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Health: Doctors

Volume 704: debated on Tuesday 21 October 2008

asked Her Majesty’s Government:

What plans they have to increase access to general practitioners following the recent Healthcare Commission report.

My Lords, the Healthcare Commission’s data show that 87 per cent of patients are able to get an appointment within two working days of requesting an appointment. We are taking action to drive further improvements in access with more than 50 per cent of GP surgeries now offering extended opening hours, PCT commissioning of 150 GP health centres which are open to any member of the public from 8 am to 8 pm seven days a week, and more than 100 new GP practices in our most poorly served communities.

My Lords, I thank my noble friend for that encouraging and positive response. How does he think that the additional funding for the NHS, which has been announced, will affect patients, particularly with regard to their access to general practitioner services?

My Lords, the Government have invested £250 million recurrently to deliver the new GP practices in health centres that I have mentioned. That investment is in addition to the funding that PCTs have already received from primary care services, so this is new money for new, additional services. Earlier this year, the Department of Health and the BMA also agreed, as part of a range of improvements to the GP contract, that £50 million will be invested in a new set of enhanced services covering all GP practices in England. It is designated to help and to embed best practice in quality of care. A further £50 million will be invested locally this year, in 2009 and in 2010 to improve the accessibility and responsiveness of GP services.

My Lords, some people leading busy working lives do not necessarily want to see their GP within 48 hours, but would prefer to make an appointment a week or two ahead to fit in with, for example, their business travel abroad. Can the Minister assure the House that GPs who accommodate such patients, and do not require them to ring up on the day they get back to Heathrow, will not be penalised by primary care trusts for not achieving the 48-hour target?

My Lords, I have just made it clear that we are significantly enhancing and expanding the capacity of access to primary care in the investments I referred to. Certainly, with the extended services that I referred to and which are part of our negotiations with the BMA, we are currently achieving a rate of 51 per cent of GP practices offering extended hours to allow patients access to GPs out of hours. I have also made numerous references to GP health centres which will allow any patient access at any time between 8 am and 8 pm seven days a week without incurring penalties or the need to register. That access will be available in most areas of the country by the end of next year.

My Lords, does the Minister agree that the recent report from the Healthcare Commission demonstrates a substantial improvement in the general standard of care throughout the UK since the last report was prepared? In particular, will he congratulate the north-east region for coming out as one of the best, if not the very best, regions in the country? Turning to the question of GP hours, it is true that 50 per cent of practices are now offering extended hours. When we can hope that that will increase to 100 per cent?

My Lords, I could not agree more with the noble Lord and I, too, congratulate not just GP practices but also their leadership at the local level, including the north-east region where the enhanced services have had a tremendous impact on the quality of access. I also acknowledge the fact that at 51 per cent we are three months ahead of our anticipated target, and that there is a significant desire in the primary care community to ensure that the extension is as wide as possible throughout the country.

My Lords, one of the concerns raised by the BMA in this area is that the Government have insisted on GP practices offering a significantly higher number of routine appointments late in the evening or on Saturday mornings irrespective of whether there is a demand for them locally. Why will not the Government countenance the idea of extended hours being determined according to local circumstances and needs?

My Lords, the responses to 6 million questionnaires in our 2006 and 2007 surveys clearly indicated that the public and users have expressed a desire in having extended hours. This Government are committed to establishing those services and I have no doubt that, as we have achieved 51 per cent, the provision to cover the demand for them could be negotiated at the local level.

My Lords, does the Minister realise that many people are concerned that some GPs are being bribed not to send patients to hospital? Does this not put extra stress on GPs and is it not dangerous in cases such as cancer?

My Lords, GPs are not bribed; they are paid to make appropriate referrals based on their clinical judgment to places where patients will receive the right treatment in the right place. We should acknowledge that the quality of primary care in this country is the envy of many. As we highlighted in the Primary and Community Care Strategy, we wish to help primary care colleagues in the next decade to shift more diagnostics into the community in order to broaden access to such diagnostic tests.

My Lords, does my noble friend agree that the Government would make even further progress in their admirable record on improving access if they phased out as quickly as possible the minimum practice income guarantee so that the money could be used to improve our performance in this area?

My Lords, I am grateful to my noble friend for that intervention. That is a contractual negotiation which NHS employers are dealing with along with the BMA, and no doubt the two parties will come to a final conclusion in due course.