General Practitioners (Clinical Audit)

Oral Answers to Questions – in the House of Commons at 12:00 am on 21st November 2000.

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Photo of Tony Wright Tony Wright Labour, Cannock Chase 12:00 am, 21st November 2000

If he will make a statement on progress with the clinical audit of general practitioners. [137636]

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

The NHS plan states that all doctors working in the NHS will be required to participate in clinical audit from 2001.

We have introduced a requirement for personal medical services pilots of three clinical audits per year and are working to introduce clinical audit for all general practitioners.

Photo of Tony Wright Tony Wright Labour, Cannock Chase

I am grateful for that answer. The Government deserve great credit for putting quality and clinical performance at the top of the NHS agenda. Is it not the case, however, that general practice remains a largely audit-free zone? Despite the Shipman affair and all that was said at the time by the General Medical Council and other organisations about the need to take action, particularly in relation to single-handed practitioners, there is no early prospect of clinical audit being introduced. Do not patients have a right to have it, and when can the Government give an assurance that it will be in place?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

My hon. Friend is absolutely right that patients have a right to feel safe and secure. That is why we are committed to introducing mandatory clinical audits for general practitioners as part of their quality agenda. It is part of a package that we have introduced to improve safety, not just in hospital trusts but in GPs' surgeries. It has to be seen as part of a package that allows us to take quick action when doctors are failing in their duty. I refer in particular to the document "Supporting Doctors, Protecting Patients".

Photo of Sir Sydney Chapman Sir Sydney Chapman Conservative, Chipping Barnet

Does the Minister agree with the chairman of the British Medical Association that the access demands in the NHS plan would require an additional 8,000 to 10,000 GPs?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

It is clear that delivering primary care service is a question not simply of the number of doctors, which we are increasing considerably—there are 2,000 extra GPs and 7,000 extra consultants—but of the way in which they work. The fact that, in the past year alone, almost two thirds of GPs are managing to do that because they have improved their services is a clear indication that the NHS plan with regard to that commitment is deliverable, and we shall deliver it with the help of the doctors.

Photo of John Cummings John Cummings Labour, Easington

I welcome the extra resources that have been directed to the Durham and Darlington health authority, which will undoubtedly have a beneficial effect on the overall health of people in my constituency. I draw the attention of my right hon. Friend the Secretary of State for Health to the increasing size of general practitioner waiting lists. The average is 2,300, with some in excess of 3,300. Will my right hon. Friend work along with officers from the progressive primary care group in Easington on any new initiative that will lead to a reduction in waiting lists?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

Of course we expect the progressive practices in particular to work very actively in this regard. I understand that, before long, my right hon. Friend the Secretary of State for Health will visit my hon. Friend's constituency to see at first hand the good work that has been done to ensure that it is copied everywhere. We expect good, reliable services uniformly across the NHS, not just in isolated pockets.

Photo of David Davis David Davis Chair, Public Accounts Committee

The most advanced work in improving the safety of the treatment of patients is probably to be found in the United States. Last year, the chief medical officer published a report called "An Organisation with Memory". What will the Department do to incorporate those findings into its current political audit work?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

The right hon. Gentleman is absolutely right—that is an extremely important and significant document. It focuses not just on detecting mistakes but on learning from them. The key outcome that we all want is safe medical treatment. We will build on that important and significant document, and I am grateful to the right hon. Gentleman for referring to it.

Photo of Brian Iddon Brian Iddon Labour, Bolton South East

Nearly 50 per cent. of the general practitioners practising in my constituency are single handed. Is my hon. Friend aware that there is a feeling abroad that single-handed practices are now disapproved of and will she reassure GPs in my constituency that they can continue working in this way indefinitely? In addition, of course, I approve of clinical audits.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

It is important to recognise that we must be certain that high clinical standards are being delivered, whether in single-handed or in group practices. Peer co-operation and peer review will be extremely important. That is why we encourage practices to work together, and also to work together in audit so that they can learn from each other. What is important is not the structure of the organisation but the quality of service that is delivered.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

Does the Minister accept that concerns about audit are merely the tip of the iceberg, and that there is a growing crisis of confidence in the Government's whole handling of general practice? Yesterday, the British Medical Association chairman expressed his doubts about aspects of the NHS plan, and he is not alone. The Royal College of General Practitioners and the General Practitioners Committee expressed their profound disappointment at the limited expansion of 480 doctors per year, when the annual appraisal alone will require 600 extra doctors. Where will they come from? If the BMA, the Royal College of General Practitioners, the NHS Alliance and the National Association of Primary Care all think that the Government have got it wrong, what, apart from their own arrogance, makes them think the contrary?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

The Tories simply could not match our commitment, in terms either of extra capital investment or of expanding the work force. I remind the hon. Gentleman that before 1997, the Tories did not seem to show a keen interest in regulating the profession or in ensuring patient safety. Since 1997, the Labour Government have introduced a framework that includes the National Institute for Clinical Excellence, the Commission for Health Improvement and the extension of audits to include not only hospital trusts but general practitioners. The Labour Government are expanding the service safely, reliably and sustainably, not undermining it as the Tories did.

Photo of Liam Fox Liam Fox Shadow Secretary of State for Health

I remind the hon. Lady that she is the Minister answering questions and that this is Question Time. Is not the real problem that GPs see a growing difference between the national health service that Ministers describe in the House and the NHS with which the rest of us have to live? When flu vaccine is in short supply, when care homes are closing, when casualty departments are shutting, and when GPs are drowning in red tape, Ministers have the nerve to talk about Labour's delivery. Was it not the final insult when the Prime Minister blamed GPs for abusing the admissions procedure? Did not that fully merit the rebuke of the chairman of the Royal College of, General Practitioners, who said:

Your remarks, coming at a time of low morale and change, have only served to heighten a feeling that primary care is not sufficiently valued by yourself and your government?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

I sometimes wonder which planet the hon. Gentleman lives on. When I go to hospitals or general practices, I see new investment in buildings, new staff and retraining. All my colleagues use the NHS because they are committed to it, unlike Opposition Front Benchers who use it only to find out what it is like for people who have to use it.

Photo of Ronnie Campbell Ronnie Campbell Labour, Blyth Valley

What advice has the Minister given to general practitioners on the prescribing of antibiotics? In my constituency, one doctor has been told that he is over-prescribing. Many of his patients are miners with bad chests or are from poor families. Have the Government any advice for general practitioners who are told that they are over-prescribing in this way?

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health)

It is important that prescribing practices within a general practice or a health authority area are carried out safely, reasonably and in response to the relevant health needs. We are committed to having a system in place in which everyone in a health authority area prescribes according to those rules, and we want to maintain that system.