asked Her Majesty’s Government:

Whether they support the proposed cuts in primary healthcare in rural Northumberland.

My Lords, Northumberland Care Trust’s proposals are not about reducing or closing services. The main aim is to ensure the continuity of existing general practitioner services and to develop further primary care services for the benefit of patients across Northumberland. It is appropriate that the Northumberland Care Trust should review its personal medical services contracts to ensure quality of services as well as value for money, in parallel with all primary care organisations in the north-east.

My Lords, do the Government support the Carr-Hill formula, which the Northumberland Care Trust is using? The formula is weighted against rural practices. Indeed, it is envisaged that the cuts would be 24 per cent at the Bellingham surgery. That would mean the closure of that surgery, which covers the largest land mass in England—1.6 per cent of England. If it closed down, those living in Byrness would have a 70-mile round trip just to see a GP in Hexham. Should the Government not review the Carr-Hill formula, considering that Professor Carr-Hill does not himself support it for rural areas?

My Lords, the fair funding formula that the noble Lord refers to is designed by the Advisory Committee on Resource Allocation, which works out the formula across the country. It is of interest that the Northumberland Care Trust is one of the only PCTs in the country that has these deficit challenges. I assure the noble Lord that the fair funding formula considers rurality in its calculations and certainly takes into account a number of factors, including local poverty, distances and geography.

My Lords, I remind the Minister that the Healthcare Commission recently gave a glowing report on the quality of the primary care and hospital services in the north-east of England, including those provided by the Northumberland Care Trust. In this widely dispersed area, was it right to consider cuts that might at the outset have resulted in the closure of general practices? Does the Minister accept that the recent consultations with the trust have happily come up with a much more acceptable formula? Nevertheless, does he agree that there is a widespread feeling in the north-east that this trust is underfunded, particularly given that the health service is on course for a surplus at the end of the financial year?

My Lords, I am grateful to the noble Lord and could not agree more with his tribute to colleagues in primary care in Northumberland and the quality of services that they provide. However, I am sure that we would all agree that value for money is also an issue. It is of interest that, of the 49 primary care providers in Northumberland, 42 are on PMS contracts and seven are on GMS contracts, which runs counter to the national configuration of 60 GMS to 40 PMS. It transpires that there is currently a differential within the PMS contracts of about £5.2 million. The PCT, in collaboration with primary care providers, is looking at exactly the types of services that are provided for that differential.

My Lords, is the noble Lord aware that the cost to the country does not necessarily mean that the needs of primary healthcare are met throughout this country, not only in rural Northumberland but much nearer to your Lordships’ House?

My Lords, I agree that the quality of primary care provision in Northumberland is exceptional, but it is important that Northumberland’s PCT, like any other NHS organisation, lives within its budget. Of the 12 PCTs in the north-east, this PCT has had financial difficulties for years. It is scrutinising its expenditure in consultation with its stakeholders, including primary care.

My Lords, is the Minister aware that, in rural areas such as Northumberland, vast areas must be covered by district nurses, GPs and ambulances, which costs a lot in travelling expenses. Are these taken into consideration?

My Lords, I agree that funding in rural areas is very different. I referred to the fair funding formula, which seems to work across England reasonably well. It is important to put this in context: in north-east England, most of which is rural, one of the 12 PCTs—the Northumberland one—seems to have had long-standing financial difficulties and it is about time that it tackled its expenditure.

My Lords, the Minister seems to be aware that drastic cuts in nursing provision are being proposed by the Northumberland Care Trust. Does that not mean that excellent nursing care for the sick, frail and elderly in remote rural areas will be difficult to maintain and improve, especially as nurses are no longer to be based in rural surgeries but are to be centralised into teams, miles from their surgeries and patients? Does the Minister agree that the resulting loss in continuation of care and knowledge sharing about patients may have a significant detrimental impact?

My Lords, the PCT locally is reconfiguring its community services to ensure that it has the right resources available in the right places across the county. I am assured that the trust is committed to doing more and to discussing these proposals with GP colleagues. I am also informed that it has started more detailed discussions with them. The aim is to provide the best possible health services in Northumberland. It is important that, no matter where people live, there is equal access to community nursing services.

My Lords, the Minister said that contracts were issued on the basis of quality of care and value for money. What is the departmental guidance on which of those two factors should take precedence in situations such as the one that he has outlined in Northumberland?

My Lords, in any service or form of healthcare delivery, effectiveness and quality are obviously of prime importance. However, I believe—I hope that noble Lords will all agree—that the cost-effectiveness of the service should also play a significant role in local decision-making.