§ 1. Mr. Tim Boswell (Daventry)
If he will make a statement on the establishment of primary care groups. 
§ The Secretary of State for Health (Mr. Frank Dobson)
Four hundred and eighty-one primary care groups, covering the whole of England, will become operational from 1 April. They will replace the divisive internal market introduced by the previous Government, which set doctor against doctor and hospital against hospital. In place of that, the primary care groups will represent all local family doctors, together with community and practice nurses, representatives of social services and lay people. They should ensure more modem and dependable services and less bureaucracy overall.
§ Mr. Boswell
Now that PCGs are a reality, is the Secretary of State worried about their management capabilities and about the level of management cost allowance, which was said by John Chisholm of the British Medical Association to be inadequate at £3 a head? Is he concerned about the suggestions by other GPs that PCGs may form a perfect vehicle for rationing health care services?
§ Mr. Dobson
Primary care groups were introduced with the consent and agreement of the BMA. The level of management costs is neither a floor nor a ceiling; it varies from place to place, and rightly so. I am confident that, as a result of the introduction of primary care groups, people will have more universal access to top-quality care. What we are proposing goes with the grain of what the professions wanted, and that is what we have delivered.
§ Mr. David Hinchliffe (Wakefield)
In developing the policy, will my right hon. Friend consider the future capital resourcing of primary care? Is he aware of the 842 difficulties with the funding arrangements in respect of GPs' surgeries and health centres, whereby GPs occasionally have to charge exorbitant rents to social services and community health trusts for community psychiatric nurses who are in attendance, which obstructs the close working relationship of health and social services in a primary care setting?
§ Mr. Dobson
We want to continue improving primary care premises. We have changed the rules to make it easier for people to develop or improve existing primary care premises in health action zones, and we will continue to try to help. As an indication of the progress that has been made, the Turnberg review of health care in London more than a year ago reported that about 50 per cent. of premises were inadequate. That figure is now down to 32 per cent.
§ Mr. Philip Hammond (Runnymede and Weybridge)
Does the Secretary of State recall telling the House on 18 January thatprimary care groups provided incentives for all concerned to level up' to the standards of the best."—[Official Report, 18 January 1999; Vol. 323, c. 594.]?What does he have to say to the 60 per cent. of patients whose GPs were fundholders and who are already finding, in the run-up to the takeover by PCGs, that services such as counselling, alternative therapies and many other innovative services are being withdrawn by those GPs? Can he tell the House by what tortuous logic he can define the withdrawal of services as levelling up?
§ Mr. Dobson
First, let us get the facts straight. It is not the case that 60 per cent. of GPs were fundholders when we took over. It was about 50 per cent.—a large number of whom were unwilling fundholders, but had decided to go along with the scheme. We have tried to make it clear to health authorities and others that we do not expect people to withdraw services that are presently being provided.
§ Mr. Dobson
If it is happening, it should not be—but that is down to local decision making. The decisions will be made by the doctors, the community nurses, the practice nurses, people from social services and lay people who serve on the boards of primary care groups. Decisions will be taken by the people who are responsible for delivering the services in each locality; the first time that that has been the case in the history of the health service.
§ Ms Sally Keeble (Northampton, North)
Is my right hon. Friend aware of the success of the primary care group in Northampton, which built on the work of the commissioning GPs—who existed under the previous Government—and did such important work in terms of commissioning emergency pelvic scanning for women, which has helped deal with the problems of the early stages of pregnancy? Does he agree that, if the doctors of Daventry are having problems setting up their primary care groups, they could come to Northampton where they would learn a great deal?
§ Mr. Dobson
I take this opportunity to pay tribute to the medical profession. Until 1 April, it will have had 843 monopoly control over decision making in primary care since primary care was invented. Voluntarily, the profession agreed to give representation to nurses, social services and lay people on the boards of the primary care groups because it thought that that was the best way of serving local people. In nearly every part of the country, the profession has made remarkable strides in developing primary care groups. I emphasise that this is an entirely voluntary arrangement; no law has been changed. However, in every part of the country, the primary care groups have been established with the consent of—and, in most cases, a great deal of enthusiasm from—the professionals on whom we depend.