HC Deb 25 April 1989 vol 151 cc499-502W
17. Mr. Madden

To ask the Secretary of State for Health how many general practitioners have indicated their intention of resigning their contracts.

Mr. Kenneth Clarke

I am aware that some local medical committees have discussed the question of resignation, but very few indeed of the letters I have received refer to this possibility.

Mr. Knox

To ask the Secretary of State for Health what is the average number of people registered with each doctor under the National Health Service in each year since 1959.

Mr. Mellor

The average number of patients on general medical practitioners' lists in England for each year since 1959 is:

Number
1959 2,300
1960 2,305
1961 2,308
1962 2,322
1963 2,343
1964 2,379

Number
1965 2,428
1966 2,470
1967 2,490
1968 2,494
1969 2,495
1970 2,478
1971 2,460
1972 2,421
1973 2,398
1974 2,384
1975 2,365
1976 2,351
1977 2,331
1978 2,312
1979 2,286
1980 2,247
1981 2,201
1982 2,155
1983 2,116
1984 2,089
1985 2,068
1986 2,042
1987 2,020

Mr. Knox

To ask the Secretary of State for Health how many general practitioners worked in the National Health Service in each year since 1959.

Mr. Mellor

The information requested is set out in the table.

Date Number of unrestricted principals in England
1 July 1959 18,467
1 July 1960 18,643
1 October 1961 18,905
1 October 1962 19,031
1 October 1963 19,065
1 October 1964 18,978
1 October 1965 18,784
1 October 1966 18,612
1 October 1967 18,617
1 October 1968 18,732
1 October 1969 18,901
1 October 1970 19,099
1 October 1971 19,374
1 October 1972 19,775
1 October 1973 19,997
1 October 1974 20,219
1 October 1975 20,377
1 October 1976 20,551
I October 1977 20,796
1 October 1978 21,040
1 October 1979 21,357
1 October 1980 21,812
1 October 1981 22,304
1 October 1982 22,786
1 October 1983 23,254
1 October 1984 23,640
1 October 1985 24,035
1 October 1986 24,460
1 October 1987 24,922

Mr. Battle

To ask the Secretary of State for Health what prior consultations were held with the medical profession before the publication of the new contract proposals for doctors in general practice.

Mr. Kenneth Clarke

I remember the need for a more performance-related contract for GPs being a widespread subject of discussion with members of the medical profession about six or seven years ago. The need for a new contract for general medical practitioners was first set out formally by the Government in the Green Paper "Primary Health Care: An Agenda for Discussion", published in April 1986. Eight months public consultation with the medical profession resulted in the proposals for a new contract set out in the White Paper "Promoting Better Health" published in November 1987.

Detailed discussions of the proposed new contract with the general medical services committee, which negotiates for GPs, began in March 1988. Between March 1988 and the publication by the GMSC of its account of the negotiating position and my publication of "A New Contract", my officials held 17 meetings lasting 80 hours with the GMSC. I also held two meetings personally with the negotiators before publication and a third, protracted one afterwards. Subsequent meetings between my officials and the GMSC have taken the total time spent on detailed negotiations past 100 hours.

The GMSC is now consulting its local medical committees and has summoned a conference for 27 April 1989. I wait to see whether it will wish to resume constructive discussions after the conference. In the meantime my officials are now preparing amendments to the regulations governing the GM services, including amendment to GPs' terms of service, and revised sections of the statement of fees and allowances (which sets out GPs' entitlement to those payments).

The new contract will not reduce the average remuneration of GPs. It will however result in good GPs—those who provide all the services that patients need, attract patients to their practices and achieve high levels of performance—being paid more. This will be achieved by redistribution of existing levels of remuneration enhanced by increased investment in the family practitioner services as promised in the White Paper "Promoting Better Health".

I believe that the GMSC agrees that the existing contract should be changed and that the changes should be introduced with effect from 1 April 1990. I hope, therefore, that the longest, most protracted, detailed and painstaking discussion of amendments to a contract in which I have ever been involved will soon come to an end. Both sides are agreed that our sole aim is to provide incentives to and fair reward for good quality primary health care and that publicly professed agreement should assist in any further discussions.

47. Mr. Latham

To ask the Secretary of State for Health whether he will make a statement on the response which he has received from general practitioners to his proposals for a new contract.

56. Mr. Mans

To ask the Secretary of State for Health how many representations he has received in the last 12 months on the subject of general practitioners' contracts.

57. Mr. Hayes

To ask the Secretary of State for Health what representations he has received on the British Medical Association's campaign against the proposed general practitioners' contract; and if he will make a statement.

Mr. Mellor

Since the publication of "General Practice in the NHS—A New Contract" on 23 February, I have received about 800 letters from individual GPs and their representative organisations. Prior to 23 February discussions on the GPs' contract with the GPs' representatives, the general medical service committee, were confidential.

Sir David Price

To ask the Secretary of State for Health what progress has been made in negotiations with the general medical services committee over a new contract for general practitioners since his publication of the Government's proposals on 23 February; and whether any of the outstanding issues have been settled.

48. Mr. Malins

To ask the Secretary of State for Health what progress has been made towards settling general practitioners' contracts.

Mr. Mellor

I refer my hon. Friends to my right hon. and learned Friend's reply to my hon. Friends the Members for Fylde (Mr. Jack), for Wyre Forest (Mr. Coombs) and for Basingstoke (Mr. Hunter) earlier today.

32. Mr. Robert B. Jones

To ask the Secretary of State for Health whether he has any plans to replace the General Medical Council with an independent body to investigate ethical complaints against general practitioners.

Mr. Freeman

The General Medical Council is an independent statutory body whose constitution and functions are regulated by the Medical Act 1983. Under this legislation the council has power to provide advice for members of the medical profession on standards of professional conduct and on medical ethics and to discipline doctors found guilty of serious professional misconduct. There are no plans to change existing arrangements.

26. Mr. Baldry

To ask the Secretary of State for Health whether he intends to make any amendments to the draft general practitioners' contract.

Mr. Mellor

The proposals set out in "A New Contract" are based on a year's intensive discussions with the general medical services committee negotiators. The principles are now settled but there will be plenty of opportunity to consider amendments to the detail as we proceed with the preparation of amendments to regulations and the statement of fees and allowances.

23. Mr. Amos

To ask the Secretary of State for Health if he will make a statement on the proposed level of capitation supplements in rural areas for rural general practitioner practices.

Mr. Kenneth Clarke

I propose that general practitioners should receive a rural capitation supplement to their basic practice allowance for each patient on their list who lives in a sparsely populated area. I envisaged three payments, the highest being for patients in the most sparsely populated areas. The amounts of these payments has not yet been decided.