No, Sir. The Government intend that savings generated within practice budgets should be spent on practice improvements and on offering more and better services to patients.
What would be the criteria for practice improvement expenses? If doctors improve their lifestyles with better suits, cars or holidays, will not patients be tempted to think that that may be taking the place of proper medical treatment? It is not the doctors' fault, but the fault of the Secretary of State for creating a system that replaces trust between patient and doctor with mistrust.
If doctors acquire better cars and suits it will be only because of the generosity of the pay awards that the Government have been implementing following the review body's recommendations. If savings are made on practice budgets we shall expect them to be ploughed back into improvements to the premises or new facilities so that services to patients can be made better. Financial and medical audits will ensure that that is done.
Is my right hon. and learned Friend aware that the reaction of some general practitioners suggests that they have either misunderstood or misinterpreted the proposals? First, will he confirm that this is a voluntary matter—that it is up to a group practice to choose whether it takes on the budget system? Secondly, would he care to spell out for their benefit the advantages of the scheme?
We are sending all GPs the working paper on the subject. I agree with my hon. Friend that the proposal is at first sight rather complicated, and I think that the working paper will improve understanding of it considerably.
Certainly, only practices wishing to participate will have a practice budget, but I find that doctors are being tempted to consider the scheme seriously because they see that large quantities of NHS resources will be placed in their hands for part of the treatment that they provide, and that they will have much more say in where and how their patients are served. That will enhance the role of the GP in a practice that has such a budget, and I believe that the more go-ahead GPs will be very interested indeed.
Section 16 of the Health and Medicines Act 1988 provides for funds to be given to certain practices through the family practitioner committees, especially in deprived areas. Will that still happen or will the budget knock it on the head? Will GPs still receive the cash to improve their properties?
The practice budgets will be set to reflect the social nature of the practice being served. The proposals in the Health and Medicines Act still stand, with the undertakings given by my hon. Friend the Minister when it was implemented. We shall soon be putting to the profession our proposals for a package on GP remuneration, and that will show how we intend to reflect the extra work that can be imposed on GPs in deprived urban areas.
Is not the implication behind the original question that money spent on the Health Service can be spent more efficiently? Will my right hon. and learned Friend take this opportunity to confirm that any GPs taking practice budgets will not have any difficulty if they overspend, and that chronically sick and geriatric patients will not be turned away?
I can certainly confirm that. It is another misunderstanding that we should quash straight away. There is no question of a GP not being able to provide proper medicine or care for an elderly or chronically sick patient, or for anyone else. Nothing in our proposals gives rise to any such danger.
Does the Secretary of State agree that his proposals for practice budgets and, indeed, for general practice overall, reduce both patient and GP choice? Has he read the Coopers and Lybrand health and management update report No. 22, section 8, which says that the Government's proposals will reduce choice for patients and GPs? Will he come clean and admit that, rather than increasing choice, the proposals will simply increase bureaucracy?
I do not agree with the hon. Gentleman's assertion, or with Coopers and Lybrand, if the report supports what the hon. Gentleman says. General practitioners who do not elect to have practice budgets will still have freedom of choice on referrals although they will have to work more closely with their district health authorities than hitherto in deciding on referral patterns from their areas. As I explained to my hon. Friend the Member for Chislehurst (Mr. Sims), a GP practice that elects to have a practice budget will have much greater choice for itself and the patients and much greater control than GPs have had in the past over quite large amounts of NHS resources.