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General Practitioners

Volume 171: debated on Tuesday 1 May 1990

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20.

To ask the Secretary of State for Health if he will make a statement on the operation of the new general practitioner contracts.

The GPs' new contract was introduced on 1 April 1990. The new contract will raise standards of care, extend services and promote greater choice for patients in the family doctor services. First indications are that GPs are responding positively to the new arrangements.Laboratories are already reporting a significant increase in the number of cervical smear tests as GPs aim to meet the targets. More GPs are applying to attend training courses in order to qualify for the new postgraduate education allowance. Some FPCs are also reporting that well over half of all GPs in their areas are applying for a place on the child health surveillance and minor surgery lists, demonstrating their wish to take advantage of the new opportunities offered by the contract.We are supporting the changes being made by the new contract with very substantial additional sums to enable GPs to recruit more practice staff and to improve their premises. Between 1988–89 and 1990–91 expenditure on staff and practice premises has increased from £232 million to £359 million, an increase of 36 per cent. in real terms. I also expect to add to the £359 million for 1990–91 in the summer in order to meet the cost of commitments entered into before the start of this financial year and which are not yet fully reflected in the current allocation.

23.

To ask the Secretary of State for Health if he will make a statement on the operation of the new general practitioner contracts.

58.

To ask the Secretary of State for Health if he will make a statement on the operation of the new general practitioner contracts.

72.

To ask the Secretary of State for Health if he will make a statement on the operation of the new general practitioner contracts.

The GPs' new contract came into operation on 1 April. The changes that have been introduced will raise standards of care, extend services and offer greater consumer choice in the family doctor services.

44.

To ask the Secretary of State for Health what effect the new general practitioners' contract will have on general practitioner list sizes.

98.

To ask the Secretary of State for Health how the new general practitioner contract will affect doctors' lists.

Average list size has fallen steadily over the past decade. This should continue as the population is almost static and the number of GPs is increasing each year. There are no grounds for supposing that the GPs' new contract will affect this trend.

52.

To ask the Secretary of State for Health what was the average list size of a family doctor in 1979 and 1989.

112.

To ask the Secretary of State for Health how many people on average a general practitioner currently has on his or her list; and what was the equivalent figure in 1979.

I refer my hon. Friends to the reply I gave to my hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes) on 20 February at column 717.

56.

To ask the Secretary of State for Health what assessment he has made of the effect of the new general practitioner contract on services to patients.

I refer my hon. Friend to the reply I gave my hon. Friends the Members for Twickenham (Mr. Jessel) and for Sherwood (Mr. Stewart) on 20 March at column 549.

59.

To ask the Secretary of State for Health if he will make a statement on the progress of the general budget-holding scheme.

Progress on the general practice scheme remains very encouraging. As my right hon. and learned Friend the Secretary of State announced on 14 March at column 280, over 850 practices in England have expressed an interest in the scheme. These practices are now in discussion with regional health authorities to determine whether they are likely to meet the eligibility criteria for participation in the scheme from 1 April 1991, subject to parliamentary approval of the relevant provisions of the National Health Service and Community Care Bill.

64.

To ask the Secretary of State for Health whether any extra assistance will be available to general practioners' practices which choose to become fund-holding.

Subject to parliamentary approval of the necessary legislation, practices which volunteer to join the general practice funding scheme will be able to claim an annual management allowance of up to £32,000 to meet expenses legitimately incurred in running a fund. In 1990–91 an allowance of half that level will be available in recognition of the preparatory work which practices will need to undertake before entering the scheme. Furthermore, practices which commit themselves formally to participating in the scheme will be able to claim an additional 25 per cent, over and above the 50 per cent. which all GPs can claim, of their computer purchasing, leasing and upgrading costs according to a scale to be published in the statement of fees and allowances.

84.

To ask the Secretary of State for Health what resources are being allocated for 1990–91 to family practitioner committees in England to enable them to fund the direct reimbursement to general practitioners for the cost of employing a wider range of practice and support staff.

Family practitioner committees (FPCs) in England have been given a preliminary allocation of £359 million to fund the direct reimbursement of general medical practitioners' practice staff and premises improvement costs in 1990–91. Within this total, FPCs have been allocated £256 million to reimburse the costs of practice staff, including new types of staff. Within their overall cash limit, FPCs are free to reapportion funds between practice staff and premises improvement costs in the light of local priorities. FPC allocations for 1990–91 will not be finalised until FPCs have reported their actual level of commitments for practice staff reimbursement and premises improvements as at 31 March 1990. A further allocation will be made in June or July to meet any difference between the preliminary allocation for 1990–91 to fund existing commitments, and the actual level of commitments.

86.

To ask the Secretary of State for Health what is the number of practice staff in the average general practitioner's practice now; and what was the number in 1979.

The average number of practice staff per partnership employed under the direct reimbursement scheme increased by 66 per cent. from 3·8 (2·3 whole-time equivalents) in 1979 to 6·3 (3·7 whole-time equivalents) in 1988.

92.

To ask the Secretary of State for Health how many general practitioners' practices have expressed an interest in becoming fund-holding practices.

I refer my hon. Friend to the reply my right hon. and learned Friend the Secretary of State gave my hon. Friend the Member for Wyre Forest (Mr. Coombs) on 14 March at column 280.

94.

To ask the Secretary of State for Health how many general practitioners' practices in England and Wales have now registered their interest in becoming fund-holding practices.

Over 850 practices in England have registered their interest in the practice funding scheme. Fund-holding practices in Wales are a matter for my right hon. Friend the Secretary of State for Wales, but I refer my hon. Friend to the reply my hon. Friend the Parliamentary Under-Secretary of State for Wales gave the hon. Member for Cardiff, South and Penarth (Mr. Michael) on 20 April at column 1056. While not all of these practices are likely to meet the full eligibility criteria and opt to take part in the scheme, we are clearly on course to meet our target of a few hundred practices choosing to participate from April 1991.

To ask the Secretary of State for Health, pursuant to his answer to the hon. Member for Uxbridge (Mr. Shersby) on 20 April, at column 1048, what factors were taken into consideration in determining to make a modification to the operation of screening targets after the commencement of the new contract for general medical practitioners; what steps have been taken to minimise any disruption resulting from this change; and if he will make a statement.

The change made to the target payment system followed representations from the general medical services committee of the British Medical Association. The Government have accepted the GM SC's argument and new arrangements are being implemented. There should be no associated disruptive effects. The first target payments will not be made until the end of September giving sufficient time to implement the change and to ensure payments are made on time.