HL Deb 15 January 2004 vol 657 cc673-5

Lord Butler of Brockwell asked Her Majesty's Government:

How they propose to ensure that changes in National Health Service funding do not adversely affect provision of medical services in universities.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, the new contract for general medical services has been negotiated between the NHS Confederation and the General Practitioners Committee of the BMA. It will provide practices on most campuses, with the same method of funding and earning opportunities that will be available to all general medical services practices. A minimum practice income guarantee for basic general medical services will be available to prevent financial instability.

Lord Butler of Brockwell

My Lords, I am grateful to the Minister for that Answer. Is he aware that the proposed capitation rates for young people do not make adequate allowance for the special needs of university students, many of whom are living away from home for the first time and who, as a matter of fact, make greater demands on their GPs than is the norm for their age group? In particular, the capitation rates make inadequate provision for the Government's other admirable initiatives on health, mental health, sex education and the prevention of drug abuse. Will the Minister please give an undertaking that the capitation rates are adjusted to make adequate allowance for the needs of university students?

Lord Warner

My Lords, the new formula for general practice remuneration has been designed to address historic inequalities in funding primary care. The contract, and the basis of the contract, was voted on by GPs themselves. Some 79 per cent of the GPs who voted accepted the new contract basis, and that was based on a 70 per cent turnout. So we are not at this point in the business of introducing new changes into the format of the contract. It will, however, be kept under review.

Under the new arrangements, primary care trusts have been given a duty to ensure that they can enter into specialist contracts—in areas of high student population, for example. If there was a particular need for sexual health, mental health or substance abuse services, the PCT would make specialist contract arrangements for those services.

Baroness Gardner of Parkes

My Lords, I declare an interest as a patient of the Imperial College health centre. I asked a Question on this subject on 8 May last year and the Answer I was given concerned the minimum practice income guarantee. I have now looked into the matter further, and it turns out that this will be based on statistics data gathered for three quarters of a year. This will include the summer months, when the academic practices are quieter and GPs and their staff tend to go on leave to fit in with the efficiency of the practice. More seriously, there will be an adverse effect on patient number records: students who leave will come off the list in July and replacement students will not return to augment the list until November. This will create a very artificial situation. In addition, capitation will be greatly reduced by all those months.

Noble Lords


Baroness Gardner of Parkes

My Lords, the Minister talks about opportunities for earning money from services such as sexual health. Westminster primary care trust has already said that it cannot possibly do that as it will not have enough funds, so that option is not available. Will the Minister tell me what specific measures he will take to deal with this unique situation and to see that the strange situation of capitation is taken into consideration in the present negotiations?

Lord Warner

My Lords, I think I have made it clear that we are not revisiting the basis of this contract, which has been negotiated over 18 months between the NHS Confederation and the BMA's General Practitioners Committee. I can see that the noble Baroness is concerned about this, but her Question was quite long, so I hope I may be allowed a couple of sentences to reply. The new contract is meant to rebalance remuneration so that those GPs with the highest workloads and the highest prevalence of: illness in their practices are suitably remunerated. As I said, the system will be kept under review. It is down to PCTs to contract for specialist services. It is worth reminding the noble Baroness that PCTs now have at their disposal 75 per cent of NHS expenditure for commissioning particular services.

Baroness Warwick of Undercliffe

My Lords, may I, in declaring an interest as chief executive of Universities UK, reinforce the concern expressed by the noble Lord, Lord Butler of Brockwell? I appreciate that the situation will be kept under review, but it is worth remembering that the turnover rates among students on campus in GP practices is 25 per cent to 30 per cent, whereas the average for most areas is 10 to 15 per cent. I hope that this can be taken into account, because there is real concern that this will have an impact on the staffing of medical centres.

Lord Warner

My Lords, the system will be kept under review by an independent UK-based group of experts. But there is no getting away from the fact that we have revamped this contract so that doctors who have the heaviest workloads with the highest prevalence of illness are reimbursed accordingly. With the full co-operation of the profession, we are remedying historical anomalies.

Baroness Sharp of Guildford

My Lords, will the Minister give us assurances on the mental health issues? Many PCTs already find it quite difficult to meet the demands in their areas for support for mental health problems. Students under stress often raise new problems. Can we be assured that they will be given the long-term support that they need?

Lord Warner

My Lords, it is down to the PCTs at the local level to assess the medical needs of their communities and enter into the contracts that meet those needs. That will include mental health. As I said, there is now a duty on PCTs to do that work and ensure that doctors and services are appropriately geared up for those particular service needs.

Lord Butler of Brockwell

My Lords, is the Minister aware that it is not an adequate answer to say that the great majority of GPs have supported the contract, because this is a specialist need in special circumstances? I should like to underline the point made by the noble Baroness, Lady Gardner of Parkes, that it is also a cop-out to say that the primary care trusts will provide for this. They simply do not have the money to do so.

Lord Warner

My Lords, I gently say to the noble Lord that the Government are increasing NHS expenditure by 7 per cent in real terms over a five-year period. That is an unprecedented historical high. It is simply not true that there are not the resources in the NHS to buy the services that are needed. As I have said on several occasions, it is down to the people at the local level to meet the service needs of their particular area with the resources available. The contract was negotiated with the profession over 18 months. It takes account of the needs of doctors who work in university areas, and the profession has overwhelmingly supported this contract.

Lord McColl of Dulwich

My Lords, is the Minister aware that there is a lot of concern about this question? He said that the contract is continuously under review—as is everything else. Will he give us a time span—and review it again in six months?

Lord Warner

My Lords, we have already agreed with the profession to carry out a review in October after six months' experience of the new contract.

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