NHS Reform

HC Deb 23 May 1989 vol 153 cc475-81W

8. Mr. Simon Hughes

To ask the Secretary of State for Health what he estimates will be the average capital charge to self-governing hospital trusts in London.

Mr. Kenneth Clarke

Self-governing trusts will not pay capital charges, but they will be given a financial regime similar to the capital charging system for district managed hospitals. The precise details are still being finalised and I expect to give further details within the next few weeks.

12. Mr. Pawsey

To ask the Secretary of State for Health if he will make a statement on the number and location of those hospitals considering self-governing status.

Mr. Kenneth Clarke

Regional health authorities have been asked to send expressions of interest to the Department by 31 May. But I understand that well over 100 expressions of interest have been received throughout the country.

13. Mr. Knapman

To ask the Secretary of State for Health what representations he has received on the White Paper proposals for medical audit.

36. Mr. Stevens

To ask the Secretary of State for Health what representations he has received on the proposals for medical audit outlined in the White Paper "Working for Patients".

60. Mr. Paice

To ask the Secretary of State for Health if he will make a statement on the proposals in the White Paper "Working for Patients" on medical audit.

Mr. Mellor

Our proposals on medical audit have been widely welcomed by doctors. The White Paper made it clear that there would be discussions with the medical profession and first meetings have already been held in a constructive manner.

23. Mr. Hague

To ask the Secretary of State for Health whether National Health Service self-governing hospitals will have to retain emergency services.

Mr. Kenneth Clarke

Yes, unless it would be better for these services to be provided elsewhere.

24. Mr. Adley

To ask the Secretary of State for Health what steps he has taken to ensure that copies of the White Paper "Working for Patients" are available to doctors.

Mr. Mellor

Copies of "Working for Patients" were sent to health authorities and family practitioner committees to explain the proposals to doctors in their management role. Copies of the three working papers directly relevant to the family doctor service were sent to all GPs. Individual copies of the White Paper are available from Her Majesty's Stationery Office, price £8.80, or by order through public libraries.

29. Mr. Knox

To ask the Secretary of State for Health how many representations he has received from members of the public about his White Paper "Working for Patients".

Mr. Mellor

In excess of 4,000 letters.

31. Mr. Day

To ask the Secretary of State for Health what representations he has received on the proposals to allow hospitals to become sell governing National Health Service hospitals.

47. Mr. Ian Taylor

To ask the Secretary of State for Health what representations he has received on his proposals to allow hospitals to become self governing.

Mr. Mellor

We have received a large number of letters from members of the public and many responses from representational bodies on the White Paper proposals including those relating to enabling hospitals to become self governing within the NHS. Many people find the proposals attractive.

32. Mr. Janman

To ask the Secretary of State for Health if he will make a statement on the consequences of allowing general practitioners' practices to hold their own budgets.

53. Mrs. Gorman

To ask the Secretary of State for Health how the proposals to allow general practitioners' practices to hold their own budgets will affect patient care.

Mr. Kenneth Clarke

Practice budgets will offer general medical practitioners new opportunities to improve the quality and standard of service to their patients. GPs with budgets will have control over large sums of taxpayers' money which they will be able to use as they judge best for the provision of care to their patients. This means that GPs will, for the first time, be able to back their referral decisions for those conditions covered by the budget with taxpayers' money to provide the chosen hospital with finance for the treatment. As a result hospitals will be encouraged to be more responsive to the needs of individual GPs and their patients, and GPs in the practice budget scheme will have a much greater role than at present in influencing the provision of hospital services. This can only be of benefit to patients and to the NHS as a whole.

33. Mr. Roy Hughes

To ask the Secretary of State for Health what representations he has received from professional bodies and trades unions concerning the review of the National Health Service.

Mr. Mellor

A good many expressing many different views.

34. Mr. Andy Stewart

To ask the Secretary of State for Health what will be the effect on doctors who choose to operate a practice budget, as proposed in the White Paper "Working for Patients" of an overspend in their budget.

Mr. Mellor

There is of course no question of patients not receiving the treatment they need as a result of a budget overspend. Larger practices which volunteer to hold a practice budget will be allowed to overspend by up to 5 per cent. a year on the basis that a corresponding reduction will be made the following year. Where the overspend is due to the changed cirumstances of a practice such as an increase in the number of patients or in their relative need for services, the practice may ask for a review of its budget. If a practice overspends by more than 5 per cent., or persistently overspends at a lower level, the family practitioner committee will initiate a thorough audit. An overspend greater than 5 per cent. for two years in succession may lead to the practice losing the right to hold its own budget.

35. Mr. Devlin

To ask the Secretary of Health how will patients be affected by the proposals in the White Paper "Working for Patients".

55. Mr. Key

To ask the Secretary of State for Health if he will make a statement on the consequences for patient care of the proposals in the White Paper "Working for Patients."

Mr. Kenneth Clarke

Our proposals will produce a better quality of care for all NHS patients, including elderly and chronically sick people. We intend to bring all services up to the standard of the very best and to make certain that taxpayers' money is used to best effect from the patients' point of view. The proposals reflect our strong commitment to the principles on which the NHS was founded and will ensure that it is more than ready to face the rapidly changing and rising demands upon it as medical science progresses and the average age of the population rises.

37. Mr. Ground

To ask the Secretary of State for Health whether under the proposals in the White Paper, "Working for Patients", a patient could go without necessary drugs if a general practitioner overspends on his or her drug budget.

Mr. Kenneth Clarke

No. As a result of our proposals no patient could ever go without necessary drugs in any circumstances. Indicative prescribing budgets for GPs will be set at sensible and realistic levels and in discussion with each practice to reflect the needs for drugs of patients in that practice. While general medical practitioners will be expected to aim to contain their prescribing within their indicative budgets, we fully accept that the legitimate demand for drugs may not follow a consistent pattern at practice level and that some practices may exceed their indicative budgets with good reason. There will be no question of any doctor ever being prevented from prescribing necessary medicine for any patient, whether or not he or she has overspent or will overspend his indicative budget.

39. Mr. McLoughlin

To ask the Secretary of State for Health if he will make a statement on the consequences of the new general practitioners' contract for rural practices.

50. Mr. David Davis

To ask the Secretary of State for Health how rural practices will be affected by the new general practitioners' contract.

51. Mr. Amos

To ask the Secretary of State for Health if he will make a statement of the future of general practitioners' practices in rural areas.

Mr. Kenneth Clarke

As I announced to the House on 5 May, we have now reached agreement with the general medical services committee's negotiators on all the major outstanding issues on the new contract for GPs. We have modified our proposals in several ways which will be welcomed by GPs serving rural areas. We have agreed to retain the present rural practice payments scheme pending its revision by the Central Advisory Committee on Rural Practice Payments. We have included home visits in the hours of availability to patients required of GPs, although in consequence we have raised the number of hours to 26 per week. We have agreed that the requirement for GPs to be available over five days a week may be reduced to four days where the GP carries out other health-related activity in the public service (for example, service in a community hospital).

We have also agreed that ad hoc minor surgical operations may be aggregated for the purpose of claiming entitlement to the new minor surgery sessional payments. Many GPs serving rural areas will benefit from retention of seniority payments (though reduced in value) and from the extension of the higher night visit fee to rotas of up to 10 GPs. Retention of partnership average list size for calculating entitlement to basic practice allowance, and the lowering of the threshold for full basic practice allowance to 1,200 patients rather than 1,500 as previously proposed, will also benefit GPs in rural areas.

The general medical services committee has agreed to put the agreement to the annual conference of local medical committee representatives in June on the basis recommended by its negotiators.

45. Mr. David Nicholson

To ask the Secretary of State for Health what representations he has received on the proposals affecting family practitioner committees in the White Paper, "Working for Patients".

Mr. Mellor

We have received responses to the White Paper "Working for Patients" from a large number of organisations and individuals. Many of these have included comments on the proposals affecting family practitioner committees.

46. Mr. Evennett

To ask the Secretary of State for Health what representations he has received on allowing district health authorities to purchase health care from hospitals.

57. Mr. Andrew Mitchell

To ask the Secretary of State for Health what recent representations he has received on his proposals to allow health authorities to purchase health care from hospitals.

Mr. Mellor

We have received a large number of representations on the White Paper proposals, from statutory, voluntary and professional bodies and from individuals including right hon. and hon. Members. Many have welcomed the proposed relationship between health authorities and general practitioner practice budget holders on the one hand and hospitals as the providers of services on the other since this will allow contracts to specify services, quality of standards and levels of agreed funding, enabling money to follow patient choice. We will take careful note of these comments in taking forward our plans for implementing our policies.

49. Mr. Colvin

To ask the Secretary of State for Health whether he will commission any pilot studies of general practitioner practices operating practice budgets similar to those proposed in the White Paper "Working for Patients".

Mr. Mellor

Eligibility for practice budgets will be confined, at least initially, to practices or groups of practices with a registered list of at least 11,000 patients to provide sufficient budgetary flexibility. Practices will also need to be able to demonstrate the ability to manage budgets including having adequate administrative support and IT and information systems. On this basis we see no need for separate pilot studies of practice budgets but we will of course keep the system under review once it has started to operate in April 1991 and make any improvements which are necessary in the light of experience.

61. Mr. Robert Hicks

To ask the Secretary of State for Health how many representations he has received to date in response to his proposals for National Health Service reforms; and if he will make a statement.

Mr. Kenneth Clarke

I refer my hon. Friend to the reply given to the hon. Member for Wentworth (Mr. Hardy) earlier today.

65. Mr. Gill

To ask the Secretary of State for Health what expressions of interest he has received from hospitals in Shropshire for the granting of National Health Service hospital trust status.

Mr. Mellor

None. However, I understand that the West Midlands regional health authority has received a number of expressions of interest in self government from hospitals in the region; these will be sent to the Department by 31 May.

66. Sir Michael McNair-Wilson

To ask the Secretary of State for Health how the proposed indicative drugs budgets for general practitioners will affect patient care.

Mr. Mellor

Indicative prescribing budgets will improve patient care. They will provide a further incentive to general practitioners to examine their prescribing patterns critically to ensure that they prescribe in the most effective way possible. This includes prescribing only when and for as long as necessary. More effective prescribing is better for patients. All patients will always get the drugs they need.

69. Mr. Macdonald

To ask the Secretary of State for Health if he will make a statement on the progress made on his proposals to cash limit general practitioners' budgets.

Mr. Mellor

We are making good progress in developing details plans for implementing practice budgets for GPs from 1 April 1991. These budgets will be available to GPs who fulfil the eligibility criteria and choose to opt for them in view of the new freedoms of choice they will confer on the practice.

74. Mr. Batiste

To ask the Secretary of State for Health whether National Health Service self governing hospitals will have to retain core services.

Mr. Mellor

Yes, unless it would be better for these services to be provided elsewhere.

75. Dr. Michael Clark

To ask the Secretary of State for Health how many hospitals have applied for self-budgeting status in accordance with the provisions in the White Paper "Working for Patients".

76. Mr. Patnick

To ask the Secretary of State for Health how many requests for information he has received from National Health Service hospitals interested in achieving self governing status.

Mr. Mellor

Regional health authorities are currently considering expressions of interest in individual hospitals becoming self governing. They have been asked to send the expressions of interest to the Department, together with their comments, by 31 May.

Mr. Harry Greenway

To ask the Secretary of State for Health what he estimates to be the optimum size of practice for a general practitioner in an average urban area; and if he will make a statement.

38. Mr. Michael Brown

To ask the Secretary of State for Health what assessment he has made of the effects of the increased capitation element in the general practitioners' contract on doctor-patient relationships.

43. Mr. Riddick

To ask the Secretary of State for Health what detailed assessment he has made of the effect of the new general practitioners' contract on list sizes.

73. Mr. Watts

To ask the Secretary of State for Health what detailed assessment he has made of the implications of the new general practitioners' contract for doctors' list sizes.

Mr. Mellor

We believe that the increase to 60 per cent. of the proportion of general practitioners' income represented by capitation payments will stimulate greater competition among general practitioners and make services more responsive to patients' needs.

Our proposals for making more information available to patients and making it easier to change doctors will encourage patients to choose the general practitioner who provides the best service. We expect therefore that general practitioners who provide a wide range of high-quality services will gain patients, and those who do not will have to improve their services in order to maintain income. List sizes will, however, settle al levels consistent with the provision and maintenance of high-quality services, because patients will not join or remain on the list of a general practitioner whose services are below standard. We do not consider that there is an optimum list size, because the quality of services depends on a range of factors (for example, the size and skills of the practice team) of which list size is only one.

Mr. Jack

To ask the Secretary of State for Health what detailed assessment he has made of the implication of the new general practitioners' contract for women doctors.

44. Mr. Tim Smith

To ask the Secretary of State for Health what representations he has received on the proposed contract for general practitioners.

54. Mr. Fearn

To ask the Secretary of State for Health what plans he has to attract more women doctors into general practice.

56. Mr. Hayes

To ask the Secretary of State for Health what further representations he has received from the British Medical Association relating to the general practitioners' contract.

Mr. Mellor

I refer my hon. Friends and the hon. Member to the reply I gave to my hon. Friends the Members for Bristol, East (Mr. Sayeed) and Rutland and Melton (Mr. Latham) earlier today.

Mr. Austin Mitchell

To ask the Secretary of State for Health what estimate the Government have made of the effects of the proposed changes in the remuneration of general practitioners on the gross income of those who do not opt for their own budgets; and what is the intended effect of the new arrangements in terms of(a) the number of patients per doctor and (b) the number of staff employed by doctors, and their remuneration.

Mr. Mellor

I refer the hon. Member to the reply that I gave to my hon. Friends the Members for Ealing, North (Mr. Greenway), for Brigg and Cleethorpes (Mr. Brown), for Slough (Mr. Watts) and for Colne Valley (Mr. Riddick) today. Under the proposals for GP practice budgets set out in the White Paper "Working for Patients" and working paper 3, practices that opt to become budget holders may invest any savings on their annual budget in improving the services they offer to patients. The Review Body on Doctors' and Dentists' Remuneration will continue, as now, to recommend the average net income and indirectly reimbursed expenses of all GPs, whether budget holders or not. Other expenses incurred by GPs are reimbursed directly.

We expect the number of staff employed by GPs to increase as a result of our intention to invest more in practice teams, and to remove the present restraints on their number and the range of qualifying duties. By enabling FPCs to target funds on areas of greatest need, the deployment of practice team staff will become more cost effective.