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Gp Budget Holders

Volume 202: debated on Tuesday 21 January 1992

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

The Government's introduction of general practitioner fundholding has been a clear success, a fact confirmed in the independent academic research undertaken by Professor Glennerster of the London school of economics reported today by the King's Fund.

To allow the advantages of fund holding to be enjoyed by more patients and doctors, I am pleased to announce that we are lowering the list size eligibility criterion from 9,000 patients to 7,000 patients for practices entering the scheme from April 1993.

My right hon. Friend's announcement is to be welcomed by GPs who welcome the principle of managing their own funds. It helps the NHS and its patients. Is not it now time that the hon. Member for Peckham (Ms. Harman) apologised to the House for saying that GPs were not interested in fund holding?

It is true that the hon. Lady said in column 687 a couple of years back on 15 March 1990—[Interruption.]—that there was "no support among GPs"—[Interruption.]

She said that that was the position of all general practitioners of fund-holding practices. [Interruption.] Hon. Members opposite must get used to the idea that I shall read out what their Front-Bench spokesmen have said about fund holding. The hon. Member for Livingston (Mr. Cook) associated himself with the sentence:

"I'll be surprised if budget holding does not collapse in the first year."—[Official Report, 13 March 1991; Vol. 187, c. 946.]
He should have the grace to admit that he was wrong and the grace to clear up the muddle that has existed in his ranks since his colleague the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) recently announced that he was going to abolish fund holding. I could not get a straight answer from the hon. Member for Livingston about this. I think that the House needs to know whether he will abolish fund holding in the teeth of opposition from virtually every GP and from the British Medical Association.

Will not the fact that the percentage of GPs who hold their own budgets still remains a very small fraction of the total number of GPs—even after today's announcement—linked to the nature of the block contract system of an internal market, inevitably mean that, if we are to avoid a two-tier health service in terms of patient referrals, either all GPs must hold their own budgets or none should be budget holders? The present two-tier structure is leading to a two-tier treatment of health.

Like those on the Opposition Front Bench, the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) is out of date. Professor Glennerster and others looked at the allegations and found no evidence of a two-tier structure emerging. Professor Glennerster said that it was clear that the benefits won by GP fund holders were swiftly being transferred to the patients of other GPs, which is what we said would happen. I think that the hon. Member, who belongs to a party that is supposed to believe in devolution, might occasionally support a practical piece of devolution.

Will my right hon. Friend accept that GPs were encouraged to introduce computerisation partly by an offer of Government funds to refund the cost of that process and, in districts such as the Wessex health authority, those funds have not been fully forthcoming? Will he agree to allow a carry-over into next year to ensure that those GPs who have introduced computerisation will be compensated by the Government, in accordance with the Government undertaking?

I have been to a large number of conferences and met many general practitioners, including many from my hon. Friend's district. I have found no such systematic problems, but if there are specific difficulties in some practices, those involved should discuss them with their regional health authority.

Why does the Minister continue to misrepresent the views of doctors? Is he aware that the chair of the local British Medical Association branch in Calderdale recently publicly rebuked local Tories who were saying that GPs wanted to become fund holders? Dr. Whittaker had to say that no doctors in Calderdale had applied to become fund holders in either the second or third wave. Is it not about time that the Minister started to represent doctors' views properly?

I am tempted to quote Oliver Cromwell and to ask whether the hon. Lady could conceive of the possibility that she might be wrong. I am making the extension because of the pressure from general practitioners who have asked me to extend the list size. People are queuing up to join the voluntary scheme.

Is my right hon. Friend aware that the fund-holding system has been a spectacular success—so much so that many of the more trendy, intellectual GPs who were initially sceptical of it now welcome it more and more with open arms? Will my right hon. Friend look again at some of the procedures for recording, note taking and keeping records, as some GPs say that the system is a little too cumbersome and bureaucratic?

I am very sympathetic to comments like that. The scheme will obviously be a permanent and beneficial part of health care in this country but is, I am sure, susceptible to improvement and further development, which I shall promote. My hon. Friend correctly records the honesty of many general practitioners, some of whom were sceptical. At his press conference this morning, Professor Glennerster said that, when he started his investigation, he was sceptical, but that he was converted by the evidence of his own eyes, and what he had seen and heard. I only wish that the Labour party had the same openness of mind.

If the Secretary of State does not believe that GP fund holding produces two-tier waiting lists, how can he explain the position in Manchester, where patients of fund holders are given eye treatment in a private wing, while patients of other GPs wait 13 months for an appointment? If that is not queue-jumping, what does the Secretary of State call it? How can he explain the position in Surrey and in St. Albans, where consultants are being placed under pressure by managers to give priority to GP fund holders because they bring extra money? If the Secretary of State does not recognise that as an example of two-tier lists, what will he recognise as such?

I shall answer the Secretary of State's question. [HON. MEMBERS: "Ah."] I welcome the fact that the Secretary of State is getting in practice and asking the questions to which I give the answers at Question Time, as it is a situation to which he shall have to become accustomed. The next Labour Government will end GP fund holding, because we shall not tolerate a two-tier list system in which the length of time a patient waits depends on the size of the GP's budget. There is a phrase for that policy—double standards. The Labour party will clear it out of the NHS.

I offer the hon. Member for Livingston (Mr. Cook) my heartfelt thanks for giving what is almost the first straight answer that I have ever extracted from him. I believe that he has, in a single word, delivered to us the votes of the majority of general practitioners in the country, for which I am most grateful. I urge him to study the remarks of Professor Glennerster, who knows rather more about this matter than he does and has laid the two-tier rumours to rest once and for all.