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General Practitioners (Opening Hours)

Volume 473: debated on Tuesday 18 March 2008

I have received representations from GPs and the British Medical Association, as well as from patients and patient groups. I am pleased that the BMA has agreed new arrangements for GP practices to be open in the evenings and at weekends. The new arrangements will benefit patients, the NHS and GPs.

I thank the Secretary of State for his answer. Do the Government have any plans to force GPs to open for a set number of hours? Does he agree that forcing them to open for extended hours in the evening when there is no demonstrable need would have a knock-on impact on the general quality of primary care services?

The answers are no and yes: no, we will not force any GPs to open longer; and yes, there would be an adverse effect if we were to do what the hon. Lady suggests. Our negotiations with the BMA were based on getting GPs to open for an extra half an hour for every 1,000 patients on their books, which would mean that an average-sized practice would be open for an extra three hours a week. A much smaller practice would not be open for so many extra hours, while a much bigger one would be open for more. Our formula takes into account the fact that in many areas—rural areas, for instance—there is no need or demand for GPs to be open longer.

In the ballot that was held, 92 per cent. of GPs who voted accepted a system that will not force them to do anything that they do not wish to do. However, the system will ensure that the taxpayer’s money that is there to incentivise GPs will, among other things, give them an incentive to open for longer. That is what the patients in the vast majority of our communities want.

Does my right hon. Friend agree that the flexibility to which he has referred should reflect the fact that a town may have a walk-in centre that also provides health services? In his discussions with the BMA and GPs, has he been able to make it clear that there will be no financial disincentive for GP practices in areas where such walk-in centres exist? Sometimes, as is the case in my area, a GP practice and a walk-in centre are located in almost exactly the same premises.

My hon. Friend makes a good point. Along with the BMA, we will be implementing the process. The BMA has made it clear that now that it has the ballot result it will work with us. Our ambition will be to ensure that there are no unintended consequences. My hon. Friend is probably right to say that the availability and accessibility of walk-in centres are fine as they are. As a result of the process, we expect about 50 per cent. of GP practices across the country to be open for longer. That will get the balance right and probably, with the 250 new GP practices that we are introducing across the country, which will be open from 8 am to 8 pm—150 of them, seven days a week—it will give the required choice to customers who want to visit their GP later in the evening or on Saturday mornings.

May I confirm what the Secretary of State has already said? Many GPs in my constituency have contacted me to say that most of their patients are either the elderly retired or mums with young children and there is simply no demand to open practices until 8 o’clock at night. I encourage the Secretary of State not to impose a one-size-fits-all solution on areas such as mine in South-West Devon.

I do not accept the argument that patients who are mainly older people and young mothers do not want surgeries to be open for longer. To me, that is in the same category as the comment of a BMA representative, who said that accountants did not open more than five days a week so why should GPs. The evidence is that where surgeries are open for longer—for example, in Tower Hamlets, where they recently opened on Saturday mornings, or Kingston, where there has been such a service for much longer—the people who visit them on Saturday mornings are indeed elderly people and mothers with young children, who welcome the choice of going there either in the week or on Saturday mornings. I really think we shall find that there has been a bit of a myth, although I accept the hon. Gentleman’s point about rural areas, which relates to my original answer.

It is now accepted that the Government originally mismanaged the GP contract negotiations, leading to an overspend of £1.76 billion. To address that imprudent miscalculation, the Government have reneged on agreements, including renegotiating the GP contract and unlawfully capping GP pensions. GPs are demoralised and disengaged; 97 per cent. of GPs have no confidence in the Government’s handling of the NHS—

Order. The hon. Gentleman must not make a speech. He should ask a question, but he has not asked one so far. Perhaps the Secretary of State could try to answer, because I have to get down the Order Paper and I am getting rather fed up with Front Benchers taking too long.

I think Opposition Members are on the wrong side of the argument about GP access. They are also wrong to say that the new contract in 2004 was an error—[Hon. Members: “Oh.”] Or erroneous? That contract was designed to address a situation in which GPs were largely leaving the service and no medical graduates wanted to be GPs. We were facing a huge shortage and, incidentally, under the old arrangements, GPs were disgracefully underpaid and worked for too long. I think we did exactly the right thing. Yes, one of the consequences is—

Yes, because now GPs work 17 per cent. less—the number of hours they work has fallen by 17 per cent.—