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NHS Finance

Volume 456: debated on Tuesday 6 February 2007

11. What assessment she has made of the effect of GP and consultant pay rises on NHS finances; and if she will make a statement. (118594)

By next year, this Government will have trebled investment in the national health service compared with 1997, including substantial extra funding for GP services and a new consultant contract. That has led to 32,000 more doctors in the NHS compared with 1997, and the improving or refurbishing of more than 2,800 GP premises.

GPs and consultants are both dedicated and hard-working. Parts of the NHS are clearly short of funds, yet there has been a recent fifteenfold increase in consultants’ pay, and GPs earn, on average, more than my chief constable, considerably more than a brigadier and nearly four times average teachers’ pay. Is it not therefore time for us to draw a clear line between the money paid to GPs and consultants to do their job, and the money that they have to provide services?

I am very interested in the implication of what the hon. Gentleman has to say, and I am sure the British Medical Association will be too, since he seems to be proposing a reduction in GP pay. The reason why GPs are paid significantly more under our new contract is that we were determined to deal with the parlous state of general practice that we inherited from the hon. Gentleman’s party and his Government, when thousands of GPs were taking early retirement and medical students simply did not want to become GPs. As a direct result of our new contract, GPs are doing far more to prevent ill health and far more to support people with long-term conditions. The result, as a recent international survey showed, is that our general practice is among the best in the world.

Does my right hon. Friend remember that before 1997 the general public were concerned about the brain drain of doctors going to work in other countries, and will she make sure that we do not return to those days by ensuring that we pay doctors properly?

My hon. Friend is right, and I am proud of the fact that we have more than 32,000 GPs, which is a rise of more than 4,500 compared with 1997, and very nearly double the number of GP registrars in training. That shows that the investment, improvements and reforms that we are making in the NHS are paying off for GPs and their patients. All of them would be put at risk by the policies of the Conservative party.

The Government negotiated a new contract with GPs, defined in it a series of outcomes that the Government presumably want, and linked the payment of improved remuneration to GPs to the delivery of those outcomes. The Secretary of State then made a speech blaming GPs because their income has gone ahead of her budgetary expectations. Is it not hardly surprising, therefore, that morale among GPs is low and that there is a divorce between them and the Government? The GPs feel, “If we’ve delivered what the Government wanted, what more can we do?”

I am very surprised that the right hon. Gentleman has not welcomed the fact that there are 360 more GPs in our east midlands region than there were when he left office. We did indeed negotiate with the BMA a performance-related pay contract. Because GPs are doing so much more than we anticipated at the time, particularly on prevention and long-term conditions, they are rightly being paid more. We will of course continue our discussions with the BMA, in order to ensure that the public go on getting the best possible value from that contract, but now that we are giving GPs even greater freedom and responsibility with practice commissioning, I have no doubt that the services that patients receive in the community from general practice will continue to improve under this Government.

My right hon. Friend will know that I had the pleasure of welcoming her excellent Minister of State, my hon. Friend the Member for Leigh (Andy Burnham), to Leicester, East, where he launched a new £12.8 million GP centre for my constituency. I agree that it is important that we should pay GPs a proper salary, but what responsibility will she place on them to ensure that they provide more training contracts for trainee doctors? I have heard anecdotal evidence of students going through medical school and coming out to find that there are no jobs for them. Can my right hon. Friend ensure that there is more responsibility on GPs to ensure that that does not happen?

I am delighted to hear my right hon. Friend’s praise for the new GP centre and new health centre in his constituency, and I know that it is excellent. I am glad that the number of GP registrars in training has doubled, as I have said. Although we have some 300,000 more staff in the NHS than in 1997, some newly qualified graduates are finding it difficult to get jobs this year. However, I am glad to say that there are some 2,000 more training places available for new doctors than there are medical graduates in England. I hope that that reassures my right hon. Friend.

Is not the real point of public concern the one raised by the hon. Member for Cannock Chase (Dr. Wright) in Prime Minister’s questions last week, when he asked the Prime Minister—and received no satisfactory answer—why GPs are being paid considerably more and doing considerably less in the way of after-hours and weekend service?

I stress that if a GP practice has decided not to carry on taking responsibility for out-of-hours services—and most of them chose not to do so—it does not get paid for that service, which is then the responsibility of the primary care trust to provide. In most places, that system works very well. GPs are earning more because they are doing more. In particular, they are doing more to care for people with long-term conditions, such as coronary heart disease, and there are thousands of people who are alive today as a direct result of the new contract. I would have thought that the hon. Gentleman would want to congratulate GPs on that achievement.

Will the Secretary of State tell us why on 17 January she told the BBC that the Government should have insisted that the new GP contracts limit the profits that hard-working GPs can earn in relation to total income, but on 4 February she told ITV that she did not believe in capping GP profits? She is all over the place. Will she tell the House her view today?

I have made it clear ever since I became Secretary of State for Health that part of our responsibility is to ensure that we get the best possible value for the increased investment and contributions that we have asked all our constituents to pay. As I have indicated, the main reason GPs are being paid significantly more is that they are doing more under the quality and outcomes framework. It is also true that a number of GP practices are taking a larger share of the practice income as profits. That is of course an issue that we will continue to discuss with the BMA to ensure that the increased investment that we are making in GP practices continues to be reinvested for the benefit of patients, as well as giving GPs the fair return that they deserve.