Family Doctor Services

Part of the debate – in the House of Commons at 2:37 pm on 11th November 2004.

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Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health 2:37 pm, 11th November 2004

I thank my hon. Friend for her intervention. Those experiences are reflected in MPs' mailbags. Perhaps the good intentions behind the target are not being translated into reality. My hon. Friend's example of patients not being able to see the same GP at their next appointment raises concerns about the continuity of care, and there are increasing concerns about access to the GP by those who work away from the area where their GP surgery is located and not being able to get an appointment when they want one.

Other wheezes that are being used to game the system have been drawn to my attention by GPs, such as restricting patients to one problem per consultation. I do not know how that works in practice, but it is being tried. Another wheeze involves setting limits on times when patients can call for an appointment and, as my hon. Friend Sarah Teather mentioned, rationing access because the telephone is engaged all the time. So many people are phoning in that they cannot get through to book an appointment. The selective release of appointment slots is a further wheeze. Appointments should be booked to meet the patient's need, not to hit an arbitrary target. All too often it seems that the target is shaping the way the system is working.

The motion refers to out-of-hours services. There is still much confusion about how such services will work after 1 January. The Select Committee on Health, whose Chairman intervened earlier, rightly raised concerns about the costs, planning and implementation of a huge change to the provision of family doctor services out of hours. I support the change. [Interruption.] If the Minister would not chunter from a sedentary position, I would be happy to outline my concerns. Hopefully, there will be a response to some of those.

It is evident from my mailbag and that of many other hon. Members that people are worried about the loss of Saturday morning surgeries and the difficulties that that will cause. How did the Government arrive at their estimate of £6,000 per GP to provide out-of-hours and Saturday morning services? According to the results of a survey by the NHS Alliance, PCTs are struggling with the logistics, staffing and finances necessary to deliver out-of-hours services. One in five PCTs say that they will restrict services on the basis of quantity or quality or both. On what basis does the Minister reject the findings of the NHS Alliance's survey? I wonder whether he has looked at it and why he does not consider it an acceptable basis on which to criticise the Government's approach to the provision of out-of-hours services in the new form under the new contract.

Where will all the extra doctors come from to staff the out-of-hours services? How much reliance will PCTs have to place on locum and overseas doctors to fill the gap? Many PCTs plan to use NHS Direct services as the front end of their out-of-hours services. However, that will need to be monitored closely in the light of recent research in the British Medical Journal. A study published on 17 September looked at the effects on consultation workload and costs of off-site triage by NHS Direct compared to on-site nurse triage in general practice. Patients in the NHS Direct group were less likely to have their call resolved by a nurse and were more likely to have an appointment with a general practitioner. In other words, it was costing more to use NHS Direct. Perhaps that explains one of the cost pressures that PCTs are grappling with. Half of PCTs have said that they will contain the extra costs by delaying investment in new services. How long will they delay investment in much-needed new services?

Ministers have said that the recent increases in accident and emergency attendances have nothing to do with the change to out-of-hours services. Certainly some of the figures suggest that the increase predates the changes. I accept that, yet reports from the front line tell another story. The Nursing Times recently quoted an accident and emergency sister at Norfolk and Norwich university hospital as saying that her department had seen a 13 per cent. rise in attendances since January. She is quoted as saying:

"People tell me they are here because it is convenient and because they cannot get an appointment at the GP's."

Perhaps that is another unintended consequence of the 48-hour access target. To what do the Government attribute the increase in accident and emergency attendance?