In response to my question, the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), said that she would arrange for a paper to be placed in the House of Commons Library. I checked, and it has not been placed there. I wonder whether it could be placed there today, because it contains important information that answers questions in which hon. Members would be interested.

indicated assent.

The point has been answered.

Reference has just been made to the report on the Nursing and Midwifery Council that was published yesterday, which highlighted the fact that that body was not fit for purpose and had a bullying culture. That vindicated claims made by many on both sides of this House and, in particular, by my constituent, Moi Ali, who is the whistleblower in this matter. She is a black lady who has a claim for racism against the NMC. She has used the internal systems and approached people, including her MP, externally to raise the matter. Because of Buggin’s turn, she is the vice-president at the moment and, sadly, she is being pressured to resign from her job. I wonder whether, through your good offices, Mr. Speaker, the Minister with responsibility could come to the House to make a statement on that report?

I am not going to be drawn into that matter.

I beg to move,

That leave be given to bring in a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes.

The debate about social inequality is beset by stereotypes and simplification. Sometimes stereotypes give us an indication of the truth, but they frequently conceal more than they reveal. So, we hear a lot about the north-south divide, and unemployment and incapacity benefit figures are frequently portrayed exclusively in terms of decayed former industrial communities in the north or in the Welsh valleys. Sometimes Tower Hamlets is contrasted with the Royal Borough of Kensington and Chelsea in what is frequently described as a tale of two cities, revealing the stark divide in average incomes, house prices and life expectancy.

Such attention is broadly welcome because it highlights the continuing extent—and in some ways the worsening or intensification—of the toxin of inequality. It is even more corrosive than poverty, in its own insidious way, as has been so well documented by academics such as Richard Wilkinson. Inequality damages health, undermines community cohesion and is now understood to be more closely correlated with crime than poverty itself.

Inequality is poorly understood. Last year’s report for the Joseph Rowntree Foundation confirmed that people’s knowledge about inequality is limited, and attitudes are complex, ambiguous and apparently contradictory. In turn, policy makers know little about how the perceptions people have are formed, or changed. We could simply choose to ignore the ramifications of inequality, precisely because public attitudes are complex and contradictory. But by doing so, we would be turning our backs on a very real problem. Over the past 20 years a consistently large majority of people have considered the gap between rich and poor to be too large, and only a small minority of people feel that the Government are doing too much to address the problem.

My Bill is intended to make a small contribution to increasing awareness and understanding of social inequality. I seek broadly to mirror the important work done by primary care trusts in their annual public health reports, which have come into their own in recent years as an essential source of data about health inequalities. By requiring all local authorities to produce an annual audit, based on a core basket of indicators, I would hope to achieve three things. First, I would like to get beyond stereotypes, whether of the north-south divide kind, or the Tower Hamlets versus Kensington and Chelsea variety. The reality is far more complex than such stereotypes would have us believe and generalisations limit understanding, not deepen it.

Secondly, I hope that the process of producing and publishing annual audits would generate interest and debate among local policy makers, the media and others, precisely because the information would be local. Of course, there are no guarantees that such interest would sharpen the focus on deprivation and inequality, but it would certainly offer communities a set of tools to hold policy makers to account. That is certainly the experience of PCTs and public health reports in recent years.

Thirdly, requiring a core set of indicators that apply to all authorities would enable more specific comparisons between small areas across the country. It would also promote a wider and more interesting debate nationally about the causes of inequality and social deprivation.

I confess to a personal stake in this issue. The local councils that make up my constituency—Westminster and Kensington and Chelsea—consistently come near to the top of national league tables for wealth and income. The prosperity of Knightsbridge, Belgravia and Chelsea, where some councillors think that international bankers constitute a “hard to reach group”, masks the fact that, as recent reports have confirmed, the Mozart estate in Queen’s Park in my constituency is the most deprived neighbourhood in the whole country, and Westbourne ward has the country’s highest proportion of children in workless households. But I—and my colleagues in other areas with generally affluent average figures—struggle to get the implications of that understood locally and nationally, and families and pensioners living in poor neighbourhoods in such areas lose out in consequence.

Local authority social equality audits would be based on existing sources of data. I am not seeking to saddle councils with major new duties in collecting and analysing information, but to bring the vast array of data already buried in the vaults—locally and nationally—blinking into the light.

What would be included? Obviously, I would want short profiles of all neighbourhoods, which currently stay anonymously labelled as “super output areas” buried in the Office for National Statistics. Which are the most prosperous areas and which the poorest? We already have information on employment levels, and the number of children in workless households—that is, families surviving on less than £10 per day for fuel, food, clothing and treats. I would want to include data that exist but are unpublished, collected in school information profiles. League tables offer us information on key stage results and useful, though poorly understood, contextualised added value, but they should be complemented by the information that we hold on all schools about free school meal entitlements and other proxies for deprivation.

Harsh words about school performance miss the target when the breathtaking variations we see in school intake receive so little attention. It would also be useful to include information on benefits and services delivered by local authorities, including housing benefit and take-up of child care and out-of-school services. That would enable more informed discussions about local welfare-to-work policies, the impact of local authority charging policies and so on.

Audits would not be exclusively about ward or neighbourhood data, either, but would include local authority rankings on key deprivation indicators and proxies for deprivation, such as substandard housing, overcrowding and homelessness. Of course, as has proved to be the case with PCT public health reports, it would be good to see themes emerge and to see priorities set from year to year between different communities that reflect local circumstances so that audits become dynamic tools, complementing and informing local area agreements and council decision-making processes.

Information does not by itself make wrongs right. Information can be powerful and can do harm if abused or used partially or selectively, yet the alternative is far worse. We should no more be ignorant about poverty and inequality than we should be about climate change or any of the other great issues of our time. By offering local communities, policy makers and the media clearly presented and comparative data, we might not get all of the right answers but we might at least ensure that people are asking the right questions.

Question put and agreed to.

Bill ordered to be brought in by Ms Karen Buck, Mr. Iain Duncan Smith, Mr. David Blunkett, Mr. Frank Field, Simon Hughes, Fiona Mactaggart, Mr. Gary Streeter, Martin Salter, Mr. Terry Rooney, Clive Efford, Lyn Brown and John Battle.

Local Authorities (Social Equality Audits)

Ms Karen Buck accordingly presented a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 17 October, and to be printed [Bill 122].

I beg to move,

That this House opposes the Government’s plans to impose a polyclinic, or GP-led health centre, in every primary care trust; regrets that this could result in the closure of up to 1,700 GP surgeries; is concerned that the imposition of polyclinics against the will of patients and GPs could be detrimental to standards of care, particularly for the elderly and vulnerable, by breaking the vital GP/patient link; further regrets that these plans are being imposed without consultation; is alarmed at the prospective loss of patient access to local GP services at a time when care closer to home should be strengthened; believes that the Government’s plans would jeopardise the independence and commissioning capability of general practice in the future; supports the strengthening of access to diagnostic and therapeutic services without undermining the structure of GP services; and calls on the Government to reconsider its plans for polyclinics.

Last Thursday, the local medical committees, which are the statutory bodies required to represent GPs across the country, met in conference and passed a vote of no confidence in the Secretary of State and the policies of the Labour Government. On the same day, the British Medical Association delivered to Downing street a petition against the Government’s polyclinic proposals consisting of 1.2 million signatures. Patients care about the future of their local surgeries and about their GP services. They and GPs are concerned that the Government’s top-down, one-size-fits-all imposition of polyclinics in London and in each primary care trust across the country will reduce access to their GP services and undermine the GP-patient relationship, which is at the heart of the successful delivery of health care.

Today’s motion is very simple. It urges the Government to think again. If the Government had offered additional funding to support the creation of extra GP practices in under-doctored areas, we would have supported them.

My local primary care trust has announced that we are to have an additional clinic, funded with additional money, in an area where some of the GP lists are full, which is an area of deprivation. The clinic will be open from 8 am to 8 pm and will provide drop-in services not only for the local community but for the whole area. Is the hon. Gentleman saying that he would deny the people of Crosby that clinic?

No. The right hon. Gentleman should remember that back in January 2006, the Government promised to provide additional general practitioner services in under-doctored areas such as his. The fact that they are doing that two and a half years on should not be a cause for congratulation; it should be a cause for regret that it has taken so long. My point is simple—

rose—

No, I will answer the right hon. Gentleman’s first question before I come on to the next one. The point is that we need additional GP services in under-doctored areas, and the decision on where and how those services are structured must be the product of local consultation and agreement, based on local needs and circumstances. For some time—for two and a half years—the Government have been saying that they will provide additional GP services in under-doctored areas, and we are not disputing the need to do so.

The hon. Gentleman mentioned petitions; I went to see my GP the other day, and the receptionist was giving out petition forms. Someone asked what the forms were for, and the receptionist said, “They’re going to close all the local surgeries down.” That is complete nonsense, and the hon. Gentleman knows it, so why does he go along with it?

It is the British Medical Association’s petition, not mine. The Secretary of State and the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), are suggesting that 1.2 million people across the country are being conned by their GPs, but that is not true. The Minister of State pops up and says that the Department had one e-mail from someone saying that they did not really believe in the petition, so I have asked the Minister whether he will publish all the e-mails presented, and every representation made, to the Department of Health. The fact is that across the country doctors have been voicing their concerns that their practice will be undermined to their patients, and I will explain in my speech why those concerns are valid. Doctors have concerns about the impact that the imposition of a polyclinic will have on their practices.

Will the hon. Gentleman give way?

I will come to the hon. Lady in a minute. The first point to make clear is that the Government could have gone ahead in a far simpler, better fashion. They could have offered primary care trusts extra funding to provide additional practices in under-doctored areas. They could have offered funding to each primary care trust across the country to enable them to provide access to diagnostics and additional therapies in each area, in places that would have made sense from the point of view of local GPs. Everywhere that I have been—that is quite a lot of places—GPs would very happily have got together and agreed where it would be appropriate for such diagnostics and therapies to be available.

Is not the point that over the past 10 years the Government have set up a system for commissioning, and are now going outside it, and that any PCT that declines to put a polyclinic somewhere in its area will get disciplined? Is that not shocking?

Yes, it is, and that is the way in which the Government now work. It is simple to say why GPs and patients across the country are angry: it is because, contrary to the Government’s rhetoric about local decision making, and contrary to the Minister’s rhetoric about all the proposals coming from primary care trusts, it is an imposed plan, generated inside the Department of Health and adopted by Ministers who should have known better.

To go back to the first intervention, the people of Crosby may be delighted that there is to be a polyclinic there, but the people of Bournemouth are concerned, and doctors are worried about the patient-doctor relationship being eroded as a result of polyclinics being created. Does my hon. Friend agree that it would have been better to have allowed Bournemouth and doctors an opportunity to have a say in the matter, and then to have determined whether a polyclinic was appropriate?

I absolutely agree with my hon. Friend, and he rightly reflects precisely the kind of points that are being made to all Members of the House. Labour Members may not admit it, but they know that GPs are telling them that they cannot see the rationale for many of the proposed imposed polyclinics across the country.

The Government were not content to bring forward proposals that would have made sense and could have been adapted and used locally. Gripped by a desire for the latest imported ideology of polyclinics, they first told London that there would have to be 150 polyclinics in the capital, and then told every primary care trust that they should have one each.

Of course, we need to strengthen primary care—no one disputes that—but Martin Roland, who is director of the National Primary Care Research and Development Centre in Manchester, said in the British Medical Journal in March:

“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.”

rose—

rose—

I will give way to the hon. Member for Cleethorpes (Shona McIsaac), but perhaps the hon. Member for Regent’s Park and Kensington, North (Ms Buck) will explain later why smaller practices that get better outcomes on the quality and outcomes framework will be shut down in favour of larger practices.

I ask the hon. Gentleman to follow up what was said by my right hon. Friend the Member for Scunthorpe (Mr. Morley). I represent the rural part of north Lincolnshire. We will get a new clinic in north Lincolnshire, but the PCT has told us that that is a local decision to meet local need, and not one rural GP practice will close as a result of these plans. So why is the hon. Gentleman and his hon. Friends scaremongering to the extent that my residents think that their practices will close?

That is quite interesting, but the hon. Lady needs to look at the material published by the North East Lincolnshire PCT to accompany its memorandum of information, which sets out 34 practices that will be in the proximity of the new polyclinic in Grimsby, with all the implications that might flow from that. That is what we have seen across the country. We are not scaremongering; people are looking at the material published by PCTs across the country. The Secretary of State for Health peddles the same line as the hon. Lady in saying that no GP practice will be affected and closed, but his own PCT in Hull says that the process will be used as a lever for the reconfiguration of GP services and that, at the end of the day, there will be fewer GP sites.

The hon. Gentleman has twice mentioned my constituency. What Hull is doing of its own volition is going out to consultation at the moment, and the proposal is additional to the proposals for the new centres that will come to under-doctored areas and additional to the GP-led health centre that we are putting into Hull. It is consulting on three additional health centres to deal with three problems: first, a preponderance of single-handed GPs; secondly, facilities and services that do not even meet the Disability Discrimination Act 2005; and thirdly, the fact that it has no women doctors whatsoever. So the PCT has gone out to consult the people of Hull, quite separately from what we are doing nationally, to seek to address those problems, and so it should.

The Secretary of State is getting desperate. I have here the presentation document from Hull PCT. If it devised the proposal, why does the powerpoint presentation say, “Darzi GP-led health centre”? It does not say that it is something that the PCT thought up. The proposal’s criteria are exactly those that the Department of Health have specified. The document’s conclusion says:

“The number of GP sites will reduce.”

[Interruption.] Labour Members should listen. If the Secretary of State is saying that Hull PCT will provide three additional GP health centres, how come the impact will be that the number of GP surgeries will reduce? We know exactly what that means.

Is not the central point that we are very happy to see polyclinics if they are additional and wanted by the local community? The element of compulsion is quite wrong, and Labour Members have got a real shock coming to them when they discover that, in their areas, GPs will dislike it but be dragooned and that they will lose their current practices.

I agree, and my right hon. Friend has a reasonable complaint if the Government are providing additional money in his area only on the basis that it will be spent in a certain way. If I recall correctly, his PCT is the lowest funded per capita in the whole country. If anywhere in the country should be given the opportunity to spend the money as it sees fit, it is his constituency.

I assure my hon. Friend that certainly GPs in Chelmsford do not think that he is scaremongering in any way. Mid Essex PCT is being forced to have a polyclinic in Chelmsford and GPs in the area are extremely worried that it will have a serious and negative impact on their practices, because of the nature of the things being imposed on them.

I am grateful to my hon. Friend, who has gone to the heart of the issue. At the moment, the Government require PCTs to publish memorandums of information before in effect tendering for the new polyclinics. We have seen the tender documents from 58 PCTs, which identify 608 GP surgeries in proximity to proposed polyclinic locations. Because the Government have insisted that the new polyclinics should register patients, the local practices identified in those documents will see their patient lists undermined, some of them potentially fatally.

The Secretary of State has said that no GP surgery will be closed as a consequence of opening polyclinics, but how can that be true? The Government amendment does not refer to the polyclinics proposal for London, which we should address for a second. The Prime Minister got up at the Dispatch Box and said that there would be 150 polyclinics, that each polyclinic would have 25 GPs and that each polyclinic would serve 50,000 people. The consequence of that would be the closure of more than 70 per cent. of existing GP surgeries in London.

Documents from half the PCTs refer to 600 GP surgeries in proximity to potential polyclinics. If the polyclinics are not additional and the GPs in them are the same GPs who currently work in their own surgeries—or, for that matter, salaried doctors in PCTs—then a number of surgeries will have to close. That was the clear implication of the Government’s proposals for London. If that is not the case and the GPs are genuinely additional GPs in additional GP practices, where will the money come from? We have done that calculation, too. If the Secretary of State is to be believed and the provision is all additional, the cost of that number of GPs in that number of surgeries would be £1.6 billion a year. However, the Government have allocated £250 million over three years, so the situation simply does not add up. One of two things must be true. Either the GPs will be moved and the practices will be moved from their present locations into larger polyclinics, or additional services will be provided and additional costs will be incurred. The Government have not answered the question about which one of those two things it will be.

In my PCT, the thinking concerns creating a polyclinic based on a hospital. That would reduce inappropriate accident and emergency attendances by people who are not registered with doctors, which hammers the hon. Gentleman’s argument that there is a one-size-fits-all solution. Is it not true that in 1981 the Acheson report addressed the issue of single-handed practices, particularly in London, where single-handed practices were over-represented? For 16 years, Conservative Governments made progress—not enough in my view—on reducing single-handed practices. Although there is good practice in some single-handed practices, by and large the quality of care is not as good as that provided by other practices. Is the hon. Gentleman saying that his party stands four-square behind all single-handed practices, regardless of the quality of care?

Nobody could responsibly say that “regardless of the quality of care”. The hon. Lady has said that we have suggested that there is a central plan, but I did not make that suggestion. Ara Darzi produced “A Framework for Action” for London, which set out the specific design for a polyclinic—25 GPs, 50,000 people, £800,000 a year rent, a number of out-patient attendances, the employment of a consultant and the provision of a number of nurses. I did not make that up; the Prime Minister stood at the Dispatch Box and paraded the fact that there would be 150 polyclinics in London. It is absurd that the hon. Member for Regent’s Park and Kensington, North has challenged us on single-handed GPs when the evidence is clear that the best quality and outcomes framework results are achieved by practices with two or three GPs. [Interruption.] I know that they are not single-handed practices. Why do the Government propose to push GPs from across London into large polyclinics, when the evidence is clear that accessible local surgeries with two or three GPs achieve the best results?

My hon. Friend has said that the situation is absurd, but there is a further bizarre twist. Is he aware that the Darzi clinics will not be subject to monitoring by health overview and scrutiny committees? The Government are introducing a two-tier NHS: parts of the NHS are subject to scrutiny by health overview and scrutiny committees, whereas independent treatment centres and Darzi clinics will not be subject to scrutiny and monitoring by health overview and scrutiny committees, which seems fundamentally wrong.

I agree with my hon. Friend. Pulse recently looked at the proposals in PCTs, and only a tiny proportion of those that it looked at had been subject to even a semblance of a public consultation. The reason is precisely the same as the reason that my hon. Friend gave: the Government are determined that the proposal should not be subject to scrutiny. Why? Because it will not stand up to that scrutiny, it is not locally determined, it does not arise out of the needs and circumstances of the area and, on the quality of care that will be provided, it is not even evidence-based.

If the aim of the proposal is to force the closure of single-handed practices, why are the Government going to parachute a polyclinic into the middle of Scarborough, where we have a number of good group practices, but not into rural areas, where we have some very good single-handed practices? It does not even follow the logic of the hon. Member for Regent's Park and Kensington, North (Ms Buck).

Work it out for yourself.

The Secretary of State says that my hon. Friend can work it out. The reason may be that the chairman of the BMA council is a GP in Scarborough, but there we go. We will see whether the Government’s conspiracy extends even to that. What my hon. Friend says is absolutely true. I have been to rural areas and talked to the head of the local medical committee in north Yorkshire, and it is completely absurd that a town such as Scarborough, which has many health needs but is not under-doctored in terms of GPs, should have money spent on it in that way. Throughout north Yorkshire, it is perfectly clear that access to diagnostics and therapies is required in a range of market towns and centres, not in one centre at the furthest extremities of the area. That is absurd. As it happens, north Yorkshire is technically among the most-doctored areas in the country.

May I thank my hon. Friend for supporting my right hon. Friend the Member for East Yorkshire (Mr. Knight) in his campaign to defend health services in Bridlington, and share with my hon. Friend the concern of people along the east Yorkshire coast about polyclinics being imposed on the area? Bridlington, while its hospital services are being devastated, is having a polyclinic imposed and being told that it represents an improvement in its health care.

It is risible. My hon. Friend will know that from his experience, as will my right hon. Friend the Member for East Yorkshire (Mr. Knight), who represents Bridlington. We visited Bridlington and District hospital together, and it is outrageous that the Government appear set on downgrading its services and then, in pursuit of a “care closer to home” philosophy, on undertaking re-provision on the same site—dressing it up as a polyclinic. We live in bizarre times.

rose—

No, I shall not give way.

The hon. Member for Regent's Park and Kensington, North was quite right to talk about London earlier, but it is important to understand that, far beyond that, there are considerable implications in rural areas. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill), and my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) in the East Riding, made it clear that there are rural areas where spending such money, so that a polyclinic is established in a place that is already well doctored, is not only wasteful of resources and prejudicial to the GP practices in the area, but, if it threatens other surgeries, could have serious implications for access.

We have done the calculation on access to GP surgeries, and NHS London made a calculation in its consultation document. It says that it has done high-level modelling, meaning that people in London will be on average only 1.5 miles away from their GP surgery. That is quite interesting, because NHS London did not go on to say that, currently, people in London are on average just half a mile away from their GP surgery. So when the Secretary of State says that he is perfectly willing to campaign on the issue, perhaps he would like to tell all the people of London that the distance to their GP surgery will triple. It is quite clear: we have done the calculation and NHS London said that the distance would be 1.5 miles. [Interruption.] It is quite clear. It is a good one. Don’t you worry, it is. [Interruption.] Actually, Ministers should know that the distance will triple in Hull and in Exeter.

In places such as North Cornwall, the distance to a GP would more than triple, rising to more than 9 miles on average. The Government are parading their belief that they can improve access to primary care, but nobody, anywhere in the country, will be able to believe the Government’s arguments if their access to a local surgery is so prejudiced. There is an enormous difference in London between going half a mile and going a mile and a half. Someone who is elderly, vulnerable, frail or a mother with children, without access to a car, becomes reliant on public transport. In rural areas, access to public transport over many of these distances is difficult to contemplate.

rose—

I mentioned Cornwall, so I must give way to the hon. Gentleman.

I agree with the hon. Gentleman in so far as the Government will end up with another independent treatment centre-type fiasco if they continue with the top-down restructuring of the type that he is criticising. He said earlier that these services should be largely designed by GPs. May I seek a reassurance that he is really trying to tell us that patients and local communities should have a big say in how primary care is designed—that it should not be designed by central Government and imposed on the local community or by those who are contracted to provide the service but designed by the local community itself?

I commend to the hon. Gentleman our document, “The patient will see you now, doctor”, published last September, which clearly set out how we would seek to empower patient choice and involvement, the effect of which would be increasingly to design primary care services around the needs of patients.

The Government and primary care trusts have gone ahead without the semblance of a public consultation. Where, in all this, is the evidence to justify the Government’s imposition of this plan? Since they published their proposals, the King’s Fund, which I am sure that Ministers will acknowledge is independent and respected, looked at the evidence for polyclinics under three criteria—quality, cost and access. On quality, it said:

“The co-location of multiple services presents opportunities for delivering more integrated care, particularly for people with chronic diseases. However, the evidence suggests that in practice these opportunities are often lost.”

On cost, it said:

“Expectations that community-based services will be less costly than hospital-based equivalents are frequently not met.”

On access, it said:

“If a substantial centralisation of primary care were pursued, the consequent reduction in access to these services would be a major sacrifice.”

Overall, it concluded:

“A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas.”

rose—

Perhaps the hon. Gentleman can explain how patients will benefit from this centralisation of services.

I think that the hon. Gentleman is concentrating too much on one particular type of polyclinic. There are many models. There is nothing to say that a polyclinic has to include every local GP. There is plenty of opportunity for hub and spoke models whereby the local GPs can remain and the polyclinic can provide central services such as X-ray, physiotherapy, consultant services and so on. There are also models where individual practices can co-locate into polyclinics and remain as individual practices. There are many examples around the country of that happening. The opportunity exists for primary care trusts to negotiate and discuss with local GPs and other providers how that type of model can benefit their area, thereby allowing patients to get the benefit of small practices and central services in one locality.

I have heard that before. The fact is that if there were going to be a hub and spoke model in London, why did the framework for action describe a polyclinic model of 25 GPs and 50,000 people? Why did the Prime Minister refer at the Dispatch Box to 150 polyclinics? Why are GPs in north London telling me that the primary care trust is saying that if they do not move into the polyclinic, their rent reimbursement will be stopped? A GP wrote to me and said that he knew what was about to happen to him because the primary care trust published a map of primary care services in his area and he was left off.

The official Opposition are coming rather late to this issue. People such as myself tabled early-day motion 1465, which flags up the more fundamental flaws with polyclinics outside London and the metropolitan areas. A fatal flaw of the Conservative motion is that it does not consider the potential of free market competition to inflict serious damage to patient access to general practice and public services. No wonder firms such as Serco, UnitedHealth and Virgin Healthcare are lining up outside the Department of Health just outside this place, licking their lips at the prospect of extracting vast sums from the NHS. Why is that not referred to in the Opposition motion? It deserves to fail because of that.

It is not there because when I have talked to, for example, GPs in Islington who were very unhappy about the way in which a tender was awarded to a commercial organisation, I found that they were willing to enter into competition as long as it was fair, and as long as it was based on a level playing field. I am not opposed to personal medical services or alternative, commercially run, providers of medical services practices, but I am opposed to the top-down system of imposing polyclinics, which is undermining the existing GP structure.

It is interesting that the Prime Minister, when challenged at his press conference last week, retorted that there would be thousands of additional GPs. I think that he said that there are already thousands of additional GPs—[Hon. Members: “There are.”] Of course there are more GPs since 1997, and so there should be. But in the last year for which figures are available, 2006-07, there were only six additional GPs in the whole country, so the Government are not in a position to make much progress on that issue. The predictions from the King’s Fund in its recent document show that we would be short of 2,000 full-time equivalent GPs by 2016. Where is the flow of additional GPs who are to fill the polyclinics?

If polyclinics take over existing GP services, local practices cannot be maintained. If primary care trusts provide the funding for polyclinics, they will, as a consequence, force the closure of many other local GP services because it is not possible to use the same money twice. The Secretary of State knows that, but he will not admit it. There is a long-term agenda in his Department to undermine the independent contractor status of most GPs and to compel them to become part of a PCT-controlled primary care structure. That is why a GP in London said the other day that the PCT was

“bending everyone’s arms very strongly. Life will be very difficult if we don’t go in.”

It is interesting to note that the Government’s amendment to the motion does not actually mention polyclinics. I suppose that the Secretary of State is going to pretend that they are health centres, not polyclinics. The Minister of State, the hon. Member for Exeter, is constantly saying that people get confused because those centres are health centres, not polyclinics. I received two answers from the Minister of State on this subject. On 15 May, he said:

“‘Health centre’ is a term used to describe a range of health services characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[Official Report, 15 May 2008; Vol. 475, c. 1666W.]

A month later, on 16 June, he said:

“‘Polyclinic’ is usually a term used to describe a range of possible health service models characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[Official Report, 16 June 2008; Vol. 477, c. 767W.]

Those definitions are absolutely the same. As far as I am concerned, if it walks like a duck and quacks like a duck, it is a duck.

Will my hon. Friend give way?

No, I shall finish now, if my hon. Friend will forgive me.

If the structure proposed forces local GP surgeries to close, forces GPs into becoming salaried employees of their primary care trusts instead of independent contractors and turns patients into through-puts rather than people, it is a polyclinic. We should follow the evidence, which says that smaller practices are often of higher quality. We know that they are more accessible. We know that patient choice and preference show that they value continuity of care even more highly than rapid access to care. We know that integrated care is about a lot more than putting all the services in one large building. How can access and care closer to home be improved if hospital services are closed down while polyclinics are built on the same site? Why are the Government so obsessed with the ideology that they have brought in, when they should understand that primary care in Britain is one of our comparative strengths? We should develop and strengthen our structure of primary care, not replace it with a German or a US-style polyclinic system.

All hon. Members should be aware of the concern raised throughout the country because of the Government’s top-down imposition of polyclinics. There is a better way. We can strengthen access to community services and strengthen the existing GP structures. We can extend GPs’ commissioning and their responsibility for providing integrated care for their patients. We can use those additional resources to improve access to community services while maintaining access to GPs locally. We can empower patients to choose their general practice and to drive up quality and access improvements through their choices. That would be a better way. The Government should reconsider their polyclinic plans. The motion would require them to do so, and I commend it 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 Government’s support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population.”

We are delighted that the hon. Member for South Cambridgeshire (Mr. Lansley) has used up another of his party’s Opposition day debates to allow us to reiterate our commitment to primary care, set out our record of investment and reform, and explain in detail our exciting plans to expand capacity in primary care.

No previous Government have more clearly demonstrated their commitment to primary care and those who work in it. Let us examine the record since 1997: investment in primary care has more than doubled; there are more than 5,000 more GPs and more than 4,400 more practice nurses; GP pay has increased by around 55 per cent. in real terms; GP hours have reduced by 17 per cent., and the time spent on each patient is up by 50 per cent. That is hardly the record of a Government who are hostile to the role of primary care in the NHS.

I want to set out as clearly as possible exactly what the Government propose throughout the country, what the NHS is seeking to do in London, and to mention briefly other separate developments that clinicians, patients and managers in local PCT areas, including—I am pleased to say—Hull, are leading.

Let me begin by stating firmly what we do not propose. According to the BMA and its political wing opposite, the Government have not one but three evil ulterior motives: to privatise primary care by allowing companies such as Boots to run GP services; to nationalise primary care by making GPs state employees; and to destroy family practices by breaking the GP-patient link.

Look behind you.

Conservative Members claim that the accusation of privatisation comes from behind me, but it appears in every BMA leaflet that I have read, at the same time as that of trying to make GPs do what Bevan could never make them do—become state employees. So we are trying to privatise and nationalise simultaneously.

The GPs of Hastings and Rye are not persuaded that the BMA has got it right. Not one has complained. They are delighted with the £15 million that my right hon. Friend has made available for a new health centre in the town centre. Patients are not compiling petitions, either.

My hon. Friend’s experience is replicated throughout the country.

We are supposed to have three ulterior motives. All that is arrant nonsense. It is possibly the most ludicrous misrepresentation made in the House since the equally ludicrous attempts to distort the principles behind the establishment of the NHS 60 years ago, and it derives from exactly the same source.

The motion refers to a Government plan to “impose” “polyclinics.” Opposition Members deliberately use that term because of its impersonal and biomedical connotations. There is a perfectly valid argument for polyclinics. There is no argument for imposing them centrally on every locality as a replacement for GP practices—that is why we do not have such a plan. A polyclinic combines primary and secondary care. The only part of the country where a network of polyclinics is proposed is London, where a comprehensive review of health services took place last year, and the Government had no say in its outcome. It was a London consultation, which the NHS in London led.

The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned north London. In my constituency, the chairman of the local medical committee, who is a local GP, made it clear that premises are limiting the advantages that GPs can offer patients. A plan that provides GP centres is therefore important. It is likely to give us a GP centre in Enfield Lock and in Enfield town—exactly what Sir George Alberti, a leading clinician, said that we need. The people of Enfield, North will not be deprived of that huge investment by the Conservative party’s propaganda.

My right hon. Friend makes an important point about health services in London. We had no role in the outcome of that review; however, like the population of London, we support NHS London’s proposals. I want to take a minute to explain to the House why the proposals, which those on the Opposition Front Bench oppose, are right for London.

If the footfall of a centralised primary care centre is 50,000 people, that adds up to about 50 per cent. of all the GP practices in any one constituency. As a south-east London MP, I should be grateful if the Secretary of State said whether he is seriously proposing that 50 per cent. of our constituents go to one place for their primary care?

I am suggesting that the hon. Lady, like her colleagues on overview and scrutiny committees throughout London, participate in the London consultation, the outcome of which has shown wide support from both the public and politicians of all political persuasions for what is being proposed in London, and well it might.

We hear the trite comments from the Opposition Front Bench, but people in London do not have access to the quality of primary care that they deserve. There are particular problems with access in this city. An Ipsos MORI poll of Londoners revealed significantly lower satisfaction ratings than the national average, and that 54 per cent. of GP practices in London have only one or two GPs, compared with 40 per cent. elsewhere, that nearly 20 per cent. of GP practices in London are unable to offer an appointment 48 hours in advance, that demand for longer opening hours is even higher than in the rest of the country, that 50 per cent. of all patients who attend A and E departments in London can be better treated elsewhere, and that more people clog up A and E in London than in any other city.

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I give way to the London MP.

One of the justifications for polyclinics is the extension of GP availability. Healthcare for London quotes the patient survey of 2007 as saying that the majority of patients are dissatisfied with their GP’s opening hours. However, the British Medical Association quotes the same survey as saying that 84 out of 100 people are satisfied with their GP opening hours, so is it not better to listen to individual patients and individual GPs? I have not had one GP or patient from my constituency contact me to say that they are in favour of polyclinics.

The hon. Lady is referring to the Healthcare Commission report, which was not a London-only survey and which showed a high level of satisfaction with GP opening hours. However, the 84 per cent. in favour left some 6 million people throughout the country who were dissatisfied. When one looked into the figures, one found that people from black and minority ethnic communities, such as the Bangladeshi community, those from poorer backgrounds and, in particular, those from London were much less satisfied than the rest of the country. According to a BMA survey, 60 per cent. of London GPs say that their facilities are unsuitable for current needs, 75 per cent. think that they cannot meet future needs and 36 per cent. doubt whether their facilities could be adapted to meet the access requirements of the Disability Discrimination Act 2005. Those are the problems in London, which London is seeking to resolve.

The Secretary of State is talking to a large extent about London. Can he tell my constituents why he wishes to impose a polyclinic on the East Riding of Yorkshire PCT, where I assure him there is very little appetite for one? This morning, a GP from Beverley told me:

“Polyclinics will lead to the end of personalised care which current patients enjoy.”

That GP, who is nearing the end of his career, also said—perhaps this will rock the Secretary of State most—that he has voted Labour all his life, but will not do so at the next election, because he has lost confidence in the Government on health.

Let us stick to London for a second.

Will the Secretary of State tell us what the total cost will be of this elaborate reorganisation?

The total cost is estimated at around £150 million, which will be money well spent and a crucial investment in improving the situation in London.

The term polyclinic has been used in London to describe a range of models that allow primary and some secondary care services, such as diagnostics, to be available in each local community, reducing travelling time and making services more convenient for patients. In some cases, that may involve bringing services together under one roof. In other cases, as my right hon. Friend the Member for Enfield, North (Joan Ryan) mentioned—this is a specific option that is part of the London proposals—it involves having a network of GP practices linked to a hub that provides more specialist services. Both of those are available in London.

Interestingly, in the one part of the country where polyclinics are being proposed, Conservative politicians support the proposals, as, indeed, do the public. Every local authority overview and scrutiny committee, including those that are Tory-led, backs the exciting plans to resolve NHS problems in the capital—problems that probably should have been dealt with 20 or 30 years ago.

I certainly welcome the additional investment in primary care, but whatever the problems in London, they are not the same in Birmingham. The report to the PCT on implementing the measures said that there was

“no clear geographical area which warranted investment in an additional three partner practice”

and no real pattern to highlight a need for the GP-led health centre to be located in one particular place. A place was chosen because accommodation was potentially available, even though there are low levels of under-doctoring there. I therefore ask my right hon. Friend please to give this money to the PCTs and to let them decide how to spend it in the interests of the people they serve.

I think that that is the Opposition’s policy—give the money to the BMA and it will decide how to spend it. It is also their policy for GPs to be allowed to set up where they want to, for GPs to be allowed to open when they want to and for GPs who work in disadvantaged areas to get more money. I do not agree with that policy. I believe that when we move on from London and talk about other parts of the country, including the west midlands, my hon. Friend will agree that our proposals are the most sensible way forward.

The Secretary of State accused a Member on his own side of the House of adopting the policy of the BMA, but the hon. Member for Birmingham, Selly Oak (Lynne Jones) actually said was that she wanted to give power to the local area so that decisions could be taken locally. Surely that is what should be done, as it is local people who know what the needs are in any particular area.

That is what we are doing—[Interruption.] I am talking about what is happening in London; I will come on to the rest of the country in a minute. London has had its own analysis of problems, which have been the subject of many reports over the last 20 years. Politicians refused to implement the proposals. We are implementing the proposals, with London’s support.

Is it not interesting to note that the BMA—when not campaigning and producing petitions—wrote a few weeks ago to all GPs and local medical committees describing the new proposals in what it called a “factual guide”? It talked about the key differences between the health centre proposals and the polyclinic proposals; and of the polyclinic proposals it said, “mostly in London”.

I have not seen that particular circular, but that is exactly what I am trying to explain. In London, there is a specific proposal about polyclinics. That is opposed by the Conservative party, despite the fact that the project has been worked up locally by people in London and has been the subject of full consultation with the public and GPs.

In my constituency, we are about to rebuild a new local hospital which will be a 24/7, GP-led urgent care centre with 40 respite beds and diagnostic services that are to be brought right into the heart of our community in Eltham. The hon. Member for South Cambridgeshire (Mr. Lansley) has proposed that any vested interests in the local health economy could scupper that in the face of widespread local support for the scheme. That is not bringing the service back to local people; it is taking it away from them and putting it in the hands of vested interests.

My hon. Friend makes a very powerful point. The Minister of State, my hon. Friend the Member for Exeter (Mr. Bradshaw), will be visiting the area next week.

Unlike the proposals for London, the 150 GP-led health centres that my Department has asked the NHS to develop across the country are not, and have never been, designed to alter the way in which existing GP services operate. The London proposals are so designed, for all the reasons that I have discussed. The proposals for the rest of the country are not seeking to change GP services at all. They are designed purely and simply to increase capacity. The average primary care trust has around 55 GP practices that will continue to provide services to their patients as they do today. In addition to those practices, each PCT will also now have a GP-led health centre, funded from ongoing additional investment, attached to which are only three conditions. No. 1 is that the centre should be in a central location; it should be accessible. No. 2 is that it should be open from 8 am to 8 pm, 365 days a year. The third is that any member of the public must be able to use the centre either to book a GP appointment or to turn up to see a GP or nurse without the need to be registered at the centre—in other words, people can continue to be registered with their local family doctor and benefit from the continuity of care that is provided.

The Secretary of State says that those are the only requirements, but surely it is a requirement that the Department has laid down that these centres—these clinics—should register patients. By extension, therefore, patients will no longer be registered with other GP surgeries.

I just mentioned that—[Interruption.] I did. I said that the third condition allows patients to be registered or to walk in and receive GP services because they are in a more convenient location. Let us consider the logical extension of the hon. Gentleman’s argument. Yes of course members of the public can decide to leave their existing surgery and register at this GP-led health centre. It is called patient choice. They are perfectly entitled to do that. What we expect is that this additional resource will be used to mix and match, as I mentioned. Most patients will want to stay with their existing GP because of the particular benefits that gives them, but they will also want to use the GP-led health service on Christmas day or on a Sunday afternoon knowing that they do not have to be registered there to use its services.

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I give way to the hon. Member for Worthing, West (Peter Bottomley).

The Secretary of State is trying to share as much information with the House as possible. Is it not true that there are two other conditions? One is that no primary care trust can say, “No, we don’t want to do it.” The second is that there is a rule that no existing GP-led health centre—that is to say, a wide practice—can turn itself into one of these new GP-led health centres.

It is absolutely the case that we are saying that in the interests of greater capacity, greater patient choice and the public being able to access primary care, this is not a zero-sum game. There will be a greater need to access primary care in the future, particularly with the plans that we have for prevention being as important as diagnosis and cure, and there must be one of these centres in each location.

I have set out the three conditions. Beyond those, it is for local GPs and the PCT to discuss exactly how the service is provided.

I thank the Secretary of State for his courtesy in giving way again. I suspect that hon. Members on both sides of the House would agree that many patients are naturally very loyal to their general practitioner. That being the case, does the right hon. Gentleman accept that if there were to be any attempts by financial mechanisms or otherwise to compel general practitioners to move into polyclinics against their will, that would be resisted by the GPs, very likely by their patients, and not least by local Members of Parliament as well?

I accept that point entirely. That is not part of our proposals.

Further to the point raised by the hon. Member for Birmingham, Selly Oak (Lynne Jones), if the Secretary of State looks at areas such as Cornwall and the Isles of Scilly, he will see that there is a geographical problem. If he is simply imposing a top-down restructuring of the type that he is describing, a single polyclinic in just one area in a place the shape and size of Cornwall will clearly have a destabilising and destructive impact. Why does he not allow that local community to design services that best meet its needs, rather than imposing this top-down, centralised restructuring? Why will he not allow the local community to design its own services and achieve the aims that I think he desires?

We have specified three conditions. The centres must be centrally located, must be open from 8 am until 8 pm seven days a week, and must allow people to use their services on a drop-in basis as well as to be registered if they wish. The money that will be invested is additional money, provided not by the local primary care trust but from the centre, to improve access throughout the country. I think that that is the right thing for a Government to do.

Members of the BMA are not the only people to comment on the proposals. The Royal College of Midwives, of which I am an honorary vice-president, tells me that it is interested in the potential of polyclinics and larger health centres to provide better midwifery services—better antenatal and post-natal care. That means, however, that the centres should provide accommodation for midwifery. Will Ministers and local NHS chiefs encourage the decision makers to provide such accommodation?

My hon. Friend has reminded me why the proposals are so exciting for London. It will be possible to provide services such as diagnostics and maternity care, and to achieve a fundamental advance in primary care in the capital. My hon. Friend has also reminded me that we should listen to the views of Age Concern. The hon. Member for South Cambridgeshire said how dreadful the new arrangements would be for elderly people. This is what Age Concern said in a briefing for today’s debate:

“For many, especially carers and those with mobility issues, the super surgery or polyclinic could be preferable to what they currently have on offer. For those without transport, it can take a whole day to get to the doctor and back, via the pharmacy. If then, they are required to visit the hospital for blood tests, x-rays or anything else, that will take them another day. There is a tentatively enthusiastic welcome to a super surgery or polyclinic that will allow them to do all these things on one day, under one roof.”

When we talk to the public and to patients, they see the attraction. Obviously they listen to the horror stories that are being peddled, because they trust their local GPs, as well they should, but when what we are proposing is contrasted with what Her Majesty’s official Opposition are suggesting that we are proposing, it can be seen that what we are doing is improving primary care throughout the country.

What would my right hon. Friend say to the GPs from the local medical committee in Sunderland who came to see us last week? They welcome the extra investment, but believe that the money could be spent more efficiently if it were spent via existing doctors’ surgeries. When asked why, they say that some of the previous reforms, such as independent treatment centres, have proved quite wasteful.

I would tell those GPs that this is not the only investment being made in primary care. About £500 million is going into primary care this year from one source or another. In Sunderland, as well as in my city of Hull, GPs will have their own plans, but we will ensure that nowhere in the country is there a single patient who cannot gain access to primary care seven days a week, 365 days a year, between 8 am and 8 pm. God forbid that I should make the link between Newcastle and Sunderland, but people who work in Newcastle and live in Sunderland will now be able to go to a GP-led health centre in Newcastle. This is about patient convenience and patient choice.

May I play devil’s advocate, and suggest that my right hon. Friend is not going anywhere near far enough? While I support his plans for super-surgeries that will be open seven days a week—I think that that will really help patient care—my real desire is for them not just to provide GP care seven days a week but to provide visiting consultants, X-rays, physiotherapy and occupational therapy. I want patients to have access to a whole range of services that people in smaller towns and rural communities currently have to travel many miles to receive. I want the centres to provide those services so that patients will not have to travel 20, 30 or more miles to major centres to receive services that they could receive far more efficiently and cheaply in their local communities.

Order. Before the Secretary of State replies, may I just remark that the interventions have been getting steadily longer? I ask everyone to remember that the list of Members wishing to take part in the debate is quite long.

My hon. Friend the Member for Dartford (Dr. Stoate) is right. I am concentrating on primary care because of the attack that these proposals will somehow diminish primary care. Bevan, at this Dispatch Box in 1946 as the National Health Service Act was passing through the House, saw the integration of primary and acute care as one of the fundamental principles of the creation of health centres around the country, and we have an opportunity to revisit that.

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I will give way one last time, and then I shall make some progress.

We in Barnsley are looking forward to having a super-surgery—or polyclinic, or whatever it will be called. We have traditionally had too few GPs, to the point where one GP practice currently has a patient list of 8,000. Nobody can tell me that that is ideal. We are therefore quite looking forward to the extra capacity that will come with these super-surgeries.

My hon. Friend refers to Barnsley. There has been a ridiculous Conservative press release today claiming that 608 practices will close.