My Lords, as the Prime Minister promised, we have looked again at the delivery of the 24/48 hour access target for primary care. In June, primary care trust data showed that less than 1 per cent of patients were denied the opportunity by their practices to book appointments more than two days ahead. Virtually all patients can now see a GP within 48 hours, compared with only about half in 1997. GPs and their staff are to be congratulated on that improved access for patients.
My Lords, I am greatly obliged to the Minister for that reply. Is he aware that we are not complaining about the need to get in quickly, but those occasions when we want to make an appointment for a routine matter, perhaps a few days or even a week ahead? Is the Minister aware that I am, unhappily, in the 1 per cent to which he refers?
My Lords, I am extremely disturbed to know that the noble Lord is in that 1 per cent, but minorities have a problem sometimes. The work of the National Primary Care Development Team is going on with practices to make sure that people in the situation of the noble Lord are not denied a more flexible access.
My Lords, does the noble Lord agree, first, that the time has come for a major review of primary care services in this country, not least their accessibility or their inaccessibility; secondly, that the range of services is far too narrow at the present time; and thirdly, that, perhaps in some instances, there needs to be a change in attitude towards their customers?
My Lords, we know from surveys of the public that there is huge public confidence in our general practitioner service, which is—perhaps I may put it this way—one of the jewels in the crown of the NHS. But the Government are planning a widespread consultation later this year on services outside hospitals, which will lead to a White Paper towards the turn of the year.
My Lords, do many practices run the type of practice that my GP does, which provides an open clinic for emergencies, and other appointments are booked? I must say that it works very well. No one is turned away if there is an emergency, yet one can book further ahead.
My Lords, a wide variety of arrangements operate through general practice providing access to patients for different services. I do not have the details of those particular arrangements, but, as I said in my earlier reply, a very small minority, unfortunately including the noble Lord, Lord Trefgarne, are being denied the flexibility that we all seek.
My Lords, the point made during the general election campaign was that some practices were misinterpreting the guidelines and thinking that they could not have forward booking. The problem is not as narrow as the Minister is suggesting to the noble Lord, Lord Trefgarne. Is any best practice guidance given to practices to make it clear that they can and should offer long-term booking for non-urgent appointments, which is greatly to the advantage of patients?
My Lords, widespread guidance about good practice is available to all practices. The noble Lord is right. At the time of the election, the latest data showed a larger number of patients not receiving the kind of flexibility that I have described. But that has now changed. Our latest information from primary care trusts, which are monitoring the situation, including using mystery shopper techniques, is that about 1 per cent of all people are denied the kind of flexibility that we are looking for.
My Lords, as the general practitioners are rewarded financially if they keep within the 48-hour target, what happens to the general practice where most patients want an appointment in a week's time?
My Lords, general practitioners are required to produce speedy and flexible access. I am not sure whether I can find many more ways of describing what is going on other than to repeat that there is guidance available and we monitor the performance of GPs in relation to the contracts they sign.
My Lords, with all due respect, the Minister has not answered my question. If general practitioners are rewarded financially for keeping to the 48-hour target and in some general practices the patients do not want to be seen within 48 hours, are the general practitioners thereby financially deprived?
My Lords, the reward system relates to the delivery of the speedy access targets—it does not relate to the flexibility arrangements. You cannot have a financial penalty if you do not require someone to do something and they then do not do it. I think that the noble Lord misunderstands the nature of the contract with the general practitioners, which may be because he comes from a hospital background.
My Lords, we do not micro-manage the general practice services. We leave general practitioners to maintain their own arrangements, provided they are meeting the requirements on their contract for speedy access and provided, as we are trying to ensure, they do not use that as an excuse not to have sufficient flexibility.
My Lords, has the Minister tried making an appointment with his local practice? You ring up at the given time and continue to dial for half an hour. When you finally get through, you then find that that day is full; you may then be late for work. Has the Minister tried that? It is not as satisfactory as he thinks, and I am sorry that he has brushed off my noble friends in the way he has.
My Lords, I have tried the system at my general practice. It provides a flexible and speedy service that is a credit to the practice. I am not trying to brush off anybody; I am trying to give the House information. I am afraid that some noble Lords just do not accept the information.
My Lords, why does not the Minister accept that this is a very silly piece of guidance? Instead of making personal remarks about my noble friend, he would do much better to go back to his friends and point out that in a large number of cases, not just a minority, the doctor wants to see a patient in three weeks, a month or two months' time and says, "Come back and see me then". That is when the difficulty arises. The guidance is not flexible enough to accommodate that. It should be, and the Minister should remind his colleagues accordingly.
My Lords, I did not intend any unkindness; I am sorry that there is so much sensitivity on the other side of the House this morning. I will repeat what I said in the Answer: the information from the primary care trusts available to the Government shows that about 1 per cent of patients do not have the flexibility which the noble Lord and his colleagues require, and which we all support—but it is 1 per cent. According to the information available to me, 99 per cent of people receive that flexibility. I am very sorry that the noble Lord, Lord Trefgarne, comes under that figure of 1 per cent.