§ 11. Mr. Awberyasked the Minister of Health what were the terms of the offer to increase the remuneration of doctors under the National Health scheme; what were the conditions attached to this offer; and if he will give an assurance that in the event of a refusal by the medical profession he will send the case to arbitration.
§ Mr. Marquand,pursuant to his reply [OFFICIAL REPORT, 28th June, 1951; Vol. 489, c. 1564] circulated the following letter:
Ministry of Health,
Whitehall, S.W. 1.,
23rd May, 1951.
Sir,
At their meeting with representatives of the General Medical Services Committee on 9th May the Minister of Health and the Secretary of State for Scotland undertook to put in writing, for consideration by the Committee, certain proposals affecting the remuneration of general practitioners in the National Health Service.
At the previous meeting on 28th February last, the Ministers accepted that there was a good prima facie case for reviewing, as a matter of urgency, both the adequacy of the total remuneration of general practitioners and its distribution. Careful and sympathetic consideration has been given to the further representations which have been made, in the light of the difficulties which many doctors are known to be experiencing and the Ministers can now confirm that in their view a measure of improved remuneration is justified for practitioners with lists in the lower and middle ranges but they do not consider that justification for additional remuneration extends to practitioners with lists of more than 2,500 patients. In arriving at this view the Ministers have not overlooked the importance of maintaining a proper relationship between remuneration obtainable by general practitioners and by specialists.
The Ministers accordingly propose that a Working Party, composed of representatives of the General Medical Services Committee, and officers of the Government Departments concerned, should be asked to suggest methods of distributing the Central Practitioners' Pool of remuneration with special reference to:
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- (a) the need to make it easier for new doctors to enter general practice especially in underdoctored areas by providing an assured income for genuine new entrants in the initial years.
- (b) improving the position of practitioners with lists of the order of 1,000 to 2,500;
- (c) the importance of diminishing the in centive for practitioners to build up unduly large lists and of stimulating group practice.
The Working Party might proceed on the assumption that some additional Exchequer money would be available if satisfactory methods of distribution were proposed by the Working Party and found to be acceptable to both sides. The Ministers would, however, feel able to recommend Parliament to provide such funds only if agreement were reached on significantly lower effective maximum numbers of patients which practitioners generally would not in future be permitted to exceed (while allowing individual practitioners now above those limits to maintain their lists at their existing levels). They would also need to be satisfied that the Committee were taking all possible steps open to it to eliminate extravagance in prescribing (of course without detriment to patients).
While the Ministers recognise that to attain the objects in view additional Exchequer money will have to be found, the profession will be aware of the rearmament programme and of the present financial stringency and it would not be useful for the Working Party to make suggestions which would involve additional funds in excess of £2 million a year under present circumstances.
I am, Sir,
Your obedient Servant,
(Sgd.) E. M. R. RUSSELL-SMITH.
Dr. D. F. Stevenson,
British Medical Association,
Tavistock Square, W.C.I.