To ask the Secretary of State for Health what is the current level of general practitioners' remuneration; and what it was in 1979.
From 1 April 1990, the intended average net remuneration for general practitioners will be £33,280 and the average reimbursement of expenses £42,843. On 1 January 1991, the figure for remuneration will rise to £34,680. The corresponding levels of remuneration and expenses in 1979 were £12,830 and £11,355 respectively.
When my right hon. and learned Friend next meets the British Medical Association, will he suggest that it gives publicity to those figures, which are responsible for the fact that we now have more general practitioners than ever and the average GP patient list is shorter than ever?
I shall put my hon. Friend's excellent suggestion to the BMA when I next meet it. It is certainly the case that the number of GPs in this country has gone up by almost one fifth and lists have become much shorter while the Government have been in power. I expect that the number of GPs will continue to rise because of the attractive figures that I have described, and that lists will continue to fall.
In respect of future remuneration of GPs, is the Secretary of State aware of the anomaly produced by the Jarman indices? Is he aware that in future GPs in the London borough of Newham are scheduled to receive different additional payments in relation to the wards in which their consulting rooms are located? He must surely know that ward boundaries, in his constituency and elsewhere, are arbitrary and that a GP's patients will not necessarily live in an adjacent ward. Will he look at what appears to be an arbitrary and unsatisfactory system for an area which is greatly in need of medical services?
I am keen on the idea of increasing remuneration for those GPs who work in deprived districts, particularly inner city areas. I am glad that I reached agreement with the BMA on that subject. We have agreed that we should apply the Jarman index, but in applying it, it is inevitable that once boundaries are drawn some GPs will be disappointed if they are just the wrong side of them. We have introduced a significant extra incentive to GPs to give the higher levels of service required by people in deprived districts. I shall keep the operation of the arrangements under review, as the hon. Gentleman suggests.
Does my right hon. and learned Friend agree that it would be excellent if more members of the public realised that general practitioners are so well paid? However, will he bear in mind the problem for some GPs with the immunisation bonus payments, which require four separate actions for the child and unless all four are completed the GP will not be deemed to have carried out the treatment?
The public should be aware that GPs are well paid, and I am sure that my hon. Friend agrees that it is right that they should be. No one has ever sought to interfere with that. Our new arrangements carefully spell out, for the first time, what we expect the best practices to deliver and how they will be paid for the best levels of service. It is true that immunisation targets will be met only when full immunisation has been given; otherwise, the child would not be properly protected. I am confident that the targets will be achieved by GPs, although I am the first to acknowledge that it involves considerable hard work and application by a practice to achieve the higher targets that we have laid down.