GP Services (South Lincolnshire)

Part of the debate – in the House of Commons at 2:37 pm on 15th October 2004.

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Photo of Quentin Davies Quentin Davies Conservative, Grantham and Stamford 2:37 pm, 15th October 2004

This is an occasion when 90 per cent. of the purpose of a debate has been achieved before it has commenced. In a dramatic reversal yesterday, the Government announced that they were restoring GP accessibility at night in south-west Lincolnshire. That does not mean that there is little point in holding this debate, nor does it reduce my great gratitude to Mr. Speaker for allowing me the opportunity to do so. Far from it— Mr. Speaker's decision to allow a debate is justified, and Parliament has been memorably and strikingly effective in changing policy and removing a considerable problem.

Parliament is the only forum in which Ministers can be held to account. Of course, they speak to the press all the time and give press conferences, issue press statements and answer questions when they feel like it. However, they are compelled to come to the House to answer for what has been done in their name. That is a generally accepted principle, and on this occasion it has proved enormously effective in its practical consequences.

It is less widely recognised that an Adjournment debate also provides an opportunity for Ministers to hold to account the bureaucracy for which they are responsible. Before attending such a debate, they ask questions about the background to it, and investigate the reason why a Member has asked for it and why Mr. Speaker has granted it. They must satisfy themselves that they are willing to defend what has been done. To his great credit, the Minister clearly has examined the position and decided that he did not want to defend the indefensible today, so yesterday he changed the position to a defensible one. Of course I am grateful for that. I am aware of the difficulties that the Government will have had in making such a change in policy, so I shall not carp, crow or score party political points. The matter is far too important for that. It goes to the most important issue of all—people's lives. One can get seriously ill at 3 am just as easily as at 3 pm on a working day. It is just as important that one should have access to a doctor at night as it is during the working week.

The role of GPs in making an initial diagnosis when something goes wrong and in making the essential clinical judgment as to what is to be done is indispensable. While I have been fighting this campaign over the past few weeks, one of the most foolish things said to me by those who tried to defend the changes that they had made in Lincolnshire was that they had put in place a system of trained nurse practitioners that was better than the availability of GPs at night, which we have always had in Lincolnshire, as in other parts of the country, since 1946, as the Minister well knows.

How could such a system be better? Nurses do wonderful work. In any context, I would be the first to praise what they do and the high standards of their profession. I recognise that as time proceeds they have an ever greater degree of training and they can be used in an ever greater number of roles, but those roles should not seek or pretend to replace the role of a doctor. In the function of diagnosis, the doctor's role is and must be irreplaceable. In making a diagnosis, a doctor draws not only on probably years of experience but on that deep immersion in the clinical disciplines of anatomy, physiology, biochemistry and pharmacology which a nurse does not have available to him or to her.

If it were true that a nurse was as good as a doctor at making a diagnosis, often in difficult circumstances in the middle of the night when something goes badly wrong, we should say that nurses are doctors. They ought to have MD, MRCP or FRCP after their name, if one argued that they were equally able to fulfil the traditional vital role of doctors. The second thing wrong with that stupid argument was the response—perhaps a slightly Socratic response—that I gave to the person who put it to me. I said, "If you are right that the new system is better for patients, you ought to have it round the clock. You ought to get rid of GPs in the morning, in the afternoon and on weekdays as well. We should just have nurses and no GPs at all." There was no response to that, of course.

I said that I would not carp and I shall not, but I must ask a number of questions to clarify the position and remove the remaining anxieties, fears and concerns, which have been very great over the past few weeks and months, about the consequences of what was being done in south-west Lincolnshire, and to prevent it happening again. Why was there so little public consultation before the change was made, and no consultation at all with local elected representatives? There was no consultation with me or with local district councils.

Two weeks ago in the Grantham Journal the leader of the Labour group of the South Kesteven district council, Councillor John Hurst, wrote in support of what I was doing in my campaign. He shared my views about the urgent necessity to bring back doctors at night. Of course, he is a clever politician. He did not want me to have a monopoly of the issue and he was trying to defend the Government's back. I understand that. However, there was no doubt about his sincerity, nor that he was as shocked and surprised as I was to discover—as I only did from patients during the summer recess—what was actually going on.

When the Government abolished community health councils, which was a mistake, they gave a commitment that they would carry out more consultation, not less, with the public and elected representatives. That was far from the case; on this occasion, there was no consultation. Of course, the Minister will have been briefed to say that there was some public meeting attended by two passers-by and a dog and that a statement was made last March that GP night-time services would be removed. However, there was no public consultation; the process was thoroughly inadequate.

Is it true, as has been put to me, that the primary care trust, in deciding to remove night-time access to GPs last April, was implementing earlier Government guidance? Is it also true, as has also been put to me, that the Government did not understand the implications for out-of-hours care of the new GP contract, which they negotiated last year, and that that is why the original guidance was faulty?

After the introduction of the new contract, why did the PCT refuse even to negotiate on the offer made by Welldoc—a co-operative consortium of GP practices and health centres in my constituency—which had been supplying night cover for many years in a large part of the area, to provide cover for the whole south-west Lincolnshire area, which corresponds, more or less, to my constituency? That offer was dismissed out of hand. The PCT apparently did not even ask Welldoc what the system would cost or how it would run. Why not?

Why did the PCT seem determined to eliminate GP services at night at all costs? Does the Minister recognise that that behaviour, and indeed the lack of consultation with the public and with elected representatives, created a crisis of confidence in the PCT, both among many GPs and among elected representatives in the area—in no way confined to elected representatives of my party political complexion.

Does the Minister recognise that a series of recent Government actions has tended to devalue—or looked as though it were intended to devalue—the role of the GP. The process started with NHS Direct, whereby nurses diagnose on the telephone patients they have never seen and for whom they have no medical records, with no access to a doctor. At least use of that service was voluntary; people could still call a GP at night, so there was no particular reason to object to NHS Direct—indeed, I have never done so. The system was voluntary and there were alternatives; nevertheless, it is something of a waste of resources.

The system in place over the past few months was quite different. As a result of the Government's assurances, given yesterday, I hope that it will soon come to an end. It was not voluntary, and it was quite impossible to see a doctor at night unless one could get to a hospital or was already in hospital.

Another worrying and sinister development, which is going in the same direction, has occurred in my constituency: the system for triaging referrals. In my constituency, in an increasing number of specialities, GPs do not make a referral to a particular surgeon or physician at a hospital: a triaging committee decides whether the patient is to be referred to the secondary sector and, if so, to whom. That is a fundamental devaluation of the role of the doctor. Is there not a danger that such measures are damaging the morale of GPs and directly affecting the willingness of young medical students to enter general practice?

I can see from the Minister's body language that he does not agree with some of the strictures implied in my remarks. Will he state unambiguously that the role of the GP in medicine, especially in the vital aspects of initial diagnosis and clinical judgment, remains as important as ever in the protection of the nation's health? Will he tell us that his Government have no intention of eroding or devaluing either that role or the influence that GPs can exert on the secondary sector on behalf of their patients? Will the Government make those commitments clear both to existing GPs and to all medical students who may be contemplating careers as generalist physicians?