that they would abolish—that is their firm policy. The 50 per cent. or so who are GP fundholders will understand that it is the Labour party's intention to abolish them if it ever comes to power, as will the 53 per cent. of the population who benefit from GP fundholding.
§ Mr. Anthony Coombs
Contrary to the drivel talked by the Opposition spokesman, is my hon. Friend aware that giving decision-making powers to GPs in my constituency has produced a better standard of primary health care than ever before? Is it not disgraceful that the Labour party should now decide to take away those powers from GPs and give them to the party's own bureaucrats, quangos and councillors? Such a move would be bad for primary care in my constituency.
§ Mr. Malone
My hon. Friend is right. The point that he rightly makes is that it is the effective purchasing power of general practitioners which has brought about change. Conservatives welcome the fact that other GPs are becoming involved in the purchasing process, but it has been driven by GP fundholding—the true success story which has brought far better patient care to all constituents, including those of my hon. Friend