What assessment she has made of patient satisfaction following the implementation of the new general practitioner contract.

There is no doubt about the success of the new contractual arrangements. Patients are receiving better care, quicker access to GPs and nurses, and more services delivered locally. GPs are more satisfied because they are better rewarded for offering more services and for delivering better care.

Does the Minister accept that patients registering with the practice rather than with a specific GP causes concern, as my constituents want their personal care delivered by someone whom they know and ask for?

The new contract underpins some important changes in primary care. As I outlined, that care involves better and faster treatment, as well as delivering more specialisms and wider services locally. Part of the reason for ensuring that registrations are often with practices as opposed to individuals is that more GPs are engaging in sub-specialisms. There are now 1,400 GPs with a sub-specialism. We promised to deliver 1,000 under the NHS plan by 2004, and we achieved the target a year early.

Patients in Snodland are delighted with the new contract. Indeed, I opened a £2 million new medical centre in Snodland just the other day. On the same day, there was a ground-breaking ceremony for a £5 million new medical centre. What else is my hon. Friend going to do for my constituency?

I congratulate my hon. Friend on that excellent news. As he says, the new GP contract is underpinning a revolution in primary care. It is absolutely essential in helping GPs to play their part in cutting mortality rates. It is no accident that death rates from cancer are down by 12 per cent. and that death rates from coronary heart disease are down by 27 per cent.—it is because the policy is right and is backed by the investment that patients such as those in my hon. Friend's constituency rightly deserve.

Would the Minister concede that there is huge dissatisfaction in rural areas with the delivery of the out-of-hours service? What steps has he taken to ensure its effective and efficient implementation?

I am grateful to the hon. Gentleman for that question. I know that he has some expertise in the subject and I welcome the speech that he made, to which I listened carefully.

It is worth pointing out that before the new GP contract was introduced, fewer than 5 per cent. of GPs provided their own out-of-hours cover. The new arrangements will ensure that the skills mix and team working that are well established in both primary and secondary care apply out of hours, accessed through a single call to NHS Direct.

The national Hepatitis C Trust has informed me that several patients have approached it after being either misdiagnosed by their GP or waiting an inordinate amount of time to be referred for either a biopsy or treatment. What processes exist to link patient feedback to GPs' continuing professional development? How will the new GP contract and appraisal system aid that activity?

The hepatitis C action plan is an important part of that, but it is up to primary care trusts to ensure that their contractual arrangements are audited effectively so that remedial action is taken when quality is found not to be up to the standard that it needs to be.

There is a question about responsiveness. Following the previous question about flexibility, how flexible is the contract? Can it change to reflect the increased prevalence of other chronic conditions such as hepatitis C? What role do patients and the feedback from patients play in that?

Primary care trusts are the local health professionals responsible for ensuring that needs in their communities are addressed. That is why they have a responsibility to audit the care that general practices provide in their area and to take remedial steps whenever they find that it is not up to the mark.

I stress that the new GP contract is delivering some important gains for constituencies throughout the country. The fact that 99.9 per cent. of people see a GP within 48 hours or a primary care professional within 24 hours is due to the new contract. Achievement in the quality in outcomes framework exceeds 95 per cent. Again, that is down to the new contract. Those changes are important. I am sure that that is why the chair of the British Medical Association's General Practitioners Committee said:

"I believe the introduction of the new GP contract marks the beginning of a change that will be better for patients and better for everyone working in general practice."

That includes people in the hon. Gentleman's constituency.

The Under-Secretary knows that one aspect of traditional primary care that is most highly valued by patients is GP support for community hospitals. Yet following the introduction of the new GP contract, GPs' out-of-hours cover for community hospitals has been greatly reduced. What assessment has he made of the threat to community and cottage hospitals following the introduction of the new contract? What will he do to ensure their long-term survival?

As the hon. Gentleman knows, about 50 community hospitals were announced as a manifesto commitment.

However, I want to be clear about the impact of the new GP contract on out-of-hospital care. The Department of Health has made it clear that primary care trusts must fulfil national quality requirements when they put arrangements in place. We can be confident that those arrangements will be satisfactory only because of the unprecedented investment that the Government are putting into primary care, not only the £54 billion that is available for local management through primary care trusts but the £322 million extra that was provided to ensure adequate out-of-hours cover.