Health and Social Care Bill

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Dr. Brand: Is it not a fact that the MPC has been largely ineffective because it has not had the power to direct? If the pattern described by the hon. Member for Runnymede and Weybridge were true, we would have a Cuban-type health system in which doctors could be directed where to go. Does the Minister recognise that independent practitioners will move to where jobs are created. If vacancies are not filled, patients will find themselves without GPs.

Mr. Denham: The MPC has had the power to say no, but it has not had the power positively to create the circumstances in which GPs would move to areas in which there were too few doctors. Enabling development of resource allocation in the way that have I described will make it easier for areas that lack doctors to attract them. The reality is that, 50 years on, we have not achieved an adequate level of general practice availability in every part of the country.

Mrs. Ro Day, chair of the Medical Practices Committee, suggested that the figures are out of date and referred to personal medical services, but the reality is that the increase in PMS doctors in Sunderland is the result of my overruling the advice that I received from the MPC not to allow PMS practices to be created in Sunderland on the scale suggested. That highlights some of the difficulties with the mechanism.

In the remaining time available, it is important to consider whether the system simply leaves the health authority, with its resource allocation, to decide what to do about GPs. The answer is no.

The decisions taken by health authorities need to be set in a wider context. Health authorities and primary care trusts are already responsible for salaried GMS GPs and the wider NHS work force, including community and hospital services, and they have a growing role in relation to PMS GPs. GPs are an essential part of that picture. Health authorities should consider GPs and the wider primary care work force in a strategic way. Determining the need for GP vacancies must form part of the health authority's local strategic planning for all its services. It must take account of the potential of the whole work force. The additional—

Dr. Brand: Will the Minister give way?

Mr. Denham: I should like to make some progress, but I will give way later if I can.

In the new arrangement, we are devolving responsibility for GP distribution to health authorities, but not in isolation. Health authorities must consider GP numbers as part of their whole NHS work force planning. There is a need for a framework to oversee national GP distribution.

The Government will set up a new national work force development board in April, as set out in last year's work force planning review and as reflected in the national plan. It will oversee the development of the work force of all NHS clinical staff, including GPs and their staff, at national level. The medical education standards board will keep under review the impact of training requirements on the distribution of GP trainees and principals. Through the national work force development board, we have established an integrated structure of national work force planning, which will be reflected in health improvement programmes at local level.

Performance monitoring and the management of work force numbers will be integral features of the new system. Performance management of health authorities by regional offices will be informed by the work of the national work force development board and the medical education standards board. As part of the process, regional offices will agree targets for GP growth with individual health authorities. That is the right balance. Health authorities will be given the freedom to manage the development of their local services across primary and secondary care.

Our new structures for work force planning and regional office performance management will provide the national framework and the necessary safeguards within which health authorities will take decisions about GP distribution. The hon. Gentleman asked about the safeguards in the system. I have described the way in which we intend it to work. The Government are committed to achieving the targets that we set out in the NHS plan and we want to ensure that those mechanisms allow us to achieve them.

Dr. Brand: Could the Minister tell us whether the new system will allow health authorities to extinguish vacancies when there is a retirement?

Mr. Denham: The current power, as I understand it, means that a vacancy is not filled unless the health authority makes a proposal to the Medical Practices Committee, which then considers it as a vacancy. Many of its decisions are taken on the basis of information provided by the health authority. We are transferring that decision to the health authority, rather than having it taken by the Medical Practices Committee at national level.

I hope that I have helped the Committee. I also hope that, in the brief time available, I have assured the hon. Member for Runnymede and Weybridge that, although we want health authorities to exercise the responsibility of planning the development of GP numbers and primary care, we want to do so within a framework that ensures that GP expansion is properly managed throughout the country.

Mr. Hammond: What we have been engaged in over the past half hour is not proper scrutiny of the Bill. I understand that it is not possible for us to vote on clause 17. As we have not exhausted the issues, I will press amendment No. 3 to a Division.

Question put, That the amendment be made:—

The Committee divided: Ayes 6, Noes 9.

Division No. 1]

AYES
Brand, Dr. Peter
Burns, Mr. Simon
Burstow, Mr. Paul
Hammond, Mr. Philip
Swayne, Mr. Desmond
Young, Sir George

NOES
Bailey, Mr. Adrian
Bradshaw, Mr. Ben
Denham, Mr. John
Foster, Mr. Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Mountford, Kali
Naysmith, Dr. Doug
Stewart, Mr. Ian

Question accordingly negatived.

It being after Five o'clock, The Chairman put the Question necessary under the terms of the programme resolution to complete the business.

Question put, That clauses 1, 17 and 18 stand part of the Bill:—

The Committee divided: Ayes 9, Noes 6.

Division No. 2]

AYES
Brand, Dr. Peter
Burns, Mr. Simon
Burstow, Mr. Paul
Hammond, Mr. Philip
Swayne, Mr. Desmond
Young, Sir George

NOES
Bailey, Mr. Adrian
Bradshaw, Mr. Ben
Denham, Mr. John
Foster, Mr. Michael Jabez
Hutton, Mr. John
Jamieson, Mr. David
Mountford, Kali
Naysmith, Dr. Doug
Stewart, Mr. Ian

Question accordingly negatived.

It being after Five o'clock, The Chairman adjourned the Committee without Question put, pursuant to Order of the Committee [this day].

Adjourned accordingly at two minutes past Five o'clock till Tuesday 23 January at half-past Ten o'clock.

The following Members attended the Committee:
Maxton, Mr. John (Chairman)
Bailey, Mr.
Bradshaw, Mr.
Brand, Dr.
Burns, Mr.
Burstow, Mr.
Denham, Mr.
Foster, Mr. Michael Jabez
Hammond, Mr.
Hutton, Mr.
Jamieson, Mr.
Mountford, Kali
Naysmith, Dr.
Stewart, Mr. Ian
Swayne, Mr.
Young, Sir George

 
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Prepared 18 January 2001