HC Deb 04 April 1989 vol 150 cc83-6W
Ms. Harman

To ask the Secretary of State for Health which interested parties will be consulted by his Department over the composition of the list of treatments included in budgets for general practitioners.

Mr. Kenneth Clarke

My Department will be discussing the composition of the list of treatments included in practice budgets for general medical practitioners with the profession and with National Health Service managers. Specific invitations to discuss working papers 3 and 4 have been issued to the general medical services committee and the Royal College of General Practitioners.

Ms. Harman

To ask the Secretary of State for Health what is the formula which will determine the weighting element of the capitation allowance payable to general practitioners under the terms of working paper and of the White Paper on the National Health Service.

Mr. Kenneth Clarke

The relative weights to be included in the capitation formula will be determined after the discussions with interested parties, referred to in the working paper on indicative prescribing budgets for general medical practitioners, have taken place.

Ms. Harman

To ask the Secretary of State for Health if it is his intention that where a group practice opts out of the budget-holding scheme for general practitioners the practice income will be preserved at the level of the last year of budget holding.

Mr. Kenneth Clarke

If a practice decides to leave the practice budget scheme, the normal remuneration arrangements for general medical practitioners will apply.

Ms. Harman

To ask the Secretary of State for Health whether he will publish the evidence relating to working paper 3 of the White Paper on the National Health Service, in respect of practice budgets offering general practitioners an opportunity to improve the quality of their services.

Mr. Kenneth Clarke

Practice budgets will offer general medical practitioners an opportunity to improve the quality and standard of service to patients. Those practices with budgets will be able to decide how to make the most effective use of funds in order to provide the best possible service to their patients. The proposed development of medical audit should ensure the maintenance and indeed raising of standards both generally and in participating practices. Improving the quality of family doctor services is also a major objective of the White Paper "Promoting Better Health". The proposals set out in "General Practice in the NHS: A New Contract", published in February, should achieve that objective by better rewarding those doctors whose standards are high and who provide a wide range of high quality services geared to patients' needs.

Ms. Harman

To ask the Secretary of State for Health what mechanisms will be introduced to ensure impartial judgments are made as to the appropriateness of patient referrals to accident and emergency units in order to meet the requirements of the White Paper on the National Health Service that accident and emergency referral would not be used as a substitute for out-patient referral.

Mr. Kenneth Clarke

Health authorities will be expected to make arrangements at hospital level to monitor attendances to ensure that referrals to accident and emergency units are not used as a substitute for out-patient referrals.

Ms. Harman

To ask the Secretary of State for Health what formulae will be used to measure relative need for services provided by general practitioners who become budget-holders under the terms of the Government's White Paper on the National Health Service.

Mr. Kenneth Clarke

We are now considering the precise method of determining the relative need for services by patients. The practice budget scheme will be structured so that general medical practitioners have no financial incentive to refuse to treat any categories of patients.

Ms. Harman

To ask the Secretary of State for Health what mechanisms exist, or will be established, within regional health authorities, to enable them to adjudicate in disputes arising over the treatments to be included within general practitioner's budgets, as proposed in working paper 3 of the White Paper on the National Health Service.

Mr. Kenneth Clarke

Regional health authorities already have medical advice available to them which could he used for this purpose.

Ms. Harman

To ask the Secretary of State for Health what evidence he has collected on whether doctors will seek to remove patients from their lists on budgetary grounds where the costs of investigation and treatment are borne by general practitioner's practices.

Mr. Kenneth Clarke

Practice budgets will be set at a level which will reflect the relative need for services by patients registered with the practice. The elderly will attract a higher contribution to the budget than the young, and in exceptional cases adjustments will be made in respect of individual patients who need more costly treatment.

The Government do not believe that doctors will seek to remove patients from their lists on budgetary grounds nor be slow to accept patients. If, however, a practice did adopt a policy of selective registration, it could have its budget withdrawn by the RHA.

Ms. Harman

To ask the Secretary of State for Health how he proposes to adjust indicative budgets for general practitioners to accommodate practices which initially have below average prescribing costs but rapidly increase their diagnosis and treatment rates for common conditions.

Mr. Kenneth Clarke

We accept that the properly planned introduction of improved patient services, such as screening for certain conditions, may lead to an increase in prescribing of particular drugs. Practices intending to introduce such services will need to discuss their plans in advance with the family practitioner committee so that the financial implications can be fully considered when allocating prescribing budgets to practices.

As set out in working paper 4, "Indicative Prescribing Budgets for General Medical Practitioners", the FPC will be expected to compare expenditure with its budget profile and also information on what is prescribed and dispensed. They will be expected to investigate any significant diversions of actual and planned expenditure and take early and effective action. The FPC will be expected to accept and accommodate reasonable explanations for the variation.