General Practitioners: Chronic Illness. Payments (Hansard, 24 May 2004)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)
My Lords, the Government are in favour of investing resources in the more effective management of chronic disease that protects patients from acute episodes of illness requiring emergency hospital admission. The scheme in Torbay has been negotiated locally. I understand that it has been welcomed by local GPs. We expect the 1050 primary care trust to monitor it carefully and ensure that it works appropriately and that there are no perverse incentives.

§ Baroness Greengross
My Lords, I thank the Minister for that reply, but I am concerned that a scheme established with the best intentions—as this one obviously has been—to stop unnecessary hospital admissions could end up having the opposite result from time to time. Someone who is very seriously ill and frail—probably an elderly person—could be kept out of hospital when that is really where that person ought to be. Is there some way in which the Department of Health could monitor this type of scheme to ensure that that does not happen?

§ Lord Warner
My Lords, as I said in my Answer, it is down to the local PCT to monitor this particular scheme. I can see that, in theory, the noble Baroness may have a point. However, I assure her that doctors are not being relieved of their obligations ethically to provide the most appropriate care for their patients. I quote the chairman of the Devon Local Medical Committee, Dr Charlie Daniels, who backed the idea in Torbay. He said that it is a preventive scheme to avoid unnecessary admissions and that it is a reasonable aspiration.

§ Lord Chan
My Lords, are there other schemes that would have the same effect? I refer in particular to that by which well qualified general practitioners would be employed to screen patients at A&E departments. Would that not he a better way of ensuring that patients who need hospital care receive it and those who do not can be cared for at home?

§ Lord Warner
My Lords, several primary care trusts around the country are now working, like Torbay, on new approaches to deal with chronic disease management. It is worth bearing in mind that there are 17.5 million people with chronic diseases, many of whom have more than one condition. We are exploring, as are people at local level, new ways of providing a better level of care and earlier identification of patients in this area.

§ Baroness Barker
My Lords, does the Minister agree that, if the objective of keeping people out of acute hospitals is an acceptable one, schemes of this type should be extended to people other than GPs—community health practitioners, for example, who are the people doing the work that enables people to stay out of hospital, rather than just planning their care?

§ Lord Warner
My Lords, we are moving through a period in which we have shifted the balance of care to primary care trusts and local hospital trusts. We should welcome the fact that PCTs are using a variety 1051 of approaches and using creatively the new quality and outcomes framework in the new GP contract to provide more responsive services to their patients.

§ Baroness Carnegy of Lour
My Lords, is it right for a primary care trust to pay doctors to do the right thing? Is that the best way of trusting professionals in their professionalism?

§ Lord Warner
My Lords, the proposal is a feature of the new GP contract, which we discussed extensively in proceedings for the Health and Social Care Bill, to which the noble Baroness made such a magnificent contribution. We discussed the fact that there would be a new contract, with a new quality and outcomes framework and new payments arrangements, some of which would provide incentives and rewards.

Lord Berkeley
My Lords, does my noble friend agree that this is an interesting way of doctors making money? Do they get £100 per disease, per week or per day for keeping people with chronic illness out of hospital, or is it a one-off payment? When does one one-off stop and another one start?

§ Lord Warner
My Lords, the Government do not believe in cut-price doctors at all. We are providing £75 of the £100 to ensure that there is a proper care plan in place so that the patient gets the most appropriate treatment for their needs.

§ Lord Ackner
My Lords, does the Minister at least agree that, in theory, the scheme could give rise to a conflict of interest? In such circumstances, how will it to be monitored?

§ Lord Warner
My Lords, as I said in response to an earlier question, the chairman of the local medical committee—who is likely to be very concerned with doctors' reputations—has welcomed this particular scheme. We hope that the PCT will evaluate the project at a later stage.

§ Baroness Gardner of Parkes
My Lords, if this scheme is a carrot—which it is—what about also providing a stick? If doctors fail to refer patients who do need hospitalisation, they could be penalised. That might be a fairer scheme and would deal with the point raised by the noble and learned Lord, Lord Ackner.

§ Lord Warner
My Lords, we prefer rewards and incentives.

§ Earl Howe
My Lords, the Minister mentioned the GP contract. Does he accept that the new contract makes it increasingly likely that the doctor who sees the patient will not be the patient's own GP—both during working hours and out of hours? As such, it is more likely that patients would be admitted to hospital, because the doctor or nurse who sees them will be unfamiliar with their cases. Do the Government recognise that the introduction of the incentive scheme 1052 in Torbay is in part, at least, a direct result of the changes made by the GP contract? Is that not a concern?

§ Lord Warner
My Lords, that is not so. My evidence is that Torbay is performing at way above the national average in respect of the length of wait for operations and so forth. It is building on its success in this particular area to go even further in giving patients the care that they need.