We are seeking to reach agreement with the British Medical Association to use resources from redundant indicators in the quality and outcomes framework for improving patient satisfaction, with access as a key indicator of quality. We are also proposing to use other resources within the contract to fund extended opening by practices. The BMA has decided to poll its members on the package. We hope that GPs will support our proposals to improve services for their patients.
I wonder whether the Secretary of State has seen the recent evidence showing that only one in 10 women who have suffered a fragility fracture have been referred for a bone scan to discover whether they have osteoporosis. The figure for men is one in 50. I am sure that the Secretary of State is aware of the cost-effectiveness of early diagnosis of osteoporosis. Will he therefore ensure at an early stage that performance indicators for osteoporosis and incentives are built into the quality and outcomes framework? Does he agree that it would be foolish if money that could be available for osteoporosis was diverted into more flexible surgery hours, given the potential savings to the NHS from preventing secondary fractures?
I pay tribute to my hon. Friend for his work on the all-party osteoporosis group. Let me make it absolutely clear that this is part of some of the misinformation flying around about the very complex area of the quality and outcomes framework points. There has never been any incentive within the framework to treat osteoporosis. We are dealing with a number of points in the system—and therefore money paid to GPs—that are now redundant. We all agree that they are redundant. We want to use those points for greater access. The BMA has suggested that they be put towards issues such as osteoporosis, virtually as a piece of propaganda to strengthen its position—[Hon. Members: "Ooh!"] The word propaganda is obviously an unparliamentary term.
I say to my hon. Friend—who I know takes a deep interest in this issue, as do many others—that this is not about our not putting money into these areas. We just do not believe that GPs need to be incentivised in such areas. We believe that we should put more money into the national service framework for older people in order to tackle osteoporosis; and we should fundamentally ensure that people can get to their GP, which is the first step to dealing properly with any ailments, including osteoporosis.
We have dealt with patient groups throughout the process. I mentioned that some points are redundant, and I do not think that there is any argument that GPs should be incentivised to do things that they should already be doing—for instance, writing out a person specification for job adverts to recruit staff to their practice. There should not be incentivisation for things that should be done as a matter of course. There is no disagreement with patient groups about that. About 6 million people in our patients survey said that they want improved access to their GP in the evenings and on Saturdays, which is why we are seeking to reach a negotiated settlement with the BMA.
Is the Secretary of State aware that no one would deny the need for the Department to ensure good value for money in the health service? It is unfortunate that a very inexact contract was prepared for general practitioners. Does he accept that, whatever developments there are, the introduction of private health care, particularly from America, where I am sorry to say the state is unable to provide adequate health care for its own people, would not only undermine the confidence of general practitioners in the national health service, but would cause grave doubts for many hon. Members who believe that this is a service worth preserving?
I do not agree with my hon. Friend that the contract was a mistake or inexact. In fact, during the period leading up to 2004, we had a crisis in GP recruitment. We could not recruit undergraduates from medical schools and we had an ageing group of GPs. A huge shortage of GPs was the big worry at that time, but our medical schools are now full—that problem has been resolved. I also do not agree that GPs who are called out at 4 o'clock in the morning should be expected to deal with patients and difficult cases at 9 o'clock when their surgery opens. The issue about working hours applies to GPs as well as others.
On my hon. Friend's second point, we are not seeking to introduce private practice into these areas. We are seeking to negotiate with the BMA for greater patient access. We want to bring more GPs into under-doctored areas, which have been appallingly treated in the past. The basic point is that customers and patients should get the service that they deserve. I hope that that will be in our present GP practices, but, if not, we will provide those practices in some other way.
What we are quantifying in this instance is about £200 million for the number of points that are being moved around the system. There is no disagreement about that; the disagreement is about where to spend the money.