I am pleased to see you in the Chair, Mr. Cook, presiding over a debate on a subject that is highly important to all our constituents. It is good that the Minister responding to the debate is my right hon. and learned Friend Mr. O'Brien, who is my Constituency neighbour to the south-west.

If we look at the Government's policy on the NHS since 1997, we can see that a welter of statistics confirm the excellent and vital progress that has been made in many areas. For example, we have over 44,000 more doctors and almost 90,000 more nurses, and 3 million more operations are carried out each year than in 1997, with the number of heart operations more than doubling. Net public spending on the NHS has nearly tripled since 1997. Then it was £35 billion; it is now more than £90 billion. Waiting times are at the lowest level in NHS history.

The risk, however, is that the effectiveness and durability of those fantastic achievements may be undermined by an obsession with organisational and administrative reform of the NHS. In the view of many NHS workers, of patients and indeed of Members of Parliament and community representatives, the commercial mantra of choice is being used as a cloak for the marketisation and privatisation of the NHS.

At the Brighton Labour party conference in September, the Secretary of State for Health said:

"I cannot see why families shouldn't register with the GP practice that suits them best. So, I've said we'll abolish GP practice boundaries within a year."

That did not exactly come out of the blue, but it caused a great deal of concern among GPs in my constituency and elsewhere. Even those GPs who saw some benefits from that rather rushed reform, such as Dr. Theresa Eynon of the Hugglescote surgery, were quick to express to me their fear that abolishing GP practice boundaries could worsen the plight of those patients most vulnerable to serious long-term health problems.

The Government's plans provide further proof that the inverse care law is alive and well. As the Minister will know, the idea was first proposed by Julian Tudor Hart in 1971. His law states that the availability of good medical care tends to vary inversely to the need for it in the population that it serves. Put simply, those who need health care services the least use them more, and more effectively, than those with the most need.

That is not to say that there is anything inherently wrong with allowing people to register with a GP practice closer to their workplace, thus enabling easier access to the surgery during the working week. Of course there is nothing wrong with wanting to offer more convenient NHS primary care, although I would quietly suggest that employers could be more flexible in allowing their employees to attend GP appointments; the wheels would not come off the local or national economy if such flexibility were more readily available.

If that was what was being proposed, I would not argue with it, and would not be debating the matter today, but that is not the full story. The Minister said in a speech to the Royal College of General Practitioners conference last month:

"The focus has to be on responding to the needs of patients...Enabling people to choose a different practice near home. Or one near to where they work. Or one with better overall quality scores and patient satisfaction but in a different location altogether."

That confirms that the Government's intentions are much more fundamental than an improvement to GP accessibility.

The proposal is more to do with the promotion of competition among GP services, supplemented by initiatives such as NHS Choices that utilise the information gleaned from the quality and outcomes framework to give the public somewhat simplistic statistics on GP practice performance. Given all the academic talk of quality and values, the most crucial issue is the future of the truly local services that GPs provide, particularly the invaluable home visits that they make to the homes of the long-term sick, the immobile and the terminally ill.

In the rush, in the words of the Health Secretary, to turn the NHS from "good to great", the Government risk ignoring the needs of that most vulnerable group of patients. I note parenthetically that the next debate in this Chamber is about age discrimination in health care. I shall read the Hansard report of that debate with great interest. The proposed reform does not seek to end home visits, but there is a very real risk that the needs of our fellow citizens with the most complex health problems will be put in direct competition with the health-care requirements of the more affluent workers and families. Each will have a QOF score, but there are no prizes for guessing who attracts the most points and, therefore, funding.

I regret to say that the potential of the change to worsen health inequalities goes even deeper than that. Those with the most complex health needs, particularly psychiatric ones, rely on social services that are geographically tied to the local authority. It does not take much imagination to realise that the consequences of abolishing GP practice boundaries may include an increase in the administrative complexity and cost of providing appropriate care packages for all who need them. Dementia patients living at home will be particularly vulnerable to instability and uncertainty.

All Labour Members hope that the Personal Care at Home Bill, which received its Second Reading this week, and the national care service will together ride to the rescue of all those with social care needs, but a period of uncertainty could result from the abolition of GP practice boundaries. I urge the Government and the Minister to think again, on these grounds alone. I should be most grateful if the Minister made a specific response about the impact of the reform on social care provision.

I turn to the intellectual threads of this reform. The spiritual leader of private health care in the NHS and former Health Secretary, my right hon. Friend Mr. Milburn, has rightly stated on numerous occasions that the health gap between rich and poor has grown inexorably since the creation of the NHS. However, that inescapable conclusion has little to do with structural failings within the NHS, as he would be quick to assert; it has more to do with the wealth of a small number of individuals and the private companies that respond to their every ailment, whether cosmetic or chronic.

It goes without saying that widening health inequality is a national concern, and I am pleased that the Government have commissioned Professor Sir Michael Marmot of University College London to consider how we could tackle health inequalities more effectively. We should all look closely at his findings and recommendations, and I hope that we will have an opportunity to debate them in the Chamber.

Men and women in our poorest communities are dying on average a decade or more before those of their generation in the most affluent areas. Putting it at its mildest, that is deeply troubling. However, that is due as much to the increased and inherent politicisation of this totemic institution since the 1980s. That culminated in the Labour Government putting up the money-but rarely the arguments-for maintaining the NHS wholly within the public sector.

With the abolition of practice boundaries, we will undoubtedly increase competition within the NHS. That will be especially so in urban areas, as GP practices have to compete for patients with NHS walk-in centres and one-stop primary care centres-the polyclinics championed in the Darzi review. That will merely distract the NHS from tackling health inequalities, as consistent and lengthy patient records will become more difficult to compile.

As someone with three decades in public sector IT, it would be remiss of me not to acknowledge that computer systems have a role to play in solving the problem, but the less said about the benighted NHS agency Connecting for Health the better. There is little doubt in my mind, however, that we would have had greater success in tackling health inequalities since 1997 if we had trusted and promoted the efficiency of the public sector over that of the private sector and its unseen and unaccountable backers and exploiters.

I mentioned the Darzi review a moment ago. We are all familiar with its aim of putting quality at the heart of the NHS. Who could disagree with that? I certainly would not, although I would question the use of other commercially-loaded terms by a senior Government appointee, who is supposed to be a clinical health specialist and not a management guru. Those phrases are more likely to come out of the mouth of the Chief Secretary to the Treasury, my right hon. Friend Mr. Byrne, than one of our most successful and respected surgeons.

However, when my right hon. Friend the Member for Darlington was Health Secretary, he said in a speech to the Commonwealth Fund in Washington 2002 that

"health care works best...when it harnesses the commitment and knowledge of clinicians to improve care for patients."

Private health insurer Kaiser Permanente of the US is cited as an example of that health care harmony, but I shall resist the temptation to be lured down that profitable but politically promiscuous avenue.

The Darzi review is the foundation for these troubling proposals in primary care, with a specific quote from Lord Darzi's summary letter in "High Quality Care for All" establishing the foundation upon which the Secretary of State decided to proceed.

Lord Darzi said:

"Patients will have greater choice of GP practice and better information to help them choose."

That raises the role of primary care trusts in designing and commissioning local primary care services, as they also have a vital role to play in the democratisation of health care. By that I mean involving patients in the decisions that most affect their health, which is a welcome development. Leicestershire County and Rutland PCT seems to be going out of its way to illustrate to patients the worst excesses of the catchment area system that currently operates. For example, patients registered at Whitwick surgery who lived four miles or so away in Hugglescote were told by the PCT that they would have to leave that practice and re-register at Hugglescote. That was immensely distressing to the patients concerned, particularly pensioners who had built up a good relationship with the GPs at Whitwick over a number of years.

At this point, it is worth quoting Dr. Orest Mulka of the Measham medical unit. He is a highly respected GP at a well-regarded surgery in my constituency, and he said:

"Of course boundaries can be misused...but boundaries aren't just for the management of GP workload. They are there to allow a practice to identify with a community and see the health of their community as more than just the sum of individual conditions that are brought to them. They allow practices to develop a sense of pride of caring for their patch."

I repeat:

"They allow practices to develop a sense of pride of caring for their patch."

He went on to say:

" In my practice we don't discriminate-anyone living in our area is accepted on our list."

I shall use Dr. Mulka's comments as evidence against the Government's claim that abolishing practice boundaries will increase local accountability. If a patient is not a member of the local community, their needs may well be at odds and even in competition with those who live closest and who may have greater clinical need.

Whatever the number of patient participation groups, welcome though they are, they cannot hope to replace that local link. That reminds us of the consumer-led nature of the Government's proposal, which has been described as a move toward a "medical supermarket" where increasing numbers of patients are routinely seen, not by GPs, doctors or nurses, but by "health care professionals" such as "nurse consultants". We are some way from such dystopian scenarios, but the Government's obsessive delivery of pro-private policies in the NHS inevitably leads in that direction. Many people see the death knell of a publicly resourced and run NHS in proposals such as abolishing GP practice boundaries; creating polyclinics; making PCTs commissioners rather than providers of health care; encouraging NHS hospitals trusts to apply for foundation status; local improvement finance trusts; and-do not get me going on this-private finance initiatives. Moreover, there are other inappropriate and unnecessary market devices.

Such reforms are the logical conclusion to the brave new world of health care partnerships piloted by my right hon. Friend the Member for Darlington when he was Health Secretary. The frequent speeches made during his tenure in Richmond house seemed intent on sending a chill down the spine of GPs and patients and included such baleful gems as the following examples. He said that

"tax funded health care can only be sustainable if it sits side by side with diversity in provision and choice for patients."

What he meant is that it is sustainable only when the local commissioning arrangements allow and indeed favour private sector bids for NHS work. He also talked about

"new private sector providers becoming a permanent feature of the NHS landscape."

Finally, he said:

"The NHS scores well on fairness but is weak on choice."

Those quotes are all from the same 2002 speech, but seem more akin to a sales pitch than a policy debate. Let us not forget that from 2001 to 2004 our former Prime Minister and right hon. Friend, Tony Blair, was advised on the NHS by Simon Stevens, who promptly joined the US firm UnitedHealth Group, which made $78.85 billion from health care services in 2008, after leaving the Downing street policy unit. By way of a footnote, let me say that at the same time as vehemently opposing President Obama's modest health care reforms in the US, UnitedHealth, with Simon Stevens on board, is bidding for and winning NHS contracts, and will no doubt regard the abolition of GP practice boundaries as welcome "mood music" at the very least.

To return to the local impact of the Government's plan, Dr. Eynon has concluded that, once again, the change is one that suits the well, working person. That brings to mind the inverse care law that I cited at the start of my speech. We must not shape our primary care system around the needs of the middle-class, peripatetic, urban elite who go to their local paper and MP every time they cannot get an appointment to treat their squash injury, as we should not normalise or accommodate the social and environmental impact of fundamentally selfish lifestyles.

By 2018, when the NHS reaches its biblical span of three score years and 10, we shall have seen GPs metamorphose from the avuncular community leaders of "Dr. Finlay's Casebook" to profit-generating assets in a Dr. Foster's cost centre. The NHS was not created to serve a minority who shout loud enough to see a doctor whenever they want, wherever they are. This proposal is designed to satisfy the few, not the many. To abolish practice boundaries is to hasten the demise of the family doctor.