§ 3. Mr. Andrew Dismore (Hendon)How many primary care groups he expects to commence during 1999. [67161]
§ 8. Mr. Jim Dobbin (Heywood and Middleton)How many primary care groups he expects to commence during 1999. [67166]
§ The Minister of State, Department of Health (Mr. John Denham)Some 481 primary care groups will commence on 1 April 1999, and they will have the capacity to commission services from that date. The degree of responsibility for commissioning services will be agreed between the PGC and the health authority.
§ Mr. DismoreLast week, I met representatives of Barnet West primary care group, who stressed the importance of recognising local factors in the work of PCGs. Does my hon. Friend share that PCG's desire for flexibility both in the setting up of PCGs and in ensuring that our doctors, our nurses and our community are in the driving seat when it comes to planning health care for our local area.
§ Mr. DenhamI can certainly assure my hon. Friend that we have established PCGs covering all the general 710 practitioners in a particular area in order to put GPs, nurses and other professionals in the driving seat in primary care. As the groups develop, enormous use will be made of the new powers of PCGs to develop much better services.
It is important that local factors and judgment are taken into account. That is why we have made it clear that the pace of development of PCGs over such matters as how quickly they take on the commissioning of services is a matter for local judgment and agreement.
§ Mr. DobbinCan my hon. Friend reassure GPs who are working hard to set up the primary care groups, and to make them work, that clinics and out-patient services provided for their local communities will be adequately funded by each health authority.
§ Mr. DenhamI acknowledge my hon. Friend's tribute to the active role that GPs are playing in ensuring that primary care groups will work. We have made it clear to health authorities that, where cost-effective and good services have been developed at practice level, we wish to see them continue. We also want to see plans drawn up to spread the benefits of those services to other patients in the PCG area.
§ Mr. Ieuan Wyn Jones (Ynys Môn)Will the Minister acknowledge concerns about the extent of lay representation on PCGs? Will he undertake to reconsider lay representation if it is shown that it would be of immense benefit to the PCGs, particularly if it brought in wider expertise from outside the medical profession.
§ Mr. DenhamI have looked at proposals for membership of primary care groups, and my view is that the different factors involved have been appropriately balanced. It is understandable that people are examining the formalities of PCG constitutions at this stage, but, given existing flexibility, primary care groups will develop effective partnerships to provide primary care at the local level. I am sure that health professionals will draw on the expertise of others, including lay people who are not themselves members of the PCG, to develop effective services. As PCGs evolve in practice, effective working partnerships will be created, and that is most important.
§ Miss Ann Widdecombe (Maidstone and The Weald)Does the hon. Gentleman agree that, even by the standards of a Government who arrogantly sideline Parliament as much as they can, it is amazing, when the Secretary of State has published a Bill within the past few days to enable the abolition of fundholding, that fundholding has already been effectively abolished, and that arrangements are in place to dragoon GPs into collectives on 1 April, by which time the Bill will not have achieved even parliamentary consent, let alone Royal Assent.
§ Mr. DenhamThe right hon. Lady has failed to notice the enthusiasm, commitment and dedication with which so many fundholding GPs have committed themselves to primary care groups. They see that this is the right way to develop the national health service. Professional GPs are working in co-operation with other health 711 professionals to develop better primary care. They realise that we are moving in the right direction, and the right hon. Lady is out of touch with them.
§ Miss WiddecombeI am wholly in touch with the timetable: primary care groups are to be set up on 1 April and the Bill has not even commenced its passage through the House. I am aware that the Minister has dodged my question—he is so ashamed of his arrogance that he will not address it. Will he now answer me?
§ Mr. DenhamThe right hon. Lady does not understand either the legal or the parliamentary situation—although it has been set out very clearly and is evident from the Bill. Primary care groups can be, and are being, established under existing legislation. Fundholding will be abolished when the Health Bill achieves Royal Assent—assuming that that occurs. We shall make provision in the Bill—it should be perfectly clear to the right hon. Lady—for a residual fundholding scheme to operate from 1 April. I believe that the vast majority of fundholders will dedicate their energies to developing primary care groups and accept that fundholding will end on 1 April. It is there in the Bill. There will be a residual scheme for fundholders which will continue until the health legislation receives Royal Assent. I have answered the right hon. Lady's question, but she does not like my answer.
§ Mr. Andrew Reed (Loughborough)The majority of Labour Members warmly welcome the establishment of primary care groups. Will the Minister join me in welcoming the establishment of such a group in North Charnwood—which covers the Loughborough constituency—which builds on existing co-operation between general practitioners in the area? However, will the Minister look closely at the management responsibilities of the group? It does not wish to appoint a manager but wants to allocate existing resources among the general practices in the group. Does that send the wrong signal to others who are involved in the PCG, for example, non-GPs—that it is GP-led?
§ Mr. DenhamIt would be wrong to comment on the particular local example to which my hon. Friend referred, although I shall be happy to look into the situation. We have published guidelines about the way in which we expect primary care groups to develop that strike the right balance between central encouragement and local flexibility. I shall look into the case that my hon. Friend has raised.
§ Mr. Robert Walter (North Dorset)When the Government were elected, they claimed that they would save £100 million on administration in the national health service. The Government have already allocated a massive sum for the administration of primary care groups and they have stated that health authorities will also have to make money available to that end. The Government also expect GPs and other health professionals to give freely of their time to help with that administration. Have the Government assessed the total cost and effectiveness of primary care groups?
§ Mr. DenhamThe hon. Gentleman fails to realise that, by introducing primary care groups, we will be able to cut 712 out a huge amount of the bureaucracy and waste that were an integral part of the internal market. For example, whereas there were about 4,000 purchasing groups under the internal market, there will be about 600 commissioning groups under the new arrangements. That will enable a huge cut in bureaucracy to occur. I assure the hon. Gentleman that we are on target to meet our aim of saving £1 billion in management costs during this Parliament.