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Family Doctor Services

Volume 474: debated on Wednesday 23 April 2008

I inform the House that I have selected the amendment in the name of the Prime Minister in both of today’s debates.

I beg to move,

That this House supports the family doctor service, and recognises that it is the first point of contact for the majority of patients; further recognises the invaluable role that GPs have in the NHS; regrets the undermining and undervaluing of GPs by the Government; is concerned about the lack of empirical and clinical evidence for the establishment of polyclinics in every primary care trust; opposes the central imposition of polyclinics against local health needs and requirements; is further concerned about the delay in publishing evidence on the cost-effectiveness of walk-in centres; believes that patients should be able to choose the most convenient GP practice, whether close to home or work; calls for GPs to be given real budgets, incentives to make savings, the freedom to re-invest for their patients and the ability to innovate in contracts with healthcare providers; supports rewarding GPs who choose to provide services in deprived areas or areas of expanding population; and further supports the incorporation of patient-reported outcome measures into the Quality and Outcomes framework and the development of structures and services in general practice that are designed by GPs and primary care providers in response to patients’ needs and choice.

The purpose of the motion is straightforward. Through the new contract with general practitioners, the Government had a major opportunity to revive general practice in this country, and to rebase the NHS in patient-centred care and primary care-led services. They failed to do that; by contrast, they have entered into a conflict with general practitioners that will undermine the service. The Government are taking an approach to the reconfiguration of primary care services that matches the dangers of the approach that they took to reconfiguration of secondary care. The progressive centralisation of services, the progressive undermining of access to care, the progressive undermining of the ability of clinicians across the NHS to determine what is best for their patients—those are the tragic consequences of the Government’s failure to negotiate the GP contract successfully. Their mean-minded approach is not to negotiate in partnership with general practitioners, but to try to arrive at a solution that cuts costs and centralises services, while undermining the independence and clinical effectiveness of general practice.

Does my hon. Friend agree that perhaps the single most popular feature of the national health service is the trust that patients have in their family practitioner, but that the Government are absolutely determined to prove that they do not trust family doctors any more? We have to rebuild that trust.

My hon. Friend is right. I have heard exactly that from GPs in his constituency, who fear that a polyclinic will be established in or near Salisbury, the effect of which will be to force the closure of other GP practices and undermine the relationship with patients.

Let me remind the House what the evidence tells us about the benefits of a strong primary care system. In the context of examining why the American health care system did not deliver successfully for Americans, which is an interesting subject, given the nature of the current debate on health care in the United States, Barbara Starfield, who is the professor of health care management at Johns Hopkins university in America, concluded:

“There is no single or simple answer, but a large part of the story—and a part that is commonly overlooked—is precisely the predominance of specialist care over primary care.”

She went on to say, and this is a good definition of primary care:

“Primary care deals with most health problems for most people most of the time. Its priorities are to be accessible as health needs arise; to focus on individuals over the long term; to offer comprehensive care for all common problems; and to coordinate services when care from elsewhere is needed.”

She continued:

“There is lots of evidence”—

indeed, there is international evidence—

“that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.”

In light of that evidence, which demonstrates how successful primary care can be, I find it utterly astonishing that today, when we tabled a motion whose purpose is to support general practice and the family doctor service and to stress the importance of the relationship between patients and their doctor and the importance of continuity of care, which is so lacking in other parts of the health care system, the Government’s amendment fails to support the family doctor service and focuses on their current ideological fixation in favour of large polyclinics, and in the process undermines precisely the continuity of care and the relationship between doctor and patient that the evidence suggests is so integral to the successful delivery of services.

Does my hon. Friend share my concern that the Government’s proposals represent a national template to be imposed on primary care trusts, with no thought given to social inequalities and need at the local level, or to the need to open more GP surgeries in areas of deprivation in our constituencies, rather than the Government’s one-size-fits-all approach?

My hon. Friend raises an important point. In the course of the GP contract negotiations, the move towards a quality and outcomes framework had real potential, but as the National Audit Office report published earlier this year set out starkly, in order to try to secure agreement with general practitioners the Government took a large amount of that money out of the pot and put it into the minimum practice income guarantee. Over the intervening years, the system of remuneration for GPs has not impacted on list size and need as it should have done, which would have helped the most deprived areas; nor has it incentivised more doctors to come into those areas.

The Government’s and everyone else’s purpose in starting to negotiate the new GP contract back in 2002 was to deal with problems of recruitment and retention. Recruitment in deprived areas was most difficult and it remains difficult. The Government’s response should have been to deal with that problem, not to try to impose a solution everywhere else. By encouraging PCTs to offer new practices in under-doctored areas, the Government are saying now the same thing as they said in 2006 in the community White Paper, which we supported throughout. However, it is wholly wrong for them to seek to impose a polyclinic system in London and across the country, including in the most under-doctored areas, which would deprive many people of access to GP surgeries in their local neighbourhood.

Does my hon. Friend agree that there is a danger that if patients do not have a named doctor—an individual doctor to whom they can relate—they may not report illnesses as soon as they should, which will add to the burden of costs to the health service?

My hon. Friend is right. In an article in the British Medical Journal on 22 March 2008, Martin Roland, professor of health care at the university of Manchester and director of the National Primary Care Research and Development Centre, said:

“The UK system of universal registration with a single general practice promotes equity, provides a ‘medical home’ for coordinating care, and is an effective mechanism for holding providers to account for the quality of care provided.”

That is where my hon. Friend is coming from. That relationship between patients and their doctor is instrumental in delivering effective care, but the Government are determined to undermine it. [Interruption.] The Secretary of State says “Rubbish,” but he should look at what his own PCT is proposing in Hull. In a document, which I have seen, the purpose of which it acknowledges is to reconfigure GP care in the area, it says that its objective is to have fewer GP sites—by which I think it means practices—and to put polyclinics down in Hull. Hull is an under-doctored area, as the Secretary of State knows perfectly well. Of course there is a case for additional practices, but the consequence of the polyclinic plan will be that some of the existing practices will be shut down, and that will not enable services to be delivered more effectively in the area.

My constituency is in a rural area outside Hull, and it is rural areas that are particularly concerned about the proposals. They suffered when the Government tinkered with dentistry and my constituency has seen a major loss of dentistry services. The idea that the Secretary of State and the Government will now be tinkering with GP services horrifies my constituents.

I agree with my hon. Friend. The impact on rural areas is one of the most significant and worrying aspects of the way in which the Government are going about this. I have been to many places throughout the country. Not so long ago I was talking to GPs in Worcester and to the local medical committee in Cornwall. One can imagine the situation: there are practices throughout Cornwall and the Department of Health tells the local PCT that it must have a polyclinic, but there is no obvious place for it, so it is just popped down next to a GP practice somewhere and practices in many neighbouring areas close down as a consequence.

There are different models of care in different parts of the country. Interestingly, the south-west has some of the largest practices in the country—for example, I went to Frome—for the simple reason that sometimes a network system between a large GP practice and satellites is one of the most effective ways of ensuring access to neighbouring villages. But scrapping all that and not having an organic system that is developed by GPs themselves, in favour of the polyclinic system where GPs do not have independent contractor status and can no longer design services for their area’s needs, will undermine access in rural areas at precisely the moment that towns and villages throughout the country are losing their post offices, shops, pubs and public services. Their GP surgery is one of the critical elements that they now perceive is under threat.

They are also losing their dispensaries. Is my hon. Friend aware that 8.5 million patients are in GP practices that dispense drugs? Under the Government’s White Paper on the future of pharmacy services it will be almost impossible for GPs to dispense drugs in the future. Why on earth remove patient choice in this way? This is yet another service that will be lost in villages in my constituency and colleagues’ constituencies.

Yes, I am interested in what my hon. Friend says because in one particular respect the effect of the pharmacy White Paper, which was published during the recess, may well be to undermine dispensing by dispensing doctors, and it may all be part of a common process by the Government. The polyclinics are expensive beasts; they cost about £800,000 each, so money has to be raised for them. I suspect that in many cases the Government intend to ensure that they have a large pharmacy, which will take the pharmacy profits, and the dispensing doctors in local surgeries will lose out and shut down as a consequence.

I caution the hon. Gentleman to go a little further down the line of variation around the country. Wolverhampton is one of the most deprived cities in the country. We have the excellent Phoenix medical centre, which might be termed a polyclinic, which is expanding its hours because it is so popular, and many of the services that it offers have been taken from the acute hospital, not from GPs. Correspondingly, the Castlecroft medical centre, with which I am registered, is building a brand new GPs’ surgery, and the Mayfields medical centre, which opened recently, has a pharmacy alongside. The configuration in different parts of the country is different, and in Wolverhampton we will have three new GP practices from the Government, which are welcome because we are under-doctored.

The hon. Gentleman has not been listening carefully, and he cannot have read the speech by my right hon. Friend the Member for Witney (Mr. Cameron) to the King’s Fund on Monday. My right hon. Friend made it clear that we do not oppose change in general practice, but it must be driven by GPs themselves. [Hon. Members: “Why?] It must be driven by GPs in response to the needs of patients—it would be useful if the Secretary of State were to read the Opposition motion. The Government amendment does not provide any evidence that the Secretary of State sees any role for GPs or clinicians in interpreting the needs of patients, so I do not know how he thinks that patients’ needs will be met.

For the PCT to contract with additional practices to provide additional services in under-doctored areas is fine—we have always said that, and there is no reason why it should not go ahead. There is no reason why services that can be delivered more effectively in the community should not be delivered in the community, and there is no reason why GPs should not be able to commission services from a hospital or a community provider transferring services into the community. Sometimes, the hospital itself can provide those services, which certainly can involve diagnostic and treatment services. There will even be places where GP practices conclude that their premises are so poor that they need to come together in larger practices and premises. None of that causes me any problem at all.

As the hon. Member for Wolverhampton, South-West (Rob Marris) represents a constituency in Wolverhampton, perhaps he has not carefully examined the Darzi plan in London and what is being rolled out in every PCT across the country in a one-size-fits-all fashion: the creation of polyclinics. The Darzi plan in London makes it clear that a polyclinic is 25 GPs occupying 16,000 sq ft costing £800,000 a year with all the services in that place. Where are those polyclinics being put? Last week, I was in Bexley, where a polyclinic is being located on the site of Queen Mary’s hospital, Sidcup. In Epsom, a polyclinic has been proposed for the site of St. Helier hospital. That is not taking care closer to home; that is centralising primary care, which will take it further away from the people whom it is meant to serve.

The hon. Gentleman seems to regard GPs as being at the centre of the infrastructure. How can we ensure that the best interests of patients are represented? What assessment has he made of the fact that GPs are most likely to commission services from themselves in areas in which they have a specialist interest? Is there not a conflict of interest, and where is the scrutiny when we discuss the best use of taxpayers’ money?

Last October, we published our document, “The patient will see you now doctor”, which the hon. Lady has probably read. In that document, we made it clear that there must be a mechanism by which, beyond the boundary of the primary medical services contract, GPs can commission services from connected providers or providers that they control only in circumstances in which there has been a tendering process controlled by the PCT, which would prevent them from handing business to themselves. That is one of the problems with GP fundholding that needed to be sorted out. The Government have not sorted it out because the same problem is occurring in places where there has been any progress on practice-based commissioning.

The hon. Lady also raised the issue of a voice for patients. We have repeatedly made it clear in this House that we need a strong voice for patients. We need “health watch” locally and nationally to make that happen, but where general practitioners are concerned, we also need the exercise of patient choice. Again, it is interesting to quote Martin Roland from Manchester:

“The NHS goal of providing patient choice in primary care is not realised in many parts of the country where patients have little real choice of practice. Increased patient choice requires more high quality practices, not the small number of large practices that some polyclinic models suggest. We know that patients in small practices rate their care more highly in terms of both access and continuity. Indeed, although small practices show more variation in quality, on average, they achieved slightly higher levels of clinical quality than larger practices in the quality and outcomes framework.”

So having more high-quality practices, which include many smaller practices, is the route down which to go. Our patient choice proposals are similar to some that the Government made in the community White Paper of 2006. They are about making sure that when patients move from one practice to another, proper capitation follows them and to ensure that practices with open lists cannot be declared full when there is no justification for that.

Those proposals are precisely the mechanisms to make sure that general practice, although integral to service delivery and commissioning, is none the less increasingly accountable to patients. At the moment, the Government seem to be moving to a world in which the only customer to matter is the primary care trust. To whom is the primary care trust accountable? The experience of everybody—including, I suspect, most of my hon. Friends across the country—is that primary care trusts are accountable only to the Department of Health and Ministers, who are the only people they ever listen to. At the moment, patients get no look in at all.

I am most grateful to my hon. Friend for giving way; he is being very generous. What he describes has particular resonance in Wiltshire, where the PCT seems to be giving GPs incentives to move towards a polyclinic system. For example, a polyclinic is being proposed for halfway between the town of Corsham and the nearby village of Box. That would be convenient for neither place, but the PCT appears to be giving GPs in both places financial incentives to move towards it, even if that is not in patients’ best interests.

That is interesting. I understand exactly what my hon. Friend has said. If there were a rationale behind the measure, the many GPs whom I have met in many places across the country would be supporting it. If it was going to provide better services for their patients, they would understand that. In some places, better services are being provided. Macclesfield is an example. My hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) is not here, but if he were, he would ask us to consider what happened in his constituency. General practices there wanted to come together and create a single premises for the whole town. They have done that, and the services are there. What is happening now? The Government say that there must be a polyclinic in every primary care trust, so the GPs in Macclesfield are threatened by the fact that the PCT wants to create another polyclinic in the PCT area. That would undermine those GPs’ situation. Frankly, that is not acceptable.

The Government made a complete mess of the GP contract. To give a simple measure of that, they paid £1.76 billion more than they were planning to. The National Audit Office reported that the Government said that under the new contract they were expecting a productivity gain in primary care of 1.5 per cent. a year. In fact, there was a drop in productivity of 2.5 per cent. in each of the first two years. The Government got the precise opposite of what they were hoping for—and we know the whole story of what happened to out-of-hours services across the country.

Interestingly, local primary care trusts that cared about open access and extended opening hours for patients—they now claim that they do—had opportunities in the contract to provide them. Local enhanced services could have commissioned Saturday morning surgeries or extended opening hours on weekdays. I find it utterly astonishing that back in February, in the midst of a conflict with the British Medical Association, I could ask the Secretary of State whether he knew whether primary care trusts had commissioned local enhanced services for extended opening hours and get the answer that he did not even know. Having not used the contract for the purpose for which it was intended, the Government now blame GPs for the costs and consequences of a contract that they negotiated and pressed GPs to accept.

The hon. Gentleman mentioned Cornwall, where there is concern that, as a result of the proposed package, we will end up with a private sector solution. That issue concerns me. I note the hon. Gentleman’s analysis: that the Secretary of State appears to be contradicting himself and imposing a top-down, centrally controlled solution in many areas. The Opposition motion talks about innovating in contracts with health care providers. To what extent does the hon. Gentleman believe that those contracts should include, or predominantly be, private sector contracts?

I am talking about contracts between GPs as commissioners and the whole range of health care providers. Overwhelmingly, the contracts will be with NHS providers, although they will include private sector providers. I see absolutely no reason why there should not be an “any willing provider” policy in respect of both community provision and secondary provision.

The hon. Member for St. Ives makes an important point; in the midst of what he was asking was the question of what the consequence of the shift to large polyclinics will be. In the past couple of days, we have seen on the Department’s website evidence of how it is guiding primary care trusts to go about not only developing polyclinics but reconfiguring the whole of general practitioner services. It is clear that it wants to do that on the basis of a small number of contracts with large providers. That is true not only for this first polyclinic, but pretty much across the board.

For a long time, the Department has wanted to get rid of the independent contractor status of GPs and turn them into salaried employees; Ministers seem now to have embraced that absurdity. Presumably, the Department is thinking that it can save a third of the cost of a GP, because a salaried GP costs only two thirds of what a principal in general practice costs. That is a dangerous route, because if practitioners lose their independent contractor status, they will find it impossible to take the position of GP budget holders or practice-based commissioners.

In November 2004, we had a debate on family doctor services in the Opposition’s time. The Government’s response then was to say, “Look how useful practice-based commissioning will be for the future.” Now we have another debate, and what is the Government’s response? It is, “Look how useful polyclinics will be in future.” Practice-based commissioning has disappeared. It has stalled across the country; more than half of primary care trusts are not giving it management support and the information to support it is not available to general practices. The proposed measure is a weak substitute for fundholding in the sense that it does not give real budgets or real incentives to save and reinvest for patients and it does not give the opportunity to innovate in contracts with health care providers.

The Government’s approach is a shameful abdication of the Government’s existing policy, which two years ago Tony Blair said was absolutely central to health care reforms. He said that there should be practice-based commissioning, but that has disappeared and is off the lexicon; instead, the Government are reverting to type and going towards a centralised, top-down, one-size-fits-all approach.

The hon. Gentleman may not have seen the briefing e-mailed in the past hour to Members by the NHS Confederation, the independent organisation representing NHS bodies. It cites the National Audit Office, which has said how successful the GP contract has been. It says that £500 million-worth of savings on the back of the contract have been fed back into new services and how for the first time the contract relates patient outcomes and curing diseases to funding. All those things are improvements brought about by the GP contract and have been cited by the NHS Confederation. They fly in the face of what the hon. Gentleman is saying.

The NHS Confederation is “independent”, is it? It is the body that negotiated the contract and is responsible, with the Department, for the outcome. It is hardly independent. The National Audit Office is independent, and its conclusions on the contract need to be read. The contract was principally about delivering GP services where they were weakest; let me quote paragraph 4.13 of the NAO report:

“Elements of the new contract have not necessarily supported practices in deprived areas. The development of a new, needs-based funding formula was the key element of the new contract aimed at reducing inequality of provision. However, the introduction of the Minimum Practice Income Guarantee significantly reduced the redistributive impact of the formula”.

The contract has undermined the tackling of health inequalities, which were at the heart of what it was trying to deliver. I will not go on about some of the other things, but if the hon. Gentleman wants another independent view about polyclinics, I refer him to the Patients Association, which understandably sees things entirely from the patient’s point of view. Dr. Halperin, its chairman, said:

“What I believe patients want is to see their own GP, to have a regular relationship with a GP, and when they require further or more specialist treatment, to go to a hospital…what you”—

that is, the Government—

“are now doing is interposing a third layer of a polyclinic and I really don't see any advantage for it.”

The hon. Member for High Peak (Tom Levitt) cited the NAO and the NHS Confederation report, and he quoted selectively. Does my hon. Friend recall the NAO pointing out that the GP contract was overspent to the tune of £1.76 billion? Who does the NAO think might be to blame for that?

We know exactly who is to blame for that—the Government. To be fair to NHS employers and the NHS Confederation, when it came down to it they were overawed by the Government, who put in their own interpretation of their estimate of the QOF—quality and outcomes framework—points that were going to be gathered by GPs. The British Medical Association, to be fair, said pretty clearly that it thought that it would be a higher figure. The difference on the QOF was about 16 per cent.—that is about 160 points, and there is £125 a point, so that is about £20,000 per GP. The Government have therefore ended up spending millions more than they ever intended. That was not simply because they got more out of the contract but because they did not put into their negotiations a proper understanding of the existing practice of GPs before they started to negotiate it.

No, if my hon. Friend will forgive me, because I need to make this clear.

The purpose of this debate is not only to criticise polyclinics and how the Government are going about this but to make it clear that the House should express its support for the family doctor service and for the future of general practice, which needs to develop in future. We need to have GP commissioning; GPs must be responsible for real budgets. There is clearly an opportunity for GPs to manage care on behalf of their patients so that the relationships and continuity that they already have can be turned into something that delivers integrated care for patients and so that where services are provided they are in the best interests of patients. GPs should not be immune from competition. There should be a role for alternative providers and different models of care, but it should not be a one-size, top-down kind of care. We need patient choice of the kind that I described. Patients should be able to exercise not only choice in secondary care but choice in who is their primary care provider. We should ensure that the remuneration of GPs not only incentivises them to be in socially and economically deprived areas looking after the patients who are most in need of their primary care services but is geared towards quality and outcomes, including patient-reported outcomes, not just the process measures that are in the QOF at the moment.

We know that primary care is highly effective—the international evidence shows that—and primary care in this country is in many respects the envy of many other countries. Primary care is instrumental to the delivery not only of high-quality care but of cost-controlled care. We can see, in this country and in others, what happens when the people making clinical decisions are not also responsible for the resource consequences. GPs can be those people. They will be well rewarded, as they are and should be, but they should have the responsibility that goes with it. They should not be treated, as the Government have treated them, as production line drones who behave only as the Government direct.

We need a future for general practice that responds to the needs of patients and to GPs’ own clinical evidence about what is in the best interests of the patients and the service. The Government use the excuse of patients wanting longer opening hours, although only 4 per cent. of patients expressed a desire for longer weekday openings. Most GPs to whom I have spoken would be happy to respond to that and would have no difficulty in doing so. Earlier this week, I spoke to a GP in Camden who said that when she went to the primary care trust and said that she wanted to open at 7 o’clock in the morning because all the patients who wanted extended hours wanted them at that time, she was told, “No, that is not good enough because the Government have told us that you’ve got to open until 8 o’clock in the evening.” She does not have any patients who want to go there at 8 o’clock in the evening—they want to arrive at 7 o’clock in the morning—but the PCT is now in such a top-down system that it will not even listen to GPs and patients.

No, I am sorry—I am about to conclude.

Using the excuse of the row with the BMA and the fact that GPs’ salaries appear to have increased—although we do not have the last two years’ data, when GP remuneration will have been at a static level—the Government are embarking on the destruction of the family doctor service as we know it. Access to primary care in local neighbourhoods will be lost, and rural areas will see a decline in further access to services. In many neighbourhoods in the most deprived areas, local pharmacies and local GP surgeries are among the public services that people most value and are some of the few things that really work at the moment, yet they too will disappear, as we can see from the example in the Secretary of State’s own constituency. The relationships between patients and GPs will be lost, continuity of care will be lost, and the independence of GPs will be lost and, as a consequence, the ability of primary care-led commissioning directly responsive to patients’ needs will also be lost.

There is one danger that my hon. Friend has omitted in talking about the push for polyclinics—the impact that they may have on the delivery of local services in, for example, cottage hospitals and smaller district general hospitals if the PCT commissions more services that can be delivered in polyclinics. As I am sure that my hon. Friend knows, my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) supported the first getting together of GPs on condition that that arrangement did not in any way challenge the services provided by Macclesfield district general hospital, which is also valuable to my constituency.

I am grateful to my hon. Friend. She may have heard me refer to the GPs coming together in Macclesfield, which demonstrates what is possible if they are given the opportunity to commission services. We are not saying that there should not be change, but that it must be driven by the needs of an area. That is why we make it absolutely clear in our motion that we are opposed to a one-size-fits-all, top-down system that is not responsive to local health needs and circumstances. My hon. Friend and her very hon. Friend fight hard for the needs of their area, as can be seen in the way that they have fought not only for the GPs there but for Macclesfield district general hospital when it was threatened with reconfigurations.

The Government’s polyclinic plan will be the triumph of the one-size-fits-all approach and bureaucracy in place of clinical evidence and professionally-led—clinician-led—services. I am sorry that Government Front Benchers, in their amendment to our motion, cannot even bring themselves to support the family doctor service. They removed that from the motion where they could have left it in. In their amendment, they propagate the fallacy that the interests of GPs and patients are opposed, but they are not—GPs and patients have common interests, and patients trust GPs. There is an overwhelming sense of trust in GPs, while 97 per cent. of GPs have now reached the point where they have no confidence in the Government. That is, I am afraid, a message that the Government really should have listened to. They cannot even bring themselves to mention in their amendment the benefit of practice-based commissioning, which two years ago was a key health reform.

I am afraid that ignorance and ideology make a fatal combination. The Secretary of State has picked up the ideology of centralisation and combined it with an ignorance of general practice. When I asked about two months ago how many GP practices the Secretary of State had visited, the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), told me that the Secretary of State had visited one GP practice—[Interruption.] I am told that it is now two.

Not in a personal capacity—in a professional capacity.

It is entirely typical of this Government that a new Secretary of State comes in, knows absolutely nothing about health, would prefer to be doing something different, visits one GP practice in Kingston that happens to extend its opening hours to 8 pm because it is in an area that has a lot of commuters, and draws the conclusion that every GP practice all over the country should do exactly the same thing. It is ignorance and ideology in the most absurd combination.

The Labour Government appear no longer able to understand primary care. They do not appear to value it but are none the less determined to interfere with it in the most high-handed and ideological fashion. Our motion sets out a framework for general practice. It sets out a framework of values that we are now going to encourage GPs and patients across the country to sign up to—a framework where the value of general practice is not only understood but enhanced through developing GP budget-holding and patient choice. That would be in the real interests of patients and of the NHS. I commend the motion to the House.

I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

“welcomes the fact that the Government is providing £250 million, in addition to existing GP services, for 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week; notes that these will offer a wide range of health services including prebookable GP appointments and walk-in services; further notes that where patients previously had trouble seeing their GP or had to make numerous visits to a variety of health professionals, they will now be able to see a doctor more quickly, collect their prescriptions, get their eyes tested, have a variety of diagnostic tests or see a physiotherapist in the same building and at times convenient to the patient; further welcomes the additional centrally funded 100 GP practices to be located in the most deprived areas which will have a strong focus on promoting health and reducing inequalities; acknowledges the landmark agreement with GPs to extend surgery hours in evenings and on Saturdays and agrees that extended access will benefit hardworking families; further welcomes the extension of the role of pharmacies to be able to prescribe for and deal with minor ailments on the NHS, as well as promoting good health, supporting those with long-term conditions and preventing illnesses through additional screening and advice; recognises that the Government is on the side of patients; and agrees that extending access to GP services through extended hours and new GP health centres can have a real impact on health inequalities.”

I am delighted that the Conservatives have used this Opposition day debate to allow us to highlight the investment that we are making in primary care and the measures that we are taking to give the public better access to the improved services that they require. Also, it is very good of the Conservatives to commemorate the 60th anniversary of the NHS by seeking to recreate the historical position of the Conservative party in 1948—opposed to better services for patients, defending instead the narrow vested interests of the more reactionary elements of the profession. I guess we could call it a sort of parliamentary version of the television programme, “Casualty 1907”.

Making sure that every citizen has access, free of charge, to a local GP if they are sick or worried about their health was the major premise on which the NHS was established, by a Labour Government in the face of fierce opposition from the Conservative party and its allies in the profession 60 years ago—it is really good to commemorate that in this anniversary year. We continue to support that premise. The role of the general practitioner as provider and commissioner of care, and as a strong advocate for their patients’ health and well-being, is central to everything that we are doing. It is why we have made an unparalleled investment in GP services, from £3 billion in 1997 to £8 billion today. It is why there are now 5,318 more GPs and 4,471 more practice nurses than there were in 1997. It is why GPs now spend, on average, 50 per cent. more time with each patient than they did in the 1990s. And it is why we have increased the pay and reduced the hours of GPs, thus resolving a serious recruitment problem, while introducing a quality and outcomes framework regarded with admiration around the world, which helps to make GPs central to the care of people with long-term conditions, achieving documented improvements in health outcomes for conditions such as asthma and diabetes. The Tory motion describes all of that as “undermining and undervaluing…GPs”. I can think of lots of professions that would love to be undermined and undervalued in such a way.

Given what the Secretary of State has just said, does he agree that GPs represent one of the most cost-effective and efficient aspects of health care in the UK?

I believe that absolutely. GPs are fundamentally important to everything that happens in the NHS, and we have world-class primary care. That is why we have introduced those measures over the past 10 years—to bring in more investment and to attract more GPs, while ensuring that they are better rewarded and can spend more time with their patients.

Let me deal with the rather pathetic attempt by the hon. Member for South Cambridgeshire (Mr. Lansley) to misrepresent our position. There is no national policy for replacing traditional GP surgeries with health centres or, indeed, polyclinics. There are no plans to herd GPs against their will, or the will of patients, into super-surgeries. We are not seeking to reduce the number of GP practices. I quote from the interim report of my noble Friend Lord Darzi—this also answers the intervention made by the hon. Member for Mid-Bedfordshire (Mrs. Dorries)— who said:

“More than 80 per cent of NHS patient care takes place in primary care... Our registered GP list system is renowned internationally. Our primary care system co-ordinates care for patients in a way few other countries match. There are strong bonds between staff and their patients, families and carers.”

One always knows that the Labour party’s arguments on health are vacuous when it is shroud-waving about the events of 60 years ago. In the week when the Government’s own Back Benchers are revolting—even more than normal—over the abolition of the 10p tax band, is it not ironic that these proposals will potentially have the most significant impact on the oldest, the poorest, the sickest and those with the least voice in Government and policy making? That is from a Labour Government of 11 years’ standing.

The hon. Gentleman will have to do better or I will not allow him to intervene again.

What are we doing? What is the destructive policy against which the Conservative party has decided to take up arms? Of what crime against humanity are we guilty? What devastating blow are we dealing to communities throughout the country? We plead guilty to investing an additional £250 million to enable the local NHS to develop more than 150 GP-led health centres in every part of the country, open seven days a week from 8 am to 8 pm, and more than 100 new GP practices in some of the most deprived areas of the country—deprived not just in terms of poverty but in terms of people’s inability to access primary care because they live in so-called under-doctored areas. A clear correlation is seen in the areas with the lowest life expectancy and the fewest GPs per head of population.

What is the Conservative party’s policy for dealing with under-doctored areas? We see it in the rather vacuous petition—“anodyne”, as one GP described it—that they have launched. It says that GPs should be free to determine where they practise. That is the situation now and, by and large, they do not choose to practise in deprived areas in sufficient numbers. If they are to do so, under the Conservatives’ primary care policy, it must be for more pay. In the words of the petition, they must be

“rewarded for working in socio-economically deprived areas.”

The Opposition motion asks right hon. and hon. Members to support

“rewarding GPs who choose to provide services in deprived areas”,

but the inequalities of access have existed for 60 years. By and large, GPs have chosen not to locate in such areas, which is why we have taken the decisive step of investing new money in new health centres to provide extra services—not to replace existing services. Those health centres will have a strong focus on the promotion of health and the prevention of health inequalities. Most will provide physiotherapy, pharmacies, district nursing and minor surgery services.

A moment ago, the Secretary of State said that he pleaded guilty to making a major investment in primary care, and without question the extra money is welcome. However, he is not pleading guilty to contradicting his welcome words of 4 July last year, when he said that he would give the NHS a

“sustained period of organisational and financial stability”

and that

“there will be no further centrally dictated, top-down restructuring”.— [Official Report, 4 July 2007; Vol. 462, c. 962.]

If he wants to realise those aims, why does he not allow local communities to decide how best to achieve the objectives, which he rightly identifies, that will meet the needs of deprived communities, instead of having this centrally dictated, top-down restructuring, which could produce the same sort of ridiculous results as the independent treatment centres that have wasted millions of pounds in Cornwall?

I announced last July that there would be no more structural reorganisation in the NHS—no more changes to strategic health authorities and no more merging of PCTs—and we have kept to that. As I hope the hon. Gentleman will accept when I come to the gist of my speech, we are not imposing a top-down measure. We are providing £250 million for investment in the expansion of the primary care service, mostly to take services away from hospitals and bring them into local communities. That is the major reason for the investment.

Does my right hon. Friend agree that in areas such as mine, which is a heavily and densely populated one, with narrow streets and little car parking, many GPs have welcomed the chance to move into modern premises with car parking for ambulances and patients’ cars, and the ability to expand their services and share support staff?

Indeed, and that is the experience throughout the country. It is the experience of my constituency, which the constituency of the hon. Member for South Cambridgeshire is a long way away from. In Hull, there has been a revolution in primary care services, which is happening in cities and communities throughout the country.

Further to my right hon. Friend’s point, I am grateful for the assurances that he has given about structural change and GP practices. Has it not been the case over the years that GPs have, by and large, migrated from single-handed practices into common practices precisely because they can deliver more and better services on the spot? Will he ensure that there is no ban on single-handed practices, while acknowledging that the pattern may well be for such practices to refer patients on to multiple-handed practices so that people can receive their care locally?

My hon. Friend makes an important point. We can take the example of London, where polyclinics are a specific proposition. A review of health services in London, carried out by NHS London and involving London clinicians, pointed out that for 40 years people have been trying to revamp, reorganise and update services there. In London, 54 per cent. of GP practices are single-handed, compared with an average of 40 per cent. throughout the country, and 97 per cent. of patients have to go to hospital for out-patient appointments. That figure stands at 90 per cent. in the rest of the country, which is still too high. The vast majority of people want to access such services in the community. In London, we have the worst problem of people going to A and E and clogging it up when they should go to primary care. That is why Lord Ara Darzi, working with clinicians in London, has devised a specific model for London, which is not a blueprint for the rest of the country.

The Secretary of State said that the policy was not centralised or imposed. If a primary care trust told the Department that it did not want to provide a polyclinic, but preferred to use the resources in another way, would he allow it to do that?

There would be no problem with that, given that we are not specifying polyclinics as any part of the exercise. The crucial point is that the local NHS will develop services in ways that best meet the needs of the local population by engaging members of the public and local doctors, nurses and other health care professionals. That is the way to implement the proposal.

The Secretary of State referred to the extra investment in new practices in under-doctored areas, and I fully support that. Does he agree that it would be ludicrous if the operation of the GP contract results in financial incentives being greater for practices in the leafy suburbs than for those in disadvantaged areas? Practices in disadvantaged areas receive less pay on average than those in wealthier areas.

That is an important point for our health inequalities strategy, which we will publish soon. As Lord Ara Darzi pointed out in his interim report, it is also a major issue for his continuing work.

I welcome my right hon. Friend’s remarks. May I urge him not to give in to the calls for a free-for-all for GPs? It has not worked in cities such as Wolverhampton. As a bit of an old Labourite—I know that he is, too—I want a bit of planning. I want a bit of planning from the excellent Wolverhampton primary care trust, engaging with local people. However, I also want some accountability on the part of the PCT, because it is not as accountable as it should be. Even though it does an excellent job, we need more accountability by primary care trusts.

I am tempted to say that, if a bedpan falls on the floor in a Wolverhampton hospital, I expect it to echo around Whitehall, to paraphrase Nye Bevan’s famous centralising edict. My hon. Friend and the hon. Member for South Cambridgeshire make a fair point about PCT accountability. As part of the review and our attempts to construct a constitution for the NHS’s 60th birthday, we need to introduce greater accountability, especially as we distribute to PCTs a far greater proportion of the central pot than we have ever done.

I am grateful for my right hon. Friend’s reassurance about polyclinics. When I first heard the word, I thought that a polyclinic was for treating people who were as sick as a parrot; clearly, I was wrong. Will my right hon. Friend clarify exactly how, in principle, a polyclinic is different from, for example, the three GP practices in Buxton, where five, six or more GPs, practice nurses and other health professionals work in one area in a system that has evolved over the years to provide better health care for people locally?

The hon. Gentleman says that it is useful to know. In the London context, we are considering including services that were previously perceived as secondary in primary care services, thus providing an integrated service, whereby patients can access a far wider range of services than they could traditionally. However, I must say that we have had such services in Hull for years and never called them polyclinics. The chief executive of the NHS said that he went to a place recently and was told that it did not want a polyclinic. He was speaking in a community hospital, which was, to all intents and purposes, a polyclinic. There is, therefore, a problem with definitions.

The Secretary of State began to discuss public engagement, and engagement with stakeholders is important, but will he reassure us that there will be no more ridiculous, sham consultations on reorganising primary and intermediate health care? Such consultations happened in Wiltshire, where three of the four community hospitals closed, much against local people’s wishes.

The Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), tells me that that horrendous action was supported by the Conservative-run overview and scrutiny committee. However, I accept the tenor of the hon. Gentleman’s points. In the big reconfiguration in Greater Manchester, there was an absence of proper involvement and engagement by the public in the early stages. When the proper engagement took place, we reached an acceptable solution, which everyone supported locally.

There has been a move towards group practices, but that has been driven by GPs as a way to improve services for their patients. In my constituency, single-handed practices are increasingly moving into fabulous new health centres, with an investment of £14.8 million in new facilities, rising to nearly £30 million by 2009 under the local improvement finance trust programme, which is transforming primary health care in our city. However, what works for Kingston upon Hull will not necessarily be right for Kingston upon Thames. It does not mean the end for single-handed practices, many of which provide an excellent service to patients across the country; they will continue where they are right for patients.

As the Secretary of State knows, I campaigned in my constituency for an urgent care centre as part of the effort to ensure that hospital reconfiguration in the area did not leave my constituents short of services. My constituents want the reassurance of an urgent care centre, but they also want GP practices where there is a familiar, friendly face. Can the Secretary of State give an assurance that people will have a family doctor, who comes out on visits and is there for them?

Of course I can. Two central fallacies underpin the Tory party position. The first is that we are imposing a system of polyclinics throughout the country. We are not. The second is that, if an area has a group practice or a health centre, or if GPs decide to move into much better facilities where several practices operate together, people can no longer see their own GP. That is nonsense. It is wrong to suggest that the proposals signal the death of the important patient-GP relationship; they do not.

Individual, single-handed GP practices will continue to operate where they are right for patients. When we talk about developing health centres, or what some local parts of the health service describe as polyclinics, we are not considering a single, fixed model of care. Those terms describe flexible models for bringing primary care together with a range of other services, be they diagnostic services, specialist care for patients with long-term conditions such as diabetes, or adult social care. It is hardly a novel idea. Health centres featured in the earliest descriptions of the national health service in 1948. Examples abound of GPs, nurses, specialists and other health care professionals coming together to provide integrated care for patients. With advances in new technology and medical science, we can and should do that to a greater extent in much more imaginative ways.

We are also guilty as charged of expanding access both through the new health centres and the new arrangements that we are introducing for extending opening times at GP surgeries in the evenings and on Saturday mornings. The Conservative party appears to have adopted wholesale the distorted view expressed in some quarters of the BMA and articulated by the right hon. Member for Witney (Mr. Cameron), who believes that the cash-rich, time-poor professionals—I paraphrase from his speech on Monday—who need to get their back problem fixed, as well as some jabs for a business trip to India, will be the main beneficiaries. One has only to visit practices that are already open for longer in the evenings and weekends to find that it is not, as so often claimed, a service for the worried well. Those who are most likely to benefit from extended hours are manual workers worried about taking time off, parents balancing child care responsibilities, certain ethnic minorities who are most dissatisfied with current access arrangements, and those very pensioners and mothers with young children, who are said by opponents of extended hours to want only a Monday to Friday service, with a half day on Wednesday.

I am grateful to the Secretary of State for giving way. When we had a debate on the issue three and a half years ago, the precise point made by the right hon. Member for Barrow and Furness (Mr. Hutton), then a Health Minister, was that the Government were planning a new system of what were called walk-in centres, which would give patients greater access and enable them to receive medical care in the evening and at weekends. What has happened to walk-in centres? The Minister here today promised to publish a review of walk-in centres last summer. It has not been published, but simply dropped in some distant part of the Department. Are walk-in centres not the mechanism that the Government said should be used?

Bristol university has already conducted an assessment of walk-in centres. It said that they were good on quality and accessibility, but that more work needed to be done on their finances. That work is ongoing and forms part of the Darzi review.

May I tell the Secretary of State about a new health centre in Wigan called Boston house, which has been open for three or four years? Taking some of the services and moving them there has transformed the lives of many patients living in the area that I represent. We are talking about a health centre outside a general hospital that provides renal services. People in Wigan have always had to go to Bolton, Salford and other places nearby for renal dialysis. Now we have that in Wigan, located in primary rather than secondary care. Is that not what health centres are all about—transforming the lives of people by taking things out of secondary care and into primary care?

That is a perfect example of why we should thank the Conservative party for allowing us to have this Opposition day debate, when we can highlight the important improvements being made throughout the country. We offer better access and improved facilities. What do the Tories offer? They offer a petition for GPs pronouncing on their absolute right to put their own interests before those of the public.

So says one of the architects of that petition. It is clear what the petition is about. I have heard the arguments from various quarters. In that petition we hear the hallowed cry of those who ask why they should have to open on Saturday, when their accountant, working in a similar profession, is not open on a Saturday. As one GP down in the west country put it to me in wonderful terms the other week, “If the public are seriously worried about their health, they should be prepared to take time off during the week to come to my surgeries”—at times that suited him, obviously. What we have in the Opposition’s petition is the articulation of all that. It says that GPs should be

“rewarded for working in socio-economically deprived areas,”

and continues:

“We also believe we should be free to determine the opening hours, size and locations of our practices”.

That is a petition for GPs to sign telling us how important it is to look after their interests rather than those of the patients. That is the position that the Opposition have put them in.

Does the Secretary of State accept that in some parts of the country GPs have already got together to provide perfectly satisfactory out-of-hours services that nobody wants changed?

The common problem among those on the Conservative Benches is that they do not understand the difference between extended hours and out-of-hours services, to which I shall come in a second.

The Opposition offer a return to the bad old days, when GPs were effectively responsible for their patients 24 hours a day, 365 days a year. The Royal College of Physicians is among the many organisations that have pointed to the international evidence of the risk to patient safety that long hours pose. How could we ever have supported a system in which tired GPs called out in the middle of the night had to attend patients the next morning, and it was common to wait weeks instead of days for an appointment that would often be little more than cursory, because of the pressures that GPs faced?

The new arrangements for extended hours will mean that the average-sized practice, run by three to four GPs, will open for an extra three hours a week. Those arrangements offer a fair deal for both doctor and patient, and I am pleased that the British Medical Association has given its agreement, following a ballot of its members in which 92 per cent. voted in favour.

The Opposition claim that they support the traditional family practice, but what does this mean—restricted opening hours, problems getting appointments, tired GPs and under-doctored areas? Yes, small family practices can work well and are popular with many patients; but we should not support this fixed model of primary care any more than we should support any other fixed model, particularly at the expense of improving access to primary care in areas of most acute need. Patients should be able to see a GP or a practice nurse at a time and location that is convenient to them. That should be a defining feature of a world-class primary care system, but it will not be for politicians to determine nationally what will work best locally.

The next stage review, led by the noble Lord Darzi of Denham, is a bottom-up process, with 2,000 clinicians engaged with the public, unions and patient groups in determining how clinical care can be improved in every part of the country. That will be another stage in the exciting journey that commenced with the NHS plan and that has seen greater investment, improved resources, new hospitals and better clinical outcomes—a journey to an NHS that is world class in all aspects, instead of world class in just some.

No, I am coming to the end of my speech.

Although the Conservative party professes to have joined us in supporting the NHS, it has proved by its approach to primary care that it remains stuck in the past—conservative in every respect and willing to put vested interests before better service to the public. I commend the amendment to the House.

This is an opportune time for us to discuss the Government’s record and their plans for family doctors. The debate gives us Liberal Democrats an opportunity to reaffirm our opposition to central control of local health services.

I was fascinated when the Secretary of State again tantalisingly indicated his recognition of the lack of accountability among primary care trusts to the communities that they serve, while the Conservatives rejected any change to the accountability of primary care trusts. May I commend to the Secretary of State the Liberal Democrats’ proposals to democratise the commissioning of health care? Primary care trust boards should be elected, not appointed nationally. Ultimately, the Conservatives want to retain the central model of control of the NHS. The Secretary of State suggested that he recognised the case that we had made, but will he go the whole way and provide proper accountability to the communities that trusts serve? We wait to see what his announcement amounts to.

I want to talk about the morale of general practice. It is important to recognise that the network of family doctors in this country is the bedrock of health care and the NHS. As others have said, that network is the envy of the world. We should not, however, be complacent or take the view that the service is never capable of improvement to meet modern needs. We should always be prepared to accept the case for evidence-based reform. The Government must recognise that they damage the service, which is so widely supported among the general public, at their peril, because it is such an important part of our health service.

Whatever the Secretary of State says about how fortunate GPs are, given the way in which the Government have treated them, he must recognise that morale among GPs is very low. I am sure that he talks to GPs throughout the country, so I am sure that he recognises that they feel demoralised. Indeed, one Norfolk GP said to me recently, “We’re well paid—we recognise that—but we feel that some of our professionalism has been taken away from us, because we’re dictated to so much from up above”—that is, from Whitehall. When GPs try to develop practice-based commissioning, those who make the decisions often do not listen. When they try to refer patients for services such as those for teenagers with mental health problems and discover that services are inadequate or simply non-existent in rural Norfolk, they cannot feel much pride in their job, despite the fact that they are being well paid. The Secretary of State should recognise the real concerns among general practitioners, who take pride in their work, which they undertake for the very best of motives. Their concerns should not simply be dismissed as unfair attacks on the Government.

I have spoken to a number of GPs in the past fortnight. They raised several issues with me, the first of which was the GP contract, and I shall come back to that in a moment. The second issue was the state of practice-based commissioning and where it is going. The Conservative spokesman rightly referred to the fact that it appeared to have completely stalled, certainly in many parts of the country. The third issue is the central imposition of what we must now call health centres, rather than polyclinics. I shall return to that issue later as well.

Are those concerns justified? Doctors feel that they are taking the blame for a contract that was ultimately the Government’s contract. It was forced through three years ago, and GP leaders at the time warned the Government of the effect it would have. The National Audit Office reports that there has been a £1.76 billion overspend on the contract since its introduction. Remarkably, the contract frustrates GPs while failing to be consistent with some of the Government’s key objectives, particularly in regard to preventive care, despite the potential of the quality and outcomes framework—QOF— system. I fully recognise that the introduction of that system could do much to incentivise preventive care. The contract also fails to be consistent with the Government’s stated objectives on reducing inequalities.

Is my hon. Friend aware that the NAO report states quite explicitly that there has been no productivity increase in GP practices?

My hon. Friend is absolutely right to highlight that. We should acknowledge, however, that measures of productivity can sometimes be misleading. If GPs are spending more time with their patients, that could be a good thing. This is certainly an issue that has been highlighted by the NAO, however.

I want to deal specifically with the QOF system—the system that encourages GPs to do all sorts of things with preventive care. When the QOF system is reviewed, there is an evidence-gathering process to determine what should be incentivised in the reviewed system. On this occasion, a lot of work was done to develop ideas for addressing osteoporosis, including testing those who are most at risk, especially after the first fracture. A lot of work was also done on peripheral arterial disease and on heart failure. But what happened then? The thing that particularly frustrated GPs and many others is that the entire objective evidence-gathering process came to nothing because, at the last minute, the Government decided that the political imperative was to force through a one-size-fits-all extension of hours. That is the reality.

An NHS Confederation briefing yesterday confirmed that the political imperative had involved increased hours and that all the evidence-based work—especially the work on osteoporosis—had gone out of the window. That is what frustrates clinicians who care about their patients more than anything. A one-size-fits-all extension of hours has now been forced through. I fully support the case for extending hours and for making access more flexible. I am sure that everyone in this Chamber finds it difficult to see their GP—because of the hours we work and the fact that we work away from home—quite apart from those on low incomes who feel anxious about taking time off work and who would like to see a GP outside normal working hours.

I agree with my hon. Friend about the one-size-fits-all solution. One of my local surgeries deals with a lot of commuters, and it has devised a scheme whereby people can e-mail their doctor and get a response on a certain day. Often, it is not a case of needing to see a doctor so much as needing to ask a question and getting reassurance, which might not be available from someone who does not know the patient. Would my hon. Friend support more such schemes being developed in the future?

Absolutely. All sorts of innovative things are being developed. In many practices, there is a commitment to speak to a patient by telephone on the same day, if an appointment cannot be arranged. Often, a telephone consultation is just what the patient needs. We should certainly support the use of e-mail and telephone consultations. Surely it should be for local commissioners to drive through decisions on increasing hours and making access more flexible in order to meet their local needs, rather than having a one-size-fits-all solution imposed from the centre.

I want to return briefly to the question of osteoporosis. When I asked about the loss of that valuable work at the NHS Confederation briefing yesterday, I was given an indication that there would be an announcement shortly on ways—outside the QOF system—of encouraging GPs to test for osteoporosis. I understand that there was a written statement yesterday, although I have not seen it. I would welcome an intervention from the Secretary of State to tell us what might be about to happen. We understand that an announcement is imminent. Will he tell us, either now or through the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), at the end of the debate, what is proposed? A lot of people who care a lot about this matter want that work to be incentivised, because it involves good, preventive health care.

In an earlier intervention, I challenged the Secretary of State about the fact that the GP contract often ends up paying more to GPs in the leafy suburbs than it does to those in the most deprived communities. I want first to look at the minimum practice income guarantee. The Health Service Journal has highlighted huge variations in payment to practices, regardless of the number of patients they serve or the needs of those patients. The article highlights two practices in Westminster, one of which happens to be based at Buckingham palace. That practice gets twice as much money as it ought to, because of the minimum practice income guarantee. The article states:

“Under the allocation formula, the Buckingham Palace practice was due to get just £14,657 this year. But the guarantee added another £16,505. That left the practice with payments of £113 for each of its 276 needs-weighted patients, compared with the sample average of £63.”

How on earth can the Government justify that system? They are paying more money to practices—often in the more affluent communities—that do not need it. As the Health Service Journal and many others have said, that money ought surely to be used to address health inequalities.

Another issue highlighted by the Health Service Journal is practices excluding patients under the QOF system. I hope that the Minister will be able to respond to this when he winds up the debate. Massive variations have been highlighted, with some practices excluding 10 times more patients than the national average. As I understand it, if patients can be excluded from the QOF target, it is easier to hit the target and to get the money. There is no evidence, however, that the problem is most serious in practices that genuinely find it difficult to approach patients because they are in hard-to-reach communities. For example, Tower Hamlets and the Heart of Birmingham primary care trusts have among the lowest levels of exclusions in the country. The point made by the Health Service Journal is that this is a misapplication of millions of pounds of public money that ought to be going towards reducing health inequalities in some of the most deprived communities.

Overall, the highest payments under the QOF system of incentivising GPs to undertake preventive health care, which is so important to reducing health care inequalities, go to practices in leafy suburbs. How on earth can the Government justify that system? My fear about the Conservative perspective is that if we simply give all the responsibility and power to GPs, that will ultimately do nothing to change such inequalities. Ultimately, if we are to ensure that money and funding is directed to the most disadvantaged communities, there is an essential role for strong commissioning.

I am grateful to the hon. Gentleman for his thoughtful speech. I think that he puts his finger on a difficulty that, if we are honest, all political parties have with these issues: on the one hand, we seem to have the shibboleth of local control and local accountability; on the other hand, we have things such as health inequalities, which we would like to address with different mechanisms. Perforce, such mechanisms are often seen as top-down control—and it seems to be another shibboleth that we should decry that sort of control. Will the hon. Gentleman explain how one does that balancing act? It is difficult for any of the three main parties to balance in their policies the top-down element, which, unlike local control, we think we do not like, bearing in mind some of the results that flow from local control—most notably displayed in the phrase “postcode lottery”.

The hon. Gentleman makes a thoughtful intervention. There is, of course, the potential for conflict. Ultimately, however, our highly centrally controlled system has failed to deliver in reducing health inequalities; and all the evidence suggests, particularly if we reflect on what happens overseas, that real engagement at the local level and integrating services for health and social care with housing, community regeneration and so forth is the best way to address those underlying inequalities. Change to that extent cannot be delivered from Whitehall; it simply does not work. All the evidence from centrally controlled systems demonstrates that point. For me, then, we are more likely to achieve success if we provide genuine accountability to the communities that are served.

The evidence that I have picked up from talking to GPs in many different parts of the country—it was reflected in what the hon. Member for South Cambridgeshire (Mr. Lansley) said earlier—suggests that practice-based commissioning is dead in the water. There is a growing frustration among GPs that all their efforts to try to make something of it and put forward innovative ideas about services that could be delivered in a community setting close to people’s homes—perhaps avoiding the need for a long journey to an acute hospital—are falling on stony ground. They feel that there is no longer any political drive behind it, which has resulted in GPs becoming completely disillusioned with the concept, increasingly believing that it is going nowhere.

Over the past few weeks, I met a group of GPs in Dorset. I noticed that the Conservative spokesman was in Poole, so I was about 10 miles up the road from there. I met another group of GPs in Norfolk last week and heard how frustrated they were about putting forward their ideas on how to develop services to the primary care trusts, yet getting no reaction at all.

The hon. Gentleman is making an intelligent point, but I have to say that I disagree with him on a number of issues. Certainly in my area, the availability of alternative community-based clinics has made a radical difference to GP referral patterns—hugely to the benefit of patients and patient satisfaction. In my practice, we do regular surveys of patient satisfaction and we have seen significant increased satisfaction as a result of patients being able to see medical people much closer to their homes and much more focused on their GP practice. In many cases, they receive care and treatment from people they personally know, which has to be an advantage. I accept that in other areas it might not be working as well, but the model itself seems to work very well.

I am encouraged to hear what the hon. Gentleman says—despite his very recent arrival in the Chamber, which I welcome. I have to say that in many parts of the country—[Interruption.] I hear a suggestion from a sedentary position that the hon. Gentleman has been saving lives, but I suspect that he was just having his lunch—[Hon. Members: “Ooh.”] I do not know how much the hon. Gentleman talks to his GP colleagues around the country, but what he referred to is simply not happening in many parts of the country, where many GPs are becoming very disillusioned as a result.

I want to say a few words about the Conservatives’ over-reliance on the GP to ensure that that whole health system works effectively and in the patient’s interests. The Conservative spokesman acknowledged, in response to an earlier intervention, the importance of recognising the potential for conflicts of interest, but that is absent from the Conservative motion and from most of their pronouncements. There are real concerns, including among many GPs, about potential conflicts of interest, and it cannot be said that GPs will always act in the patient’s interests. One example can be seen in what I said earlier about exclusions under the QOF system. In my view, it is a dangerous game simply to believe that GPs can run the whole system. They are absolutely central to it, but their role has to be combined with strong, effective commissioning.

This afternoon’s discussion on the difference between a polyclinic and a health centre was interesting. As I said at the NHS Confederation briefing yesterday, the honest truth is that the difference amounts only to a rebadging. The Government were calling these bodies polyclinics, but they got such a bad name through what GPs and others said about them that we now call them something else. When I asked what a GP-led health centre was all about, all the things that I was told they would contain sounded very much like a polyclinic. These are, at the very least, embryonic polyclinics.

There is a lack of semantic clarity about the issue, as we have already seen in our debate, but one would expect the Government to know where polyclinics were. When I asked the Secretary of State

“how many NHS polyclinics there are in England; and where each is situated”,

I received the reply:

“The Department does not collect information about services commissioned locally by primary care trusts”.—[Official Report, 29 February 2008; Vol. 472, c. 1982W.]

That was news to all of us; as well as not knowing what they are, it seems that we do not know where they are.

It is a state of total confusion—[Interruption.] The hon. Member for Wolverhampton, South-West (Rob Marris) talks from a sedentary position about denying centralisation, but we know that there is a central imposition of a GP-led health centre in every primary care trust. There is no option; all trusts have to introduce them. I had discussions with the East of England strategic health authority, which made it clear that every PCT must have such a centre. In the case of Norfolk, for example, I was told by the GPs I met last week that the PCT has not yet even completed its review of its estate—the buildings it owns—to ensure that it makes the most effective use of that estate. Suddenly, however, because the Government told the trust to do so, it has stopped doing that work and is now having to focus on the introduction of a polyclinic—sorry, a health centre—in Norwich.

Introducing a centre of that sort in Norwich does nothing for rural disadvantaged people who have no access to a car and have poor public transport. It also does nothing for the greatly disadvantaged community in Thetford, which has a low income level and has a great need to improve primary care services. The imposition from Whitehall of a GP-led health centre in the centre of Norwich will do absolutely nothing for those people. That is what frustrates so many.

Amid the usual slurry in the Opposition motion is one nugget of gold that is worthy of note: the reference to a

“lack of empirical and clinical evidence for… polyclinics”.

That lack is undeniable, and I raised it in Prime Minister’s Question Time only a week or two ago.

Does the hon. Gentleman hope, as I do, that the Minister who replies will provide more substantial evidence of where the concept has worked? Countries in eastern Europe and elsewhere that have used it are retreating rapidly towards our own model in order to retain doctor-patient relationships and put a distance between doctors and specialists, and to deal with other issues on which polyclinics have foundered.

The hon. Gentleman makes a good point. I believe that policy should be based on evidence. The hon. Gentleman, who is familiar with north Norfolk, will know about rural disadvantage. In disadvantaged parts of Norfolk, a polyclinic—or health centre, or whatever it is called—in Norwich will have no impact at all. As the hon. Gentleman says, we should also try to learn the lessons of experiences overseas.

I am grateful to the hon. Gentleman for giving way for a second and, I hope, final time.

Although this policy may be a partial solution in London and other major cities, I do not think it will translate to rural areas and suburbia in anything like the way that the Government imagine. The same has been true of policies on, for example, housing and trust schools.

The hon. Gentleman makes another good point. I want to say more about the concept of the health centre, or polyclinic. It seems to me that such schemes should be piloted to establish how they work in given settings, so that the lessons can be learned. I think that there is something in the concept for certain communities.

Last summer I visited the Arches centre, in a very disadvantaged part of Belfast. People in the Province have the benefit of health and social care trusts, which the Liberal Democrats support. That health centre combines various services. It brings together health and social care, and makes available to the community services that would normally be in a more remote acute hospital. That is a very attractive model. Surely we should let these centres develop and grow, and then analyse their successes and, in some cases, their failures empirically before rolling them out across the country. What I find both extraordinary and frustrating is that, without such empirical evidence-gathering, the system is being imposed throughout the country on a ludicrously tight time scale. The Government should be condemned for that.

I thank the hon. Gentleman for giving way to me again. He is being very generous with his time. Perhaps I can help him. I have a letter from the commissioning lead for one of the primary care trust consortiums in my constituency, who says precisely the same about the need for piloting. He writes:

“The intentions of the bids are to encourage a range of pilots that will explore the potential and flexibility of the concept.”

Pilots could, he says, be

“existing health facilities which could be adapted or expanded… on-going developments”

or any other combination that local people decided was good for their area.

I do not understand where the hon. Gentleman is coming from when he says that there is no flexibility and no ability to pilot. That letter makes it entirely clear that the flexibility exists. [Interruption.]

As my hon. Friend the Member for Southport (Dr. Pugh) observes from a sedentary position, everyone is compelled to pilot. I do not consider it a pilot approach to tell every primary care trust that it must introduce a GP-led health centre.

The NHS Confederation confirmed yesterday that every PCT had been so instructed, and we see the same in all the evidence. The strategic health authorities have confirmed it as well.

Perhaps I could assist the hon. Gentleman. It was set out in a press release accompanying the Labour party’s local election campaign that the Secretary of State and the Minister launched in Exeter about 10 days ago.

I am grateful to the Conservative spokesman for that information. It is of some concern that the Chair of the Select Committee on Health does not appear to know what the Government policy is.

There seems to be a conflict in the Government’s approach to the NHS. They talk of empowering patients and responding to what they really want, but when it comes to the crunch they always opt for a model imposed from the centre.

The Phoenix centre—I do not know whether it is a medical centre or a health centre, but it is certainly not called a polyclinic—is just outside my constituency, and serves some of my constituents. It has been open for about three years, and provides social care as well as health services. It is so popular that, as I said earlier, it is extending its hours and its services. As far as I am aware, that model was not centrally imposed on the excellent Wolverhampton PCT, but it worked, and it will be more or less replicated elsewhere in the city because it has been so successful locally.

I entirely support that approach. As I said earlier, I should prefer a PCT that decided to adopt it to be democratically accountable to the community that it served, but I have no difficulty with the concept. What I have difficulty with is the Government’s telling every PCT to complete the process by the end of the year. That appears to be the model that they are imposing.

As I have tried to make clear, I am in favour of examining the principle. It is entirely sensible to trial the idea of taking diagnostics away from more remote acute hospitals and integrating services, and to learn lessons from the experiment. However, as was pointed out by the hon. Gentleman’s colleague the hon. Member for North-West Leicestershire (David Taylor), concerns are emerging from the adoption of that approach in other countries, and those lessons should be learnt as well.

One legitimate concern is the eventual loss of the network of local GP surgeries, about which many people will be very anxious. If this kind of model is to be adopted, I think that a rural community hospital should be used as a basis for the development of such an extended range of services. We in Norfolk are in a ludicrous position. We face the loss of a community hospital in Aylsham, a market town, and we are seeing the loss of beds in other community hospitals. Surely we should develop existing, trusted centres of excellence and take the consultants out of acute hospitals, ending the divide between primary and secondary care and providing genuine local care for those who need it.

I want to say a word about the Conservatives. I think there is a degree of hypocrisy in their complaint about central control. They have conveyed the clear message that they dislike the degree of central control exercised by the present Government, yet they propose to introduce a CSA-style unaccountable quango, presumably based in London, to direct the national health service. The Child Support Agency is rather unpopular, and I suspect that when people find that their local hospital is to be closed by a centralised unaccountable quango in London, they will regard it much as they regard the CSA. There is no democratic local accountability in that, and the Conservatives know it. They reject this model, and decide instead to retain the idea of a centralised system. That is even worse than the Government’s approach, which at least involves some democratic input in the House.

The Conservatives’ approach is to opt for a centralised quango that does not even have any accountability to this place. It is supposed to have discussions with the Secretary of State before it decides what to do, but it is clear from the powers of this body that the Conservatives seek to establish—[Interruption.] The hon. Member for Mid-Bedfordshire (Mrs. Dorries) may not like to hear what the Conservatives are proposing, but the fact is that a centralised quango will have extensive powers over commissioning and determining what should happen at local level, and people will not like that if they have to deal with it.

The motion is right to address the Government’s excessive emphasis on central control. I challenge the Government to provide genuine accountability for local communities, as the Liberal Democrats propose. I also urge the Secretary of State to listen to the concerns of general practitioners. The model that we should choose is democratic local accountability on the shape of health services serving a community. Alongside that, we should free up GPs and health professionals to do the job that they are qualified to do without overly controlling them from Whitehall.

I wish to start by paying tribute to GP Professor Dr. Brian McGuinness who retired this week as the chairman of the Society of Medical Writers. He is plain old Dr. McGuinness to me and he epitomises the type of GP that we all talk about. He was the ultimate family GP. I have not seen him for about 20 years, but he established one of the first large GP practices that I was aware of, in a socially deprived area in the north-west. That practice encompassed many of the services that we have been talking about with regard to polyclinics. His practice was not a polyclinic—it did not have a fancy title—but it was a good practice providing a good service to the local community, commensurate with its needs.

The practice had a good patients forum that met regularly and advised the GPs—many GPs do take advice from patients and local patient groups. The practice had seven or eight GPs and provided adequate services to the local community and was well respected. Dr. McGuinness was possibly one of the most highly regarded GPs I have ever known, especially in the socially deprived area in which he practised. He recently received a lifetime achievement award, but it is to his credit that he has vowed to continue to work to encourage GPs and other medics to write about their experiences. I therefore begin by paying tribute to GP Professor Dr. Brian McGuinness, who is one of the best of men as well as one of the best doctors I have ever encountered.

In preparation for this debate, I spoke to some of my local GPs and I want to feed back some of the comments that they made. As their MP, my job is to represent the opinion of all my constituents, and my GPs have some very strong opinions about what is happening and the Government’s proposals. They are unanimous in being incredibly angry and they feel undermined and persecuted by the Government. It all stems from the much spun pay rise that GPs received in 2004. It is very rarely mentioned that that pay rise brought GPs’ pay to an acceptable level, given their training, experience, commitment and hours. Before the pay rise, GPs were one of the lowest paid professions, so it was right to give them that pay rise and bring their pay to that level.

I would not be surprised if the Department of Health had a unit solely devoted to spinning against GPs. We have seen some ludicrous headlines in the tabloids recently, but they did not dream them up. They did not come from GPs either. Those headlines were spun somewhere in the Department of Health. It was preposterous to have stories about GPs earning £250,000 on the front page of national newspapers, and that did GPs no good. As I said when I intervened on the Secretary of State earlier, GPs represent the most cost-effective and efficient branch of the health service. They cost £20 per consultation, even for long consultations.

As I said, the 2004 pay rise brought GPs pay to a reasonable level. Since then, they have had a 0 per cent. pay rise for three years. Which other profession would put up with having a pay rise that just brought them back into line with what they should have been earning, followed by a pay freeze in the next three years?

A recent report by the National Audit Office said that in real terms partnership GPs have had a 50 per cent. increase in the past three years. Does the hon. Lady think that that is bad?

I have absolutely no idea where that figure comes from. My GPs have had no pay rise for the past three years, at the same time as their staffing costs have increased by an average of 5 per cent.

For the sake of accuracy, I wish to point out that the NAO said that there had been a 58 per cent. increase over three years from 2002-03 to 2005-06. My hon. Friend is making a point about what has happened since 2005-06. The return of doctors to general practice has remained the same, but costs have risen. The position has changed since 2005-06, and we do not have the figures yet.

I specifically referred to the past three years. Staffing costs have increased for general practice, and the front of this week’s GP, the GPs’ magazine, reveals that some GP practices could face a 10-year pay freeze. So not all GP practices’ finances are rosy, and GPs are feeling persecuted and undermined by the Government. Morale is very low.

One result of the pay rise was a rebalancing of GPs’ morale, but there was also an easing in recruitment. It became easier to recruit on to the GP training scheme and to recruit new GPs. However, over the past few years, that has suddenly and dramatically changed and it is again becoming difficult to recruit. Just in my constituency, I know of GPs who are leaving general practice to go to New Zealand or the US, because of the demoralisation and confusion about the future of the service that GPs are beginning to feel.

Patients want, above all else, the stability and continuity of having access to a GP whom they know and with whom they have built up a relationship. They want to have confidence in their GP, especially if they have a difficult illness or are elderly. GPs work on the relationship with their patients because they know the value of having a good relationship with them, including an element of confidence. Polyclinics will probably include Australian or other antipodean doctors, or Polish doctors. They will come and staff the clinic for six months, probably as part of their travels, and then move on. The relationship that patients have with their GPs will no longer exist.

GPs are leaving the service at the moment, so I would like to know how the polyclinics that the Government propose will be staffed. Where will the GPs come from? Many GPs want to retain the service that they provide to their communities, because that is what patients want. Patients do not want polyclinics. As the end users of the service, patients must have a voice in deciding what will be provided. GPs must also have a voice in what they are going to provide. By and large, they do not want large polyclinics.

In rural constituencies such as mine, with a high elderly population and poor transport links, it is preposterous to suggest that people will be able to get on a bus and travel to a polyclinic. Bus services have been cut dramatically in the past two years, so they will be unable to get a bus to a polyclinic, wherever it might be. It is also likely that such a clinic would be in Bedford or the outer areas of that town, but only 12 per cent. of my constituency is built on, as it is a rural area. It would be extremely difficult for my constituents to get to a polyclinic.

Another problem is staffing. More GPs are leaving the profession than are arriving. Which services will be offered in the polyclinics? If radiography services and other physiotherapy services are to be carried out in polyclinics, who will carry them out in hospitals? Hospitals are already finding recruitment difficult. If a radiographer is out in a polyclinic, who will be in the hospital?

My hon. Friend is making a compelling case. Surely the logical corollary of her argument is that any general practitioner in a family practice that is doing well will not want to move to a polyclinic. As there are shortages of fully trained medical practitioners in many parts of the country, will not the system embed second-class health care at polyclinics for some of the most vulnerable people in our communities?

My hon. Friend is absolutely right. The polyclinics will take off in the areas of higher social deprivation where, because of the transient nature of those who will work in those polyclinics and the problems in various hospitals, such as Peterborough, we will see a lesser service on offer rather than a better one. GPs who can combine—like those in the example from Macclesfield that we were given—will do so if it is what the community wants, desires and needs. If it is cost-effective and serves the community better, nothing stops GPs getting together now to provide such services. Many GP practices already do that so there is no barrier to the essence of a polyclinic; GPs can provide that service if their patients need it.

I hope that the Minister will clarify those services that a polyclinic will provide better to a community than those that GPs have the freedom to provide now. What is this magic bullet represented by a polyclinic? What will it do that GPs cannot do today?

I can help the hon. Lady on that point. One thing that polyclinics will do, for example, is to be open 12 hours a day, seven days a week. Virtually no GP practices are open for such hours. Secondly, polyclinics will provide services such as radiography, blood testing, ECGs and all sorts of facilities that are not available in the vast majority of GP practices—nor are they likely to be. Polyclinics are a model that will, we hope, keep patients away from acute hospitals and prevent long queues forming in accident and emergency made up of people who have no need to be there. They will enable those people to be looked after in a much more comfortable setting much closer to their home. On the transport issue raised by the hon. Lady, people will travel on average far shorter distances to reach such services than they have to under the district general hospital model.

The hon. Gentleman makes a number of points. The only reason why we see pressures on accident and emergency services at the moment is that cottage hospitals and community hospitals are being closed down. As for 12-hour practices, I have had no letters in my postbag on that subject and no constituents coming to my surgeries to say, “I wish my doctors’ surgery was open for 12 hours a day.” It is unreasonable to expect GP surgeries to open for 12 hours a day, if we have good local facilities provided by the PCT.

Let me give the hon. Gentleman an example. A GP recently told me of a PCT manager who got very stroppy with him in his surgery, because the GP had seen a patient who had been out of hospital for 10 days after a post-partum haemorrhage in hospital, and who went to his surgery and complained of chest pains and a pain in the leg. She was a very poorly lady. The GP immediately thought that that could be a pulmonary embolism, did the right thing and sent her to hospital. He was then criticised by the PCT for doing so, when any GP anywhere would do the same in such circumstances, polyclinic or no polyclinic. When a GP sees a patient with acute needs, such as chest pains, he saves the PCT that £3,000 admission fee, because many GPs will diagnose and treat in their surgery as far as possible before sending a patient to hospital.

I do not see polyclinics as filling a need because I do not think that the need is there. GPs provide an excellent service; they save PCTs a huge amount of money; and they are incredibly cost-effective. Patients like the service. They like having a local GP. GPs enjoy building up a good relationship with their patients, so why, if it is not broken, do we need to fix it? That is what I do not understand.

In areas such as Macclesfield, where we need such services, we have provided them. What is the image of the polyclinic? Why are we imposing such a service on communities? Why are we making it more difficult for patients? Why are we imposing something that doctors do not want?

On the point about blood counts, can anyone show me a GP who does not take blood tests and send them on to a hospital lab? A GP who does not do that in his practice should not be a GP. Many GPs provide that service—I have never heard of one who does not. Can anyone show me a GP who does not refer on for radiography or who does not provide the test? They have those services at their fingertips if they need them.

New technology offers other opportunities. Clearly, the hon. Member for Dartford (Dr. Stoate) might not be aware of the pilot scheme in Lancashire whereby GPs’ surgeries can send ECGs to a centre in Manchester where trained cardiac nurses interpret them on their behalf. They do not need the patients to go to a single place. Local GPs are perfectly capable of carrying out 12-lead ECGs and sending them off for remote interpretation.

I know many GPs are capable of doing 12-lead ECGs and of reading the results themselves, because they have trained to be able to do so, as well as sending them off to the cardiac nurses. I do not understand the need for polyclinics, but I do understand that GPs are not happy. Patients do not understand the need for polyclinics. In fact, nobody understands why the Government are doing this. The system is not broken, so why are the Government trying to impose this change unless they are trying to save costs in some way?

In conclusion, I have voiced the concerns of my GPs and patients, who are happy with long-established GPs in my constituency. They do not want a polyclinic. They like what they have at the moment. If they were to have anything, they would want greater resources to be given to GPs so that they could extend the services that they currently offer. They do not want a centralised polyclinic to which they would have to travel, particularly in Bedfordshire.

After that cogitation, I am grateful to have been called to speak, Mr. Deputy Speaker.

I was encouraged when the Secretary of State sat down and since then I have become more and more depressed. I was delighted that he acknowledged the quality of our family doctor services, and that he acknowledged the crucial importance of the strong ties between GPs and their patients and their families. I welcome the extra money and his clear statement that there are no plans to herd GPs willy-nilly into polyclinics, whether they want them or not, and that it is not a top-down measure.

We all know from our PCTs that they have been told that they must have a polyclinic. I am sorry that the Minister is not here at this moment, because I want him to confirm that I can go back to my PCT and say that the Secretary of State has said that if the trust can provide the same sort of services that a polyclinic would have provided in the enlarged health centres, which it has planned according to local need and with the money that has been provided for that purpose, the polyclinic will not be imposed on that trust.

I am delighted to see that the Minister is back. I hope that he has got the gist.

I am grateful to the hon. Gentleman. I was privileged to serve with him on the Select Committee on Health, of which he is a distinguished member. Is his experience the same as mine? My city council’s health and scrutiny committee has been given the health centre/polyclinic as a fait accompli, with the caveat that it will be placed in an area of social deprivation in my constituency. Effectively, the committee can do nothing about that decision except rubber stamp it.

I have absolutely no objection to siting these facilities, whatever they are called, in areas where they are needed. I just want to be able to tell my local PCT that it is up to it to decide what is best for the local area.

My real worry about polyclinics is that they could open the door to commercialisation. The hon. Member for St. Ives (Andrew George) touched on that problem in an earlier intervention, but I want to look at it in a bit more detail. People often ask what all the fuss is about, and a letter in my local paper, the Worcester News, carried the headline “Just what point are GPs trying to make?” The letter stated:

“Let me try to understand. They are, apparently, totally opposed to the “privatisation” of general practice—yet, of course, the private sector is precisely where they themselves work and earn their crust!”

I was rather disappointed by a document distributed at yesterday’s NHS Confederation briefing. Headed “Privatisation and reduced quality”, it stated:

“There is concern that opening up contracts to the private sector will have an adverse impact on quality and that there is not a level playing field between the private sector and incumbent GPs. However, this seems to ignore the fact that GP practices are independent for-profit contractors already.”

The most effective response to that approach comes from the pressure group “Keep Our NHS Public”. It is not a rabid, left-wing group: its members are highly dedicated professionals who are passionate supporters of the NHS, through and through, and I shall paraphrase some of the points that they make.

The group accepts that GPs are independent contractors, but asserts that they are crucially different from the large corporations that stand ready to compete for the provision of health services. It says that GPs know their patients and are driven by local priorities—exactly what the Secretary of State said when he acknowledged the value of the relationship between GPs and local families. The group believes that profits for shareholders drive the private corporations, and that those corporations will decide which patients to treat and which services to offer.

The pressure group believes that professional judgment can be overridden by company policy, and that governance and the monitoring of standards of care could be impeded by commercial confidentiality. It also says that the skill mix may be downgraded, and that NHS pay, conditions of service and pensions might not be retained. I believe that such warnings about the dangers of commercialisation need to be taken very seriously, and in that regard I commend to Ministers two seminal articles that have been published recently.

The first article appeared in the British Medical Journal, and it looked at the US experience of competition in the health care system. It said that the US has long combined public funding with private health care management and delivery. It noted that extensive research had found that the US for-profit health institutions provide inferior care at inflated prices, and that the US experience shows that market mechanisms undermine medical institutions that are unable—or unwilling—to tailor care to profitability. Finally, the article said that the poor performance of US health care is directly attributable to reliance on market mechanisms and for-profit firms, and that it should serve to warn other nations from following that path.

The second article was published in the New England Journal of Medicine, which is highly respected in this country. It states:

“The extreme failure of the US to contain medical costs results primarily from our unique, pervasive commercialisation …Medicine…does not lend itself to market discipline.”

The article describes in detail the cost-containment tactics and false economies that commercial organisations plan, and it also looks at revenue-maximisation strategies, the concentration on lucrative procedures and the selection of risk. It even pays a tribute to the British system, saying:

“When the British NHS faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialised system seems incapable of producing that result.”

The article ends with the observation:

“Sometimes we Americans do the right thing only after exhausting all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance.”

That worry has been reinforced by at least one whistleblower, who was reported in The Guardian on 9 April. I have seen the papers involved, which I think that he probably sent to all members of the Health Committee. They were very long and complicated, so I do not blame any colleague who has not read them through, but the man who provided them has seen the lengths to which organisations that want to break into the market will go to enhance profits. I am reminded of the recent revelations about how a drug manufacturer went to unethical lengths to prolong the life of one of its proprietary drugs that was long out of patent.

I have the marvellous privilege of being able to choose how to vote at the end of this debate, but my problem is that I do not know whether to support the motion or the amendment. That terrible quandary arises because I am not completely sure that the NHS as I have known it for years will be entirely safe under either of the two main parties. I do not yet know how I shall decide to vote, but my voting record would suffer if I did not support either proposition.

I welcome much of what the Government have done for the NHS. I appreciate the extra money that they have provided and the way that they have handled the service, but I hope that they will look very seriously at the warnings that I have repeated about the dangers of opening up family doctor services to commercialisation.

However, I am also worried about the Conservatives. We all know the proverb about how difficult it is for a leopard to change its spots, but it has a corollary—that even when a leopard does change its spots, it remains rather proud of having had them. The changes to the NHS made by the previous Tory Government included the introduction of market forces, the purchaser-provider split and the private finance initiative. I therefore cannot quite accept that any future Conservative Government would oppose the commercialisation that I strongly believe is not welcome in general practice.

First, may I apologise to you, Mr. Deputy Speaker, for not being in my place at the start of the debate? I had a meeting with the Prime Minister, but one of the issues that I raised with him was the proposal on polyclinics, so at least that was relevant to this discussion.

As many hon. Members will know, I am a practising GP, something that I hope will enable me to make a constructive contribution. It will be of no surprise to the House if I say that I speak to an awful lot of GPs around the country. Many of them are concerned about what the polyclinic model might lead to, and worried about how it might affect their practices and patients. I therefore think that it will help the House if I set out what I see as the vision for this type of health care.

I envisage a mechanism whereby people can be treated far closer to their own homes, with far less reliance on public transport, far shorter queues and much less reliance on accident and emergency departments, which are often inappropriate places for people to go with many health care needs. They are often not seen by the most appropriate person in the department, and in many cases it is not the nicest place to be. A and E departments simply become clogged up, which often gets in the way of the serious, life-saving work that they need to do. The last thing that they need is a group of patients coming to the A and E who would be far more appropriately treated by their GP practice, district nurse or pharmacist, in a setting that would be far better for their health care.

It is important to set out exactly what the polyclinic model is intended to do. The hon. Member for Mid-Bedfordshire (Mrs. Dorries) said that there is nothing that a polyclinic can provide that cannot be provided by a GP service. I am sorry that she is not currently in her place. The fact is that a polyclinic or such a model could offer a huge number of services that currently cannot be made available in GP services. An obvious example is X-rays. The hon. Member for South Cambridgeshire (Mr. Lansley) made the point that ECGs can be sent online. Of course they can, and of course blood tests can be taken in GP practices. However, it is much more difficult for a GP practice to have an X-ray or ultrasound department with the necessary scanning equipment and range of health care professionals. That is well beyond the scope of current general practice, and we need a radically new way of deciding how those facilities should be produced.

When I ask my patients what they want, they say that they want to be treated as near to their homes as possible, hopefully by people whom they know, trust and have had dealings with before. They do not want to go and sit in a crowded, noisy hospital among patients who clearly have far greater health needs and therefore should obviously take priority. The polyclinic model is a good example of how we can transform the patient experience.

Another obvious example of why the system might work is that it is currently estimated that every time somebody walks into A and E, it costs the health service about £150. A GP consultation costs about £20, so we can immediately see that anybody who attends their GP surgery instead of going to A and E will lead to a dramatic saving in health care expenditure, which could therefore be targeted better than by spending it on A and E. Obviously a polyclinic would have extra fixed costs and there would be other services to consider, but it would still mean a significant cost saving compared with people going to A and E, and it would therefore leave far more money for investment in NHS services and for better use in patient care.

The NHS has moved on. Clinical practice is evolving all the time, and patients’ expectations are changing. When I first entered general practice, people almost always had surgery as in-patients in hospital. They often stayed in hospital for several days, or even weeks. Now, 70 to 80 per cent. of all surgery is day surgery. The idea of relying on large, impersonal hospitals is a model that has outgrown its usefulness, and we need to move on to a much more flexible and modern approach. I believe that polyclinics, rather than diminish the range of services and choice, will increase it.

The myth that goes around that if a polyclinic is set up, patients will no longer have a choice of GP, is clearly rubbish. Under the patient choice directive, patients will be able to request a specific GP. Provided that that GP is on duty, that it is reasonable and that he or she has the available appointments, the patient will be able to specify that GP. It does not have to be impersonal. In fact, the model that I read out in an earlier intervention will, in many cases, be based around existing practices, which could be significantly extended or developed to add the extra services that are not currently available, albeit with extra funding and resourcing.

Another advantage of polyclinics is that they will allow GPs, acute specialists and other health professionals such as pharmacists to work together for the first time. General practice can often be isolating, and in small, isolated practices it is often quite difficult to have the mix of colleagues and clinical expertise that is required for personal and professional development.

I am aware that time is pressing on, so I do not wish to go on too long, but I wish briefly to quote Mr. Anthony McKeever, the chief executive of the care trust in Bexley, where my practice is situated. I wrote to him recently to ask what the PCT’s model of polyclinics was. He stated:

“We do not intend to create polyclinics on the assumption that ‘one size would fit all’…A couple of local practices have indicated that they would like actively to explore the possibilities of providing a more integrated care landscape…So, there will be plenty of opportunity to avoid the pitfalls which some anticipate…Certainly, however, the GPs I spoke to direct recognised that the development of primary care ‘hubs’ or polyclinics could be achieved without damaging and unintended consequences.”

As far as I can see, that is the chief executive of a PCT being sensible and pragmatic and understanding that flexibility is perfectly acceptable under the Government’s plans, and who actively wishes to work with local GP practices to ensure that what actually happens is a huge improvement in patient care outcomes. Hopefully, that is what we are all aiming for.

It is a pleasure to follow the hon. Member for Dartford (Dr. Stoate), with whom I served on the Select Committee on Health.

I should like to make a few general points about family doctor services. That is the subject of the debate; it is not just about health centres and polyclinics. At the kernel of the debate is a question of honesty and integrity on the part of the Government. I do not believe that they have made the case transparently and openly for a Kaiser Permanente, California model of private sector health provision. They know full well that were they to make that case, they would not get it past their own parliamentary party, the health sector trade unions or other health care professionals. There may be merit in their model, but at the moment we are not having an honest debate about it. It is incumbent upon the Government to put their cards on the table and make the case for polyclinics or health centres.

It is ironic that the Secretary of State was in crowing mood. As I said earlier, we always see the vacuity of the Labour party’s record and arguments on the health sector when it has to go back 60 years, to historic documents about what was or was not said by general practitioners and medical practitioners in 1947. The fact is that this Government have presided over a doubling of expenditure on the health service but barely any change in outputs and the impact on patients. Their work force planning was described in the Select Committee’s report last year as “disastrous”. The right hon. Member for Rother Valley (Mr. Barron) was noticeably shy in not sharing that with the House.

The Government have presided over a health service in which one is more likely to die of a hospital-acquired infection than, for instance, in a road traffic accident. They will have spent approximately £100 billion on the health service, and we will not take any lectures from a Government who, for example, have increased GP salaries by 50 per cent. for less work. I do not blame the general practitioners for that; it is this Government’s cack-handed mismanagement that has resulted in that situation.

I well remember that the then Prime Minister came to Peterborough in April 2000 to open the walk-in centre in Midgate, in the city centre. Such centres were then the great thing, the next big thing of Labour’s Maoist onward march of health reform. They were going to solve all the problems and take up the slack in the primary care sector. Of course, they are not in fashion now, so we have even more change.

My opposition to the scheme is not a knee-jerk opposition to change. Dare I say it, I am quite Fabian in my approach—I believe in the inevitability of gradualism. In such a big organisation, there will always be change, but I object to the top-down approach of the change and the fact that there is no real autonomy, authority or democracy in respect of general practitioners, health care professionals, nurses, managers, elected councillors and others at local level. The change is being imposed. That is to be regretted—a point made by Members across the House.

General practitioners in particular need to be properly consulted; they need buy-in to the new health centres or polyclinics. It is no good the Secretary of State, in his rather uncharacteristically sneering remarks, belittling the work of GPs, who are the most trusted health care professionals in the UK—perhaps the only point in my speech with which the hon. Member for Dartford will agree. It ill behoves the Secretary of State to take that confrontational tone, and it is no wonder that such a significant number of GPs are not predisposed to vote Labour at the next general election.

I want to give the House a slight history lesson about primary care in the city of Peterborough. The city pioneered collaboration between adult social care and primary care, which the Liberal Democrat spokesman, the hon. Member for North Norfolk (Norman Lamb), described as an exemplar for the country. If I may, briefly, be positive, one of the only aspects of the Government’s health policy with which I agree was that they listened to us about Peterborough’s primary care reorganisation in 2005. We in Peterborough said that as we had pioneered collaboration between adult social care and primary care it would be ludicrous to throw it away in an unpopular and uncalled-for reorganisation. The Government listened, and the former Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), threw out the plans.

There were other reasons why we insisted that we should have a city-wide health care body or primary care trust. We in Peterborough have specific health needs and health inequalities. Even in a relatively small area such as Cambridgeshire there is a great gulf between the needs of my constituents and, for instance, those in a relatively wealthy constituency such as Cambridge. We have issues around asthma, chronic obstructive pulmonary disorder, diabetes and heart disease. We have a large ethnic minority population who are predisposed to some chronic conditions. We felt that to be subsumed into a greater Cambridgeshire PCT was not appropriate—the fact that the trust was approximately £30 million in deficit at the time concentrated our minds somewhat, too. The Government listened, and we went forward.

I pay tribute to the PCT in Peterborough and the professionals who work in the organisation, especially Angela Bailey, the chief executive. However, when I read the proposals and listen to the Secretary of State, I am astonished that a Government who exult in the fact that the NHS is 60 years old and that they were responsible for founding the national health service could really be presiding over changes that would give the sickest, the very oldest, the very youngest and the poorest—the least able to speak up for themselves—a second-class primary health care system. As I said earlier, I cannot believe that of a Government who seem to be having a nervous breakdown in their interaction with those who should be their core supporters. We know that the Labour party has always had a rather sanctimonious, smug attitude—only Labour cares about public health, the poorest people in our society and the health service. Of course, that has never, ever been true.

In an area such as Macclesfield, which I represent, where there is an out-of-hours service staffed by GPs at the district general hospital and where all the GP practices in the town came together, with the agreement of the PCT, in a super-surgery to provide the wide range of facilities that the hon. Member for Dartford (Dr. Stoate) described, does my hon. Friend agree that it should be the PCT that takes the decision and not central Government?

I am grateful to my hon. Friend for making the pertinent point, alluding to his constituency, that where we trust NHS professionals and give them authority, autonomy and budgets, they will work for their benefit and the benefit of patients and the whole community. We can see an example of that co-operative work in the primary care sector in Cheshire, particularly in Macclesfield. I pay tribute to my hon. Friend for his role in producing that outcome.

As of March 2009, a polyclinic or health centre, or whatever it is to be called, will be foisted on my constituents in Peterborough, with only partial lip service to democracy—the gloss of democracy—via the city council health overview and scrutiny committee. What is the strange beast that will be foisted on us? Open 12 hours a day, seven days a week, it will apparently provide a one-stop, multidisciplinary medical assessment, diagnosis and treatment facility, supposedly located in a deprived area of the city. All fine and dandy in principle, but what does one-stop medicine actually mean? Where will the doctors to staff the polyclinic come from? No established doctor who has his or her own family practice will want to give it up to work at a polyclinic. Does that mean that less experienced and capable staff will be recruited? I hope not. When we board an aeroplane we hope it will be flown by a pilot, not an air stewardess. I hope that when my constituents go to a polyclinic they will receive the highest possible standard of primary care from clinicians and NHS professionals.

We have already seen shortages across the country—for example, of fully trained radiographers, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) said, and of specialist nurses and hospital doctors. What about X-rays, scans and blood tests? Will there be consultants on site to oversee such work? If so, who will cover their work at Peterborough district hospital and Edith Cavell hospital? What are the resource implications?

Will polyclinics deal only with straightforward cases, such as the young, the wealthy and the only occasionally poorly—Tarquin and Jocasta popping down in their 4x4 before they go off on a business trip? Will polyclinics treat only the so-called worrying well? That may be the case. What about the very old, the poor and people with chronic conditions, such as chronic mental health issues? Will they be welcome at the polyclinic? I am not entirely convinced.

What will be the future of the family doctor service in my constituency? Will those services go the way of local shops and pharmacies? Mention was made earlier of the impact of the 2005 regulations on small pharmacies, which are closing at an alarming rate, giving way to the provision of pharmaceutical services in large supermarkets such as Sainsbury’s and Asda. Will those services go the way of NHS dental surgeries and of post offices? We know of the Government’s lamentable record of duplicity about post office closures over a number of months and years.

The Department of Health has promised more money for polyclinics, but will it be from existing, struggling NHS local budgets? I beg the indulgence of the House while I make my next point—one with which my hon. Friend the Member for Boston and Skegness (Mark Simmonds) will have some sympathy. We have had a huge influx of EU migration in Peterborough that has put massive strain on surgeries across the city, notably the surgery of Drs. Modha and Modha at Thistlemoor road, New England, and Dr. Prasad’s surgery at the Westwood clinic. They are straining under the weight of inward migration from the EU. Will that be taken into account in the national template forced on local PCTs? No one in Peterborough has voted to end the relationship between patients and their local, trusted and—mostly—friendly general practitioners for the sake of those super-surgeries.

We should be opening more family practitioner surgeries in the poorest areas of my constituency. We should not be centralising and putting everything in one place—a place that people who have travel and transportation problems as a result of their illnesses and medical conditions may find it difficult to reach. As always happens under this Government, there will probably end up being a great fanfare and lots of money spent, but at the end of the day there will be depersonalised services, dumbed-down care and a system without comprehensive budgeting, risk assessment or proper consultation.

I apologise for my late return to the debate. I wonder whether my hon. Friend agrees that we may end up with another situation that often arises under this Government. Government Members are fighting against their own tax rates, and Government Members who have voted to close post offices are leading campaigns to protect their local post offices. Does my hon. Friend believe that we will see Labour Members leading protests against the closure of family practices, even though they will doubtless vote for those closures later this afternoon, having had yet another loss of conscience?

Labour Members of Parliament, who are in a weird parallel universe with the Prime Minister, voted against a Conservative motion on post offices in the Lobby, and then ran hotfoot to their constituencies to address public meetings, in which they said how hard they were working to keep post offices open, having issued press releases and put them on their websites. I am an old cynic, but I foresee occasions when my Labour opponent will be fighting tooth and claw to protect surgeries that his own Government have led to be closed.

My admiration for local NHS staff is well known, and we are fortunate to have good managers in our area, but my job as a Member of Parliament is to stick up for the people in my constituency who do not have a voice, and to ask awkward questions. I will continue to ask those questions until we have full, honest and transparent answers from the Government on polyclinics, and until we concentrate on the really important issues—on making the whole of our communities better—instead of on gimmicks that will lead to disaster.

I declare an interest: I am a lay member of the General Medical Council. First, I want to reply to a comment made by the hon. Member for Wyre Forest (Dr. Taylor) about clinical judgment being superseded by the needs of a company—I think that he was quoting from the NHS campaign group, Keep Our NHS Public. In all my years on the GMC, that has not happened. People who work in the independent sector come before the GMC from time to time, but I have never met anyone in the medical profession who felt that they would have to do something that was against their clinical judgment; that would be wholly wrong and unprofessional. We may argue about one pharmaceutical prescription as opposed to another, but I do not see any proposals that would endanger the patient.

The hon. Member for Peterborough (Mr. Jackson) was a member of the Select Committee on Health a few months ago. We criticised the national health service, and therefore the Government, on work force planning. That is absolutely right. As most people in the national health service would agree, work force planning has been dysfunctional for a long time now. That situation is beginning to get a little bit better—I am pleased about that, and I hope that the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), is, too—but it in no way threatens family doctor services.

I point out to my hon. Friend the Minister that family doctor services have been the backbone of the NHS for the vast majority of our constituents since 1948, and will remain so. It is true to say that those services are not always the first port of call. The hon. Member for Romsey (Sandra Gidley) would probably jump up and tell us that our constituents’ first port of call for health care help and professional advice is the local pharmacist, and not the local GP; that will remain the case. The vast majority of doctors who work in family care services are committed to their flock—their patients in the community where they practise. I have no doubt about that, and I do not feel that they are under threat in any way.

Let me say why I do not support the Opposition motion and why I support the Government amendment. In their changes, the Government are investing an extra £250 million to establish more than 250 new primary care services, which will include both GP-run health centres and GP practices. Some 113 of them will be established in some of the most deprived communities in the country which have historically been under-doctored. There will be 152 new state of the art GP-led health centres, which will be open between 8 am and 8 pm, seven days a week. One such structure will be built in a constituency that neighbours mine, but it will serve my constituents well. Those health centres will offer a wide range of health services, including pre-bookable GP appointments and walk-in services for registered and non-registered patients, and a range of specialist services.

I had discussions last September with the local foundation trust. It will bid to provide some of the services that will be offered in the new primary care centre, as we will call it in Rotherham. Those services may not be offered in the district general hospital. Particularly for those who do not have their own transport, it is a lot easier to go to the town centre by bus than it is to get to the local hospital, so it will be a great advantage to urban Rotherham to have that facility, which will be open seven days a week, 12 hours a day.

Has the Chairman of the Select Committee had a lot of people in his area writing letters or coming to his advice surgery to demand those extra hours—the Saturday and Sunday service, and for services to be open 12 hours a day? Has there been a lot of demand for that?

No, there has not; that is the true and honest answer to the question. Around the time of the last general election, there were problems with the way in which one practice near my constituency office interpreted the 48-hour rule that was introduced a few years ago. That was the only time that anything was said about the health service at the time of the general election. People were upset that they had to phone in the morning for an appointment that day—an impossible task, particularly for people who work and people with young families. I thought that that was a gross misinterpretation of the agreement, and so did the primary care trust. It had to try to negotiate with the GP practice on whether it would relax its strict interpretation of the rule and free-up access in a reasonable way. We were not talking about opening the practice seven days a week, 12 hours a day; we just wanted to free-up access in a reasonable way, so that people who were on that family doctor services list could get seen in a more reasonable time. That was a complaint about one surgery; there were no complaints about the many other GP surgeries in my constituency.

Perhaps I can help my right hon. Friend. The issue is not so much about the number of people who demand such services when they are well as it is about the number of people who are using accident and emergency departments on a Saturday and Sunday, but who would far rather be seen in their local clinic, a bus ride away, by their local GP, pharmacist or practice nurse. The real benefit of opening 12 hours a day, seven days a week, is far more to do with keeping people away from accident and emergency departments—many of which may be 10 or 20 miles away, or even more—that are inappropriate for them. We should localise the care that is appropriate to their needs, so that it is far closer to their homes.

I agree. The question posed in the motion, and asked by the hon. Member for South Cambridgeshire (Mr. Lansley), is what about walk-in centres. Our walk-in centre in Rotherham will close. It is based in a pretty old building that used to be a hospital. It is not an acute hospital now, although services such as podiatry are based there. People will instead go to the new primary health care centre—we are not calling it a polyclinic—that will be built in Rotherham. I had an e-mail from the primary care trust earlier this week saying that there will be two new GP practices in there. Those practices will not be transferred; they will be new. It also said that local GPs who want to bid for that contract will have the right to do so. Family doctor services could even expand if they are successful in obtaining an NHS contract to provide that type of service in the Rotherham primary care centre. We should recognise that no matter who runs such centres, those are national health service contracts designed to provide better services for our constituents.

I am grateful to the current Chairman of the Health Committee, which I had the honour to chair in the past, for giving way. Will he say to the House that polyclinics should not be forced upon areas where there is already adequate cover by way of out-of-hours services, staffed by local GPs—in my case, as I said in an earlier intervention, at the district general hospital? In Macclesfield all the GPs’ services have come together in an excellent super-surgery, where they operate separately as individual practices, which is so important to people. Is it not right that a polyclinic should not be forced on areas where there is already adequate coverage?

The hon. Gentleman is not the first to cite that example. His better half, the hon. Member for Congleton (Ann Winterton), mentioned family doctor services in Macclesfield earlier. There is and always has been the flexibility in the national health service for that to happen. The question is whether it does. I shall come to that.

I know that the right hon. Gentleman shares my concern about provision in rural areas. There is, as my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) observed, a fear about the imposition of polyclinics. The policy will go down particularly ill in rural areas where minor injuries units in community hospitals have been shut down or had their hours massively reduced. If Ministers suddenly espouse the need for provision 12 hours a day, seven days a week, people in those communities will not understand why that has been removed from community hospitals throughout the country, and they will not believe that the policy is likely to lead to the improvement in rural areas that the right hon. Gentleman implies will happen.

I am no expert on the hon. Gentleman’s constituency but, as was said earlier, and not by me, there is and should be flexibility. It might be the local community hospital that delivers the service. That might be a structural matter. Years ago I visited some of the community hospitals outside my constituency; they were so old that they were hardly suitable for the 20th century, let alone the 21st. A decision will have to be taken at local level about how and where the service is provided.

The motion states that the Opposition are against the imposition of polyclinics

“against local health needs and requirements”.

What is the evidence? There is little evidence. Most decision making in the national health service could hardly be called evidence-based. On the contrary, it is often a matter of wetting one’s finger, putting it up in the air and seeing which way the wind is blowing. This is the first time I have said that, but it is a true representation of how decisions have been taken for the past 59 years.

The hon. Member for Peterborough (Mr. Jackson) mentioned Kaiser Permanente in California. Studies in the US have shown that where there are more primary care practitioners on the ground—not just GPs, but other health professionals as well—there are healthier communities. That may be an international finding and it may not be specific to east Yorkshire or south Yorkshire, but in general, it is likely that by expanding the number of primary care health professionals, not just GPs, better health care will result for the people in that area.

The Opposition motion opposing the imposition of polyclinics

“against local health needs and requirements”

echoes the BMA brief, which states:

“The BMA acknowledges that there may be a case for establishing a polyclinic in some very specific circumstances, such as where local patients and clinicians agree on a proven need in their area.”

That has been the subject of debate for 59 years in the national health service. Who takes that decision? How is the need measured?

I represent an area with very high disease burdens. Fifteen years ago it had the highest patient to GP ratio in England and Wales. It is a little less now because of the action that this Government have taken, but are GPs flooding into south Yorkshire to come and work alongside the hard-working GPs dealing with massive problems at every surgery, because of the difficulties that we have, sadly, with smoking, drinking, eating and the scars that industry has left on individuals? If it were not for the Government changing the GP contract, we would have the same patient to GP ratio that we had previously.

I should like to know—I say this to those on both Front Benches and to everyone in the debate—how we measure the needs of communities, if not by looking at the disease burden that they carry and taking the action proposed by the Government to put GP services into those communities? What other way of measuring need is there? I do not know another way. If it is true that in America more primary health care professionals lead to healthier communities, the Government’s proposals should be endorsed by everybody, including the medical profession.

Most of the Government’s proposals in recent months relating to family doctor services have been grudgingly accepted. One doctor turned up at my constituency surgery to discuss the issue of doctors’ hours, which went to ballot. The rest of them get on with doing a very hard job under difficult circumstances because of the size of their patient list and the disease burden that those patients carry. The BMA badly misrepresents GPs, as it did on the issue of extending practice opening by a few hours in the evening and on Saturday. The BMA and the GPs within it are badly led.

One of my constituents sent me a leaflet picked up in a neighbouring constituency. Headed “Your family doctor service is under threat”, it states:

“If we don’t agree to this, the government has threatened to take this money away from patient services anyway and give it to local Primary Care Trusts (PCT) to fund large town centre ‘Superclinics’, probably run by private companies for profit. This could be the first stage in privatising all family doctor services and then the whole NHS.”

We heard the hon. Member for Wyre Forest say that family doctor services are not and never have been run by the state. They are private businesses that are run under contract to the state.

The hon. Member for Peterborough said that the Labour party always harks back to what happened 60 years ago when the national health service was created. It was on precisely the matter of GPs that Nye Bevan fell out with many people, and I suspect with those on the Labour Benches in the Chamber, although at the time the Chamber had been knocked down for a few years. It was agreed that GPs would not work for the state, although there are some in my constituency and in all other constituencies who work on a salary, and thank goodness they do. That has enabled us to bring down the patient to GP ratio a little.

I have had only two letters on the matter, but leaflets such as the one that I quoted are outrageous and do the profession terrible harm. A similar one was being circulated in neighbouring Doncaster. I am pleased that my right hon. Friend the Secretary of State stuck to his guns and said that, under the new contract and its treatment of doctors, it is reasonable for us to expect that doctors’ surgeries should open on a Saturday morning. They always used to do so when I worked in industry, before I came to the House, and sometimes in the evening, to make it easier for people to attend.

I am dismayed at the lack of professional leadership that the BMA provides to general practitioners. Dr. Laurence Buckman wrote an article on family service access. I have met him a couple of times and he is obviously an independent-minded person. In the “Royal College of GP News” in February 2008, he is quoted as saying:

“If there is a boat I’ll rock it…I don’t shy away from confrontation—people need to hear our point of view. I first got involved with the BMA because I was an angry young man with something to say and I still feel the same way now.”

The last trade union leader to say that was Arthur Scargill, and look what happened to the coal mines. I do not think that the GP surgeries in Rother Valley will suffer the same fate as the coal mines, but that is not good, sensible and responsible leadership. Dr. Buckman went on to say:

“Politicians aren’t primarily interested in the health service; they’re out for what will be good for themselves and their constituents.”

That is absolutely right. After 59 years of being dictated to by those who work in the health service as opposed to those who need to use it, I could not agree more. If that man were representing me, I would be going along to the next branch meeting.

Is this the same gentleman who has one of the highest rates of exempted patients in the country when it comes to calculating QOF points? He has the nerve to say that we are in it for what suits us, but he may be in it for what suits him.

I do not know the detail of his QOF points, but the Select Committee will be looking at QOF points later in the year in relation to health inequality. I expect that the debate will be ongoing for a long time, but I come back to how we can assess local health needs other than by measuring the disease burden in communities to determine whether we need more health practitioners, perhaps for preventive reasons or to enable people to be seen more quickly. How do we measure such needs other than by taking such action? Rather than destabilising or closing local GP surgeries, it will give them the opportunity to bid for and to work in the new centre in Rotherham.

The Government seek to take the health service to those who need it so that they can make better use of it than they can at the moment because there are fewer doctors in their areas than there should be and those who are there are working hard with a difficult patient work load. The sooner this is sorted out collectively—it does not look as though we will reach a decision on the matter today—the better it will be for the NHS and our constituents.