HC Deb 20 May 1997 vol 294 cc495-6
6. Mr. Colvin

To ask the Secretary of State for Health what percentage of general practitioners are now fund holders. [409]

Mr. Dobson

As of 1 April 1997, 56 per cent. of general practitioners were members of fundholding schemes.

Mr. Colvin

I congratulate the Secretary of State on his appointment. His answer shows that more than half of all NHS patients are treated by GPs who are fundholders. If, for ideological reasons, the Government intend to scrap those arrangements, which enable doctors to back their professional judgment with hard cash, which I am sure the late Nye Bevin would have approved of, what alternative arrangement does the Secretary of State intend to propose?

Mr. Dobson

What I can say is that we have taken immediate action to start to reduce the unfairness and bureaucracy of the existing two-tier system. We are determined that non-fundholding practices, and patients from them, should no longer be at a disadvantage. Looking further ahead, I am inviting the representative bodies and others in the NHS to join us in developing and testing alternative primary care-led models of commissioning, based on the principles of fairness and meeting local needs. To create breathing space for that process of genuine exploration and debate, I can announce today that I propose to defer all further entries to the eighth wave of GP fundholding.

Mr. Sheerman

May I congratulate my right hon. Friend and his new team on their appointment, and congratulate him also on what he has just said? My constituents are more worried about the quality of GP care than whether they are a fund holder. As a matter of priority, will my right hon. Friend do something about single-person practitioners, who are so often linked to inefficiency and bad service to constituents?

Mr. Dobson

There is a general feeling that single-handed practitioners are not the best arrangement but, certainly in some regions, there are single-handed practitioners who do a very good job. There is of course occasionally the odd large partnership that does not do a particularly good job, but we are determined to find, from pilot schemes throughout the country, new methods of commissioning health care, to consider those pilot schemes, to assess their outcome and then—and only then—to start full-scale change throughout the country. We do not, like the previous Government, intend a wholesale, revolutionary change of the NHS without trying it out first.

Mr. Dorrell

I join those who have offered the right hon. Gentleman their good wishes in his new responsibilities. In answer to an earlier question, he said that the new Government do not intend to launch into a major further reorganisation of the health service. Will he apply that principle to GP fundholding? Can he confirm that the majority of Britain's GPs, who have chosen fundholding, have chosen it because they think that that is the best way of delivering NHS care to their patients? Can he give the House and Britain's GPs the assurance that if those GPs continue to believe that that is the best way of delivering NHS care to their patients, he will leave that option open to them, or is it his policy to compel those GPs to surrender fundholding against their will, despite the fact that in their view their fundholding status is the best means of delivering NHS care to their patients?

Mr. Dobson

We are determined to ensure that all patients are treated on the basis of their clinical need, not the status of their general practitioner. That is not the case at present, and we are discussing with the medical profession and the other professions a commissioning approach in which all GPs and other health professionals in each locality can commission a service. The former Secretary of State for Health should get himself up to date. My hon. Friend the Minister of State, the Member for Darlington (Mr. Milburn), like me, has met a number of doctors over the past few days. Today he met representatives of the National Association of Fund Holding Practices and of the general medical services committee of the British Medical Association. They seem to be satisfied with what we are proposing.