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General Practice (Northamptonshire)

Volume 464: debated on Tuesday 9 October 2007

I am sure that you have had a busy and productive morning, Mr. Taylor, but I suggest that this debate will be the highlight of your entertaining morning. I thank Mr. Speaker for granting me permission to hold the debate, and I also thank general practitioners throughout Northamptonshire and all their staff for the wonderful job that they do for people in Kettering and across the county.

One of my reasons for seeking today’s debate is that when we talk about the national health service, all too often we talk about hospitals and do not spend enough time talking about GPs. Yet most people’s most frequent contact with the NHS is through their local family doctor. Having talked to GPs in Northamptonshire, I know that their impression is that they are an overlooked part of the NHS. When the Government talk about schools and hospitals, they should not forget that GPs provide an extremely important part of our NHS.

The hon. Gentleman has rightly said that we should value GPs, that they ought to have more priority and that there is too much emphasis on hospitals. How does he feel that ripping up GPs’ contracts will enhance morale amongst GPs in his community?

I am not suggesting that GP contracts should be ripped up. If the Minister wants to expand on his question, I will be happy to tackle it.

May I say gently to the hon. Gentleman that at his party’s conference, the shadow Secretary of State for Health announced his intention to rip up GPs’ contracts and start again. I assume that the hon. Gentleman is bound by the policy of those on his own Front Bench.

The purpose of today’s debate is not, from my perspective, a party political one. I am a Back-Bench Member of Parliament, I speak my own mind on these issues and I am disappointed, to be blunt, with the Minister’s tone in these opening exchanges. For me, the purpose of this debate is to draw his attention, as a Minister of the Crown, to the future of general practice in Northamptonshire. I suggest that whether I am a Conservative or Labour Member, many of the things that I shall say today are comments that any MP would want to put to him.

One of the biggest and most important issues affecting GPs in Northamptonshire is the fact that it is a designated growth area. The population of the county is due to increase by between one third and one half in the next 15 to 20 years. I should like the Minister to clarify how PCTs are funded in that respect. It is certainly the impression of local GPs that PCT funding is determined by the number of patients who are registered with GPs rather than the actual number of people resident in the area. One statistic that I have been given is that there are an estimated 20,000 unregistered patients in the county town of Northampton alone. Such people tend to make extensive and often inappropriate use of accident and emergency facilities at a cost to the PCT under the payment by results plan, which means that resources that could be provided to local GP practices are not being provided. The Government’s own statistics, given in answer to one of my parliamentary written questions, told me that the average practice list size of a GP practice in Northamptonshire is 8,000 patients, which is 30 per cent. above the national average of 6,000. Even before the very rapid increase in population that the Government have planned for Northamptonshire, general practice list sizes in the county are already one third above the national average.

I congratulate my hon. Friend on securing what is an important debate for Northamptonshire. Is he aware that in many areas in my constituency it is almost impossible to get on to the list of a GP practice? I had a case in which an 80-year-old who came to the town could not get on to a list. She had to apply and was put on a list elsewhere in the town. That has occurred before the growth has taken place.

I know that my hon. Friend attaches great importance to health service issues as part of his “Listening to Wellingborough and Rushden” campaign, and I am delighted that he has taken this opportunity to highlight what is a real problem for many vulnerable people in Wellingborough and Kettering. Often, several members of the same family will find themselves being registered with different local GPs, which cannot be the best outcome.

An increasingly important issue in Kettering and Northamptonshire is the number of people arriving from eastern Europe and seeking GP services. That is causing problems for GPs with language—many such people are unable to speak proper English, especially when it comes to medical terms—and with gaining access to previous medical records. Every GP to whom I spoke in the summer recess said that they had new arrivals from eastern Europe on their books and that it is a genuine problem for them. Many GPs feel that it is inappropriate to include translation services, which are paid for by the PCT, in the enhanced services budget, because the PCT can then claim that it spends more than the indicative sum on enhanced services. That effectively deletes the money that is available for the development of medical GP services. Will the Minister be kind enough to look into that important issue?

GPs are also concerned about the recent NHS reorganisation in the county. The PCTs that existed two years ago have been merged into one PCT that covers the whole county. My hon. Friend the Member for Wellingborough (Mr. Bone) and I opposed that reorganisation, as I understand Labour Members in the county did, but the Government nevertheless went ahead with it. The problem is that part of the big overspend in the south of Northamptonshire has effectively been transferred to the north, where the overspend was not nearly as great, putting budgetary pressures that did not previously exist on GP practices in the north. As a result, GPs are prescribing cheaper drugs than they would otherwise prescribe because of the budgetary pressures from the PCT and the strategic health authority.

Another big concern that local GPs have brought to my attention is the state of children’s mental health services in the county. One GP wrote to tell me:

“I think the most significant aspect of healthcare in the Shire is the poor service available in Mental Health and particularly Children’s Mental Health. Only this week…we have a 13-year-old girl with…an Eating Disorder who has been dismissed as “depressed” by the Service and she is too young to access alternative services so her (not well-heeled parents) are referring her privately.”

The letter goes on:

“If young people’s mental health problems are not properly addressed, they are at best emotionally scarred for life and grow up to be emotional cripples, unable to sustain healthy relationships, and at worst end up in crime”

or on drugs. All the GPs to whom I spoke highlighted that as being an issue—patients requiring services that, all too often, simply are not available.

It has been brought to my attention that computerised cognitive behaviour therapy has been proposed by the National Institute for Health and Clinical Excellence as an effective tool for many patients. It was announced some six months ago that CCBT would be available. It is due to become available in Northamptonshire this month, but the responsible PCT team has only just been appointed. To add further insult, access to the therapy is being restricted to patients with severe depression, whereas NICE recommends it for mild depression and neuroses such as obsessive-compulsive behaviour. Again, there is a real concern that GPs are not able to access the services that they would want to access from the local mental health team.

GPs are also concerned that they are required to spend a growing amount of time on collecting and producing data under the quality and outcomes framework. They rightly say to me that, all too often, they spend far too much time on data processing instead of patient care, particularly as they have to deal with lists that are 30 per cent. above the national average.

Unfortunately, there are also problems with the choose and book scheme. One example that I can put before the Minister is from a local GP who referred a patient through choose and book for orthopaedics. The GP phoned the number, and someone took the details and said that the patient should phone the office where orthopaedic referrals were triaged. The GP phoned the number, but an answerphone said that staff were on holiday for two weeks and to phone another number. The GP phoned the other and was told that the office was not taking bookings like that but that it would wait for a GP letter and then write back. Two weeks later, a letter was received advising that the patient needed to see an orthopaedic consultant and to phone yet another number. The GP phoned the number six times, each time being cut off when the phone was answered. The GP finally got through and was told that the phone “is always doing that”. Those are frustrating circumstances for hard-pressed GPs. They made a particular point of wanting me to highlight the fact that choose and book is not working as it should.

Now we come to the issue of GP contracts. In good faith, the Government negotiated contracts with GPs. Reference was made to out-of-hours services. NHS survey data published in July show that 85 per cent. of patients in Northamptonshire are satisfied with GP surgery opening hours. Only 7 per cent. of patients said that they would like GP surgeries to open at weekends. There may be demand for surgeries to open in the evenings and at weekends, but having asked my constituents and having spoken to GPs, I can detect no such surge of opinion in Kettering or Northamptonshire.

GPs rightly say that they would expect few people to take advantage of the service if they were to open for weekend surgeries. They also point out that although the Government may be pressing the issue because they are embarrassed that, in their view, they are paying GPs more than they should get, there would be extra costs outside the GPs’ remuneration for paying for staff and building occupancy at weekends.

Local GPs provide an out-of-hours service through the Keydoc service. It is provided on a rota basis, and I can tell the Minister that it does a better job than NHS Direct, and at a far lower cost. In many cases, phone callers find themselves speaking with the Keydoc service because NHS Direct is unable to cope with the volume of calls that it gets. I am not saying that Keydoc is perfect. I have had complaints about it, but I have also had complaints about NHS Direct. I draw the Minister’s attention to the concerns of a constituent who e-mailed me. He stated:

“I today had occasion to contact the NHS Direct service. I needed medical advice after swallowing an object…I tried to call for over 4 hours and constantly received an engaged tone. In the end I contacted my GP surgery who were able to reassure me. A quick straw poll of work associates shows this is typical and generally they call the out of hours GP service because NHS Direct is either busy or is so general in advice that it is not sufficient for purpose.”

That unsolicited e-mail was from a constituent in Rothwell. Local GPs are concerned about the amount of money that the Government put into NHS Direct, particularly when they compare its cost-effectiveness with that of Keydoc.

Overall, the message from Northamptonshire is that GPs are extremely hard-working. In general, the system is working well, but GPs are beginning to feel unappreciated by the present Government, particularly in respect of the unnecessary pressure to extend opening times outside the weekday appointments system. There is growing concern about the amount of data that they have to collect, and they feel that the Government ought to reprioritise GP care rather than concentrate only on hospitals when they talk about the NHS.

I close by placing on the record three surgeries in the Kettering constituency that in a recent NHS survey achieved levels of satisfaction that were higher than the national average. The Guilsborough, Dryland and Mawsley surgeries are setting an extremely good example for local GP surgeries throughout Northamptonshire.

It is always a pleasure to serve under your chairmanship, Mr. Taylor. I congratulate the hon. Member for Kettering (Mr. Hollobone) on securing this Adjournment debate. The intervention of the hon. Member for Wellingborough (Mr. Bone) was obviously important from his constituents’ point of view. I have to say, as a Manchester City supporter, that he would be greeted in a positive way if he were to venture into Manchester these days, in view of his well-known likeness to a certain high-profile football manager.

Seriously, this is an important debate, and the hon. Member for Kettering raised some valid, legitimate issues on behalf of his constituents. I do not wish to be churlish, but the emphasis and focus of his speech were disingenuous. I shall explain why it is fair to say that.

First, the hon. Gentleman said to GPs in his community that he and his party are on their side and that the Government are doing things to the national health service that are getting in the way of their doing their job. That was his main message. He used anecdotes about individuals to prove a point. I always think that it is unfair to try to talk down the NHS by doing that, as 99 per cent. of anecdotes would demonstrate that people receive a wonderful service.

I suspect that the hon. Gentleman wrote his speech before the announcement at his party’s conference about ripping up the contract that GPs and the Government recently signed. That is now the position of the Conservative party. It has gone down incredibly badly with GPs at a time when the Government’s message is that, yes, we need to make significant changes to primary care, but that we intend to do that in partnership with the profession, building on the contract rather than simply ripping it up and starting all over again. The Conservative policy is putting his party into conflict with GPs who are working hard every day of the week to improve the NHS.

I shall make some progress and then give way to the hon. Gentleman. Major progress has been made in Northamptonshire. All Northamptonshire patients are able to see a GP or a nurse for a routine appointment within 48 hours; Northamptonshire practices achieved an average of 960.1 quality points out of a possible 1,000 in the quality and outcomes framework, and 74 per cent. of the population aged 65 and above have been vaccinated for influenza. Across Northamptonshire, all practices have open lists and are accepting new patients—the hon. Gentleman disputes that—and several practices employ highly skilled nurse practitioners who provide a range of services from the management of long-term conditions to diagnosis and treatment of minor ailments.

The performance of the health service in the hon. Gentleman’s constituency has advanced massively in the past 10 years. He will not like my saying this, but a significant reason for that is the near tripling of investment in the NHS that the Government chose to make. The NHS had been starved of resources in the previous 20 years, which meant that the baseline of NHS funding was a scandal when compared with other countries around the world.

The hon. Gentleman is right about growth. The Northamptonshire PCT received growth area adjustment in its 2006-08 revenue allocation to take account of the demographic issues that he properly raised.

I will give way in a moment. I shall provide some recent information, which is not made up, about what is happening in the hon. Gentleman’s health economy area. Six large extensions opened in 2007—three in Northampton, two in Corby and one in Daventry—and a new surgery has opened in Higham Ferrers in east Northamptonshire. Two large new medical centres will open within the next nine months in Rothwell and Kettering, and an extension is due for completion in December in Northampton. There are plans to develop health facilities in Kettering, Thrapston, Raunds, Corby and Northampton, and the south midlands LIFT project will see the development of new facilities in Corby, Wellingborough and Northampton.

A new approach to service delivery will involve a series of health hubs providing a wide range of services along the lines of polyclinics. Willowbrook community hospital polyclinic in Corby will have investment of £27 million, and the integrated care centre polyclinic in west Northampton will have investment of £21 million.

My point is that there is now massive, unprecedented and sustained investment in primary care in the constituencies of the hon. Members for Kettering and for Wellingborough. That recognises that patient expectations, technology and science means that health care must be incredibly different if we are to make best use of the new technology and new drugs being created almost daily, and if we are to respond to patient expectations.

I understand the Minister’s case, but unfortunately it falls flat when it comes to Northamptonshire PCT because under the national capitation formula, which the Government set up to decide how many millions of pounds each PCT receives, Northamptonshire has received less than 100 per cent. in each and every year since that formula was implemented. Over the past few years, that has equated to £110 million. If the Government implemented their own programme, we would not have a problem, but they do not do so in Northamptonshire.

I shall deal with that accusation head-on. In 2006-07, the allocation to the PCT increased to £730 million—a cash increase of 12.7 per cent. In 2007-08, it received £870 million, which is a further cash increase of 12 per cent. That is a cash increase of 26.3 per cent. over the two years 2006-07 and 2007-08, compared with a national average of 19.5 per cent. The funding formula and the funding system recognise that the hon. Gentlemen’s constituencies have particular issues and challenges that must be addressed.

No. It is exceptionally disingenuous for hon. Members who represent a political party that slashed NHS spending in every part of the country to come here and undermine the massive additional, above-average investment in their communities. We should remember that during the past seven or eight years, that party has repeatedly opposed the additional investment that the Government have chosen to put into the national health service.

It is important that we do not mix up the debate about out-of-hours and emergency services provided by GPs with extended hours in terms of evening and weekend opening. Under the previous system, GPs often worked until midnight or 1, 2 or 3 o’clock in the morning, and then went back to their practices at 8 am to see patients. That was an unreasonable set of expectations and did not necessarily lead to the best possible, safe patient care. Under the new contracts, GPs were given the option of saying that they no longer wanted to provide emergency or out-of-hours cover, and the PCTs were given responsibility for securing that out-of-hours cover.

The argument about extended hours is that because of labour market realities, choice and preference, many patients would like to be able to see their GPs in the evenings or at weekends. That would be more convenient for patients and a more personalised service. That is the next stage in the NHS transformation that the Prime Minister, Lord Darzi and the Secretary of State have spoken about. Having fixed the NHS and rebuilt its foundations, we must now move to a highly personalised service. I find it astonishing that any Member would stand up here and say that patients are not entitled to that and do not want that. Surely we should create an NHS that continues to be increasingly responsive as society changes. Let us not mix up emergency out-of-hours cover with extended hours and more convenience for patients.

This is the 10th debate on local issues that I have managed to secure, with the permission of Mr. Speaker, in the past two years, and this is the most inappropriate party political response that I have had from any Minister. This Chamber should be a genuine forum for Back-Bench Members to raise genuine constituency cases. I was not making any political points whatever. Will the Minister confirm that NHS spending in Northamptonshire is based on registered patients at GP practices, and not on the population? On extra opening times for GP surgeries, I was simply quoting to the Minister his Department’s survey data, which show that 85 per cent. of patients in Northamptonshire are satisfied with the current opening hours of GP surgeries.

The tone of the hon. Gentleman’s presentation was to talk down the NHS and its performance, and to use anecdotes to say that the Government’s desire to respond to patient preference and choice is misguided. He did not refer to the fact that at his party’s conference, the shadow Secretary of State waged war on the GP profession by saying that the Tory party’s position is to rip up GPs’ contracts.

The hon. Gentleman rightly referred to access to children’s mental health services. The Government have begun to rebuild child and adolescent mental health services—CAMHS—and have put a lot more money into them, but there is a long way to go because, as you are aware, Mr. Taylor, such services were practically non-existent in many parts of the country back in 1997-98. We have two trailblazers and another 11 are starting now. Access to talking therapies through primary care in every community is something that I am proud of, and later today there will be further announcements about health spend over the next three or four years. It is important that, in future, there will be greater emphasis on investing in talking therapies, which can make a massive difference to people’s quality of life and mental health. There was no access to talking therapies in this country when we came into government, and people waited months and years for an operation. By next year, people will wait a maximum of 18 weeks.

The hon. Gentleman’s community should respond positively to the Darzi interim review proposals. There will be more than 100 new GP practices, including up to 900 GPs, nurses and health care assistants in the 25 per cent. of PCTs with the poorest provision. It may well be that the hon. Gentleman’s constituency could benefit from that. New resources will enable PCTs to develop some 150 GP-run health centres, with up to 1,750 GPs and nurses situated in easily accessible locations and offering a range of services to all members of their local population. As a result of last week’s interim review announcement by Lord Darzi and the Secretary of State, the hon. Gentleman may be able to secure even more resources for primary care for his constituents.

The hon. Gentleman raised valid and legitimate issues, but it is important that we do not allow people to suggest that the health service has not advanced massively. In our vision for transformation, personalisation is the next stage, and the Government will match that with continued and sustained record levels of investment.

Question put and agreed to.

Adjourned accordingly at Two o’clock.