HC Deb 14 September 2004 vol 424 cc1112-5
5. Mr Adrian Bailey (West Bromwich, West) (Lab)

What change there has been in the provision of general practitioners since 1997. [188505]

The Secretary of State for Health (Dr. John Reid)

Since 1997, there has been an increase of 3,081—11 per cent.—in the number of GPs, excluding retainers, registrars and locums, and an increase of 1,096—no less than 81.6 per cent.—in the number of doctors training to be GPs. In March 2004, there were 31,127 GPs, the highest number in the history of the NHS. I believe that those record numbers show the Government's commitment to expanding the GP work force.

Mr. Bailey

Those figures are reflected in my constituency, which has historically been underprovided with GPs. There are still shortages, however, and to get around the problem local practices have been pooling resources, sharing information technology, appointment systems and the recruitment of positions' assistants. What steps are being taken to promote such examples of best practice in other areas with chronic shortages, and ensure that everyone everywhere enjoys the standard of service that we should expect?

Dr. Reid

I am aware of the steps that have been taken by my hon. Friend's local primary care trusts, particularly Wednesbury and West Bromwich PCT. In partnership with Birmingham and The Black Country strategic health authority and other local PCTs, it has been developing a fairly radical plan to improve its own GP recruitment and retention.

Nationally, we are taking action to ensure that the current record number of GPs can work in partnership whenever possible, to ensure excellent primary care provision. For example, the national primary care development team is working with practices to promote primary care modernisation, and some 5,000 practices are taking part. That covers more than 32 million patients in England. Not only do we have a record number of GPs; increasingly, GPs are working in partnership to produce an even better service.

Mr. A. J. Beith (Berwick-upon-Tweed) (LD)

Is the Minister aware that one of the changes of which constituents are most conscious is the withdrawal of practices from night cover, which has resulted in my constituency in an area of 1,000 square miles having resident within it only one doctor on duty between midnight and 8 am? That has put great pressure on the ambulance service, and some health authorities have been reported as having to recruit doctors from Germany to provide night cover. One Scottish health board has had to pay £1,000 a night for health cover. Has this part of the new contract not gone rather worryingly wrong?

Dr. Reid

I do not believe that it has gone worryingly wrong. That part of the new contract, allied with the record number of general practitioners in this country, is meant to give a greater, better and faster service to patients. However, if the right hon. Gentleman brings to my attention examples about which he is concerned as the arrangements develop, I will certainly look further into specific cases. As a general point, it is necessary to make it absolutely plain—everyone must understand this—that we are committed to ensuring that patients have access to high-quality, appropriate and timely health care out of hours. I can tell the right hon. Gentleman that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton) will shortly be publishing requirements that clarify exactly what is expected of out-of-hours cover. I can make it absolutely clear in the meantime that that will include access to home visits—this is very important—from a GP, should a patient's condition require it, and access to a Saturday morning surgery.

Andrew Mackinlay (Thurrock) (Lab)

May I remind the Secretary of State that one aspect of the Government's policy and programme that both he and I enthusiastically support is the development of the Thames gateway? I should like to draw to his attention the need for him to discuss with the Minister for London and with my primary care trust the acute shortage that already exists in Thurrock—a new town with an urban development corporation and an awful lot of single GP practices. If we are to succeed in our policy objectives, we need truly joined-up government as between my right hon. Friend the Secretary of State and the Office of the Deputy Prime Minister, to ensure that my constituents' needs for GPs are met. I am currently facing a crisis and there must be sufficient GP provision as we build up the area and make it a quality place in which to live.

Dr. Reid

My hon. Friend will have heard what I said about the national picture in England and about the record number of GPs. He will also know that, throughout the country, about 19 out of 20 patients can now see a GP within 48 hours and a nurse practitioner within 24. However, I recognise that there are regional variations and particular problems in certain areas. Nineteen out of 20 implies that some people do not secure that access. On the implications of the Thames gateway project, I can tell my hon. Friend that we are aware of it; that we have made more money available because of it; and that we are ahead of him in that we are already entering discussions, through my right hon. Friend the Minister of State, with the local primary care trusts. I hope that my hon. Friend does not feel that the door is so open that he has fallen through it, but he is certainly pushing a door that is already ajar.

Dame Marion Roe (Broxbourne) (Con)

I welcome the Government's target of 2,000 new GPs, but does the Secretary of State agree that simply referring to the total number of GPs does not reveal the difference between whole-time equivalents and part-timers? After all, the British Medical Association says that we need 10,000 new doctors. Will the Secretary of State tell the House how and when this target will be achieved and what plans he has to recruit more GPs?

Dr. Reid

That is an excellent question from an excellent Member of Parliament. First, I welcome her support—[Interruption.] Indeed. She followed another excellent Member of Parliament in the previous question. I welcome her support for sensible targets and objectives for increasing the number of doctors. Secondly, I can assure her that we not only have a record number of GPs in terms of head count, but the biggest ever increase in terms of whole-time equivalents as well. Thirdly, I would say that this is a slightly different thing from saying that we have as many GPs as we want and need. We do not: there is still a shortage. The addition of 19,000 doctors in our seven years in office is something about which we can have some satisfaction, but it does not make us in the least complacent.

Finally, in respect of achieving all the objectives that the hon. Member for Broxbourne (Dame Marion Roe) so sensibly outlined, it would be a disaster to approach that task by reducing the money going to the mainstream NHS and introducing charges for NHS patients. Perhaps she should have a word with hon. Members on her own Front Bench about that.

Sir Patrick Cormack (South Staffordshire) (Con)

May I congratulate the Secretary of State on his admirable bedside manner? Does he agree that the best general practitioners are those who know their patients as individuals? To revert to a point made by the right hon. Member for Berwick-upon-Tweed (Mr. Beith), what percentage of GPs offer an out-of-hours service, compared with the percentage that obtained in 1997?

Dr. Reid

The number of GPs offering out-of-hours services is changing as a result of the new contract, but I would not like to say that it has changed dramatically. There has been a gradual change in such provision over the period as, for example, more co-operatives and locums have come to be used. Opposition Front-Bench Members should not pretend that that did not happen under the previous Government. Things are changing because of the new contract, and we will keep a close eye on that, but I have made it plain already that we fully expect that those who need a GP call-out can get one, and that Saturday morning surgeries will be provided. My right hon. Friend the Minister of State will repeat that message in more specific terms later this week, and he may even offer more detail later today.