"Promoting Better Health" (Hansard, 23 February 1989)

§ Mr Kenneth Clarke

A Green Paper "Primary Health Care—an agenda for discussion" was published in April 1986. Following public consultation, the primary care White Paper "Promoting Better Health" was published in November 1987. Detailed proposals for implementing the reforms to the family doctor services as set out in the White Paper, were sent in March 1988 to the negotiators of the general medical services committee (GMSC), the GPs' representative body. Since then the reforms have been the subject of full consultation for almost a year with the GMSC negotiators.

800W

Consultations are now nearing completion and my right hon. Friend the Secretary of State for Wales and I have decided to send to all general practitioners a report setting out in full the changes to the GPs' remuneration system and terms of service that the Government wish to introduce. This report will form the basis of final discussions with GMSC negotiators early in March. Copies of this report have been lodged in the Libraries of both Houses.

A number of themes run through our proposals. In the first place we want to make it much easier for the patient to find the GP that best suits that individual's needs. More information about the services that GPs provide will therefore be made available. The bureaucracy involved in changing doctors will be removed and the patients' complaints procedure simplified. Family practitioner committees will be conducting consumer surveys to ensure that patients' views are being taken into account in the development of health care services.

Secondly, health promotion and disease prevention will become a central feature of general practice in future. GPs will be expected to provide regular check-ups for their patients—this means giving good advice on keeping well and avoiding future health problems. There will be particular emphasis on the assessment of childhood development for the under-fives and on mobility and well-being of the over-75s. New target payments are to be introduced to encourage GPs to provide improved cover for childhood immunisation and screening for cancer of the cervix. Increasingly, GPs will be running clinics for a range of health promotion activities such as anti-smoking, alcohol control, well-person, dieting, exercise and stress management.

Thirdly, important changes are to be made to the GPs' terms of service and remuneration system. The terms of service will in future set out in more specific terms what is expected of a family doctor who is in contract with the National Health Service. Aspects such as health promotion and disease prevention—not previously stated in specific terms—will be made a clear requirement of the GPs contract.

Changes to the remuneration system are designed to make general practice more responsive to patient needs and to ensure that the taxpayer gets better value for money. As proposed in "Working for Patients", capitation fees will form a much greater proportion of the GPs' income from fees and allowances. This means that capitation fees for each patient will be much higher and, as a consequence, greater recognition will be given to the importance of the individual patient to the practice and to the importance of providing all of the services that that patient needs. New incentive payments will be introduced to encourage the health promotion and disease prevention measures already mentioned. In addition, the importance of medical education will be given greater prominence in the remuneration system. Continuing education—keeping up to date with the latest techniques, therapies and disease management methods—will be encouraged through a new postgraduate education allowance payable to GPs who regularly attend approved courses. GPs who teach medical students will receive a new allowance.

Lastly, we are preparing family practitioner committees (FPCs) to play a greater management role in the provision of local services. In particular they will manage service development budgets aimed at improving surgery premises and extending practice teams. The Government believe 801W that GPs working with other health care professionals will provide a better service to patients. FPCs will have service development plans aimed at encouraging greater use of practice nurses, counsellors, chiropodists and other health professionals.

The package of changes that we plan to introduce will provide a better range and quality of services for patients. Many GPs already run first-class practices and under the new arrangements these GPs will be better rewarded. Others may need to consider extending their services to ensure that they too benefit from the reforms that the Government are planning.