I think that the NHS and the relationship between patients and GPs have changed since 1948. Some patients want to see the same doctor, particularly if they have a long-term medical condition and they do not want to have to explain their problems all over again to a new doctor. However, some patients are not worried about whether they see the same doctor. If a patient does not have a long-term condition and is, in effect, seeing a GP at random-they might have developed a condition that they just want advice on-they may not be bothered about which GP they see.

There is a tradition of sorts that the relationship between patient and doctor is sanctified. For some people it is, but for others it is not, and we must provide an NHS that enables those people who want to see a particular doctor to see that doctor and those people who are not bothered in the least about which doctor they see not to have to see the same doctor continually. Some people I know do not want to see their allocated doctor at all. They happen to have been allocated to that doctor and end up seeing them. I remember that at some point in the past, although thankfully not at the moment, that was the case for people in my family.

Therefore, we need to ensure that people are able to see the GP who best suits them. My hon. Friend is absolutely right that many people want to see the same GP, but some are not bothered about which GP they see.

We need to provide people with choice, because choice and competition can both make a difference to patients and improve the quality of care. The polyclinics are based in London; we do not have them elsewhere. We have GP-led health centres elsewhere and many are very successful, but the development of polyclinics, which was restricted to the capital, has been enormously successful, particularly in deprived areas. Polyclinics have brought GPs to deprived areas and improved the quality of care in those areas, which we want to continue to work on.

We have pushed power away from Westminster and Whitehall into the hands of primary care trusts, through the world-class commissioning programme, and directly to individual and groups of GPs, through practice-based commissioning. That is all about providing the best possible service for patients-an aspiration that I am sure my hon. Friend shares.

As the Secretary of State has set out, where NHS services are providing excellent quality and performing at the level of the very best, there is no ideological predisposition to look to the market. On the contrary-we want health care provided in the best way that the NHS can possibly provide it. The public service is our preferred provider, but if it is not providing we have to look elsewhere, because the patient comes first.

Where NHS services can deliver, that is good-we want them to deliver-but we are also saying that patients need more power to choose the service that suits them. We in the Labour party created patient choice, precisely because we believe that it should be the interests of patients, rather than those of providers, that determine how health care is provided in this country.

We have already given people far greater choice through the introduction of 90 NHS walk-in centres, which are used by 3 million people every year, and, more recently, through the introduction of GP-led health centres, which enables someone to walk in to see a GP or a nurse while remaining registered at their own GP practice. People can go to the GP-led health centre if they have a random or minor health issue, but if they have a long-term health issue they can still go to see their own GP. They have a choice. Despite fierce Opposition to GP-led health centres from some parts of the medical profession and from elsewhere, they have, by and large, proved very popular with patients. Overall, nearly 3 million people have used such a centre already.

Evidence from the UK and from overseas shows that treatments are more effective if patients choose, understand and control their own care. We are putting ever more information about services in the hands of the public. That information will include the waiting times for a particular hospital and the personal comments of patients at a GP practice, so patients can comment on how good their GP practice is.

This process is slowly transforming the traditional doctor-patient relationship, in a way that gives the patient more power. Some GPs do not like it, but it gives patients more power. A more empowered and informed patient can take a more active role in their own care. They can decide, with their own doctor, which hospital to be treated at, and they can take a rational decision about which GP practice is best for them.

The NHS constitution already gives people the right to choose their own GP practice, but for many people that choice is severely limited. Most patients can choose between only a few practices and some patients have no choice at all. That limited choice reduces the competition between practices to attract patients and weakens the incentive for some GP practices to improve quality. Under the constitution, a GP practice must accept a patient's choice unless there are reasonable grounds for not doing so. At the moment, being outside a practice's boundary counts as reasonable grounds.

As my hon. Friend said, in September the Secretary of State set out our intention that, within 12 months, people should be able to register wherever they choose. For now, the practice that lies closest to someone's home may not be the easiest for them to get to.

I ask my hon. Friend to consider his constituents who commute to work and who may find it far simpler to see a GP near their work rather than taking half a day off to see a GP closer to their home. It is all very well to say, as he did, that employers should be more understanding, but some employers just are not so understanding. In addition, many people get paid by the hour, so they would lose money if they had to take more time off work to see a GP.

I also ask my hon. Friend to consider people with children who go to school beyond the boundary of their GP's practice. Those people may find it easier to register with a GP nearer the school, keeping time off school to a minimum should their child need to see a doctor. Furthermore, some of his constituents may want to change their GP practice because of the better quality of services available at other practices in their area. They may even want to register with the practice closest to their home but cannot do so because it lies just the other side of a line or boundary, or perhaps because of the "closed shop" arrangements that exist in some areas, because a GP practice's list of patients is full or because lines have been agreed about where the boundary between practices will exist.

The qualities and outcomes framework-the new arrangements to ensure that GPs provide greater health care-has attracted a lot of attention, because money is attached to it. The key thing is that the funding formula is weighted in favour of those people with long-term medical conditions and the elderly. Indeed, there is clear evidence that, since QOF was introduced, health inequalities have narrowed-that is what it is all about. Money follows the patient, so offering people a choice gives practices a strong incentive to improve and attract new patients and retain existing ones.

Similarly, part of the positive impact of the new GP-led health centres has been that they have led other practices to open for longer and to expand their practice boundaries, so that they can compete with new services such as the GP-led health centres. Choice means better access to higher-quality medical care and I cannot see how anyone would want people not to have choice, if that is what choice indeed means.

Of course, given a choice most people will stay exactly where they are; I believe that that is what most people will do. Only a limited number of people want to exercise choice in this regard and, yes, sometimes they are well, middle-class people who just want the choice. Why on earth should they not have it? If they want it, the NHS should be able to provide them with it.

I do not want people to have to go off somewhere and pay privately to get a choice that they really ought to have within the NHS. Frankly, if people are well, young and middle-class, I want them to use the NHS and stay with it. I want them to realise that the NHS will give them a choice, so that later on, when they perhaps really need the NHS for their kids or for themselves when they develop a long-term condition, they will stay with the NHS-those are the people we want too.

However, my hon. Friend is right that we also need to ensure that we care for the people who really need the NHS. They include people from the mining community, such as some of his constituents and some of mine, who have long-term health care conditions. We want to ensure that such people receive the service and the priority that they need.

People with complex long-term medical conditions will want to maintain the continuity of being registered with their local GP, especially when so much of their care will involve other local organisations such as social services, community nursing and diagnostic services.

We want to ensure that where patients want choice, they get it. However, most patients who do not need that choice should not have it forced upon them. In the end, it remains something that patients should choose or not choose for themselves. It is a matter for them.