Sir George raises doubts about Out of Hours cover in Andover
21 Apr 2004
This is the text of the speech Sir George made in the House of Commons about the new GP contract:

Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor), who speaks with such authority on this subject and whose very presence in the Chamber is a reminder to us all of the potency of health as a political issue in our constituencies. He mentioned that he was approached by Hartlepool, whose local hospital is threatened, for advice. I hope that he advised that an independent candidate should stand against the Labour Member there to achieve some results.

I want to speak briefly about the new GP contract, which I broadly welcome. Of course, it makes sense to reduce the number of hours that doctors work. If it makes no sense for MPs to be up all night and then be expected to do a proper day's work, it makes less sense for the country's doctors and GPs to have to attend to their patients when they have not had a decent night's rest.

I sound a brief note of caution before Ministers make claims about the impact of the new contract on patients. The Minister of State, who is normally alert and fleet of foot, does not understand the depth of concern in constituencies about what will happen when the new out-of-hours contract is introduced. The evidence that I have seen is that patients in my constituency will feel worse off because the level of service will be manifestly less than it is at the moment. If steps are not taken before 1 July, when the new out-of-hours opt-out contract starts in Hampshire, Ministers may find it difficult to
convince my constituents about their investment in primary health care and their commitment to a quality service.
There are three areas of concern on which I want to touch: first, cover at Andover hospital—the position is the same at other smaller or cottage hospitals; secondly, the loss of Saturday surgeries; and thirdly, the operation of the new out-of-hours contract, which in my case is with Primecare. None of that is the fault of the local PCT or the local GPs. Simply, the money saved by not paying GPs to provide out-of-hours cover, even when topped up by new money from the Department, is not enough to replicate the service that GPs currently provide, mainly because it was provided on the cheap.

Let me begin with Saturday surgeries, which have not really featured in this debate. At the moment, I can see my GP in Andover on a Saturday. For those who commute from Andover or who work long hours, that may be the only time that they can see their GP without taking time off work. Last Saturday, my GP saw 15 patients and processed a number of repeat prescriptions. With the new contract, Saturday is out of hours, so the local GPs are not contracted to provide any service on that day. They could do so if the local PCT bought it in as a local enhanced service, but my PCT does not have the resources to do so, a point to which I will return in a moment.

My PCT is struggling with funding for taking over the out-of-hours service. It has been allocated 6 per cent. of what is called the global sum, part of the GP income stream, and GPs have taken a commensurate reduction. But that is simply not enough to replace the service. I know of only one GP practice that is going to open extra-contractually on a Saturday and that is a dispensing practice in a neighbouring constituency that can do so from the dispensing surplus. None of the surgeries in Andover will be accessible on a Saturday.

In fairness, there are plans for a replacement GP service. On Saturday and Sunday, there will be five sessions at Andover hospital operated by a GP or GP registrar. It may be bookable, but, basically, it is open house. Of course, one will not see one's own GP and the GP whom one sees will not have access to one's records. For most people, the hospital is more difficult to access then their local medical centre, so by any definition, the service offered on a Saturday will be seen by my constituents as reduced.

Then we have the position of Andover hospital. Andover is the largest town in my constituency, with a population of 40,000 and growing. The Andover War Memorial hospital hosts a range of services, including out-patients, diagnostic imaging, day surgery and so on. For anything more serious, one must go 15 miles to Winchester. At the moment, out-of-hours cover at that hospital is provided by local GPs, so one can go to the minor injuries unit at any time and be treated. A nurse deals with the patient and, if required, a GP will be called out. Although details of the contract after 1 July are still being negotiated, it looks very much as if there will be no local GP cover at the hospital out of hours. From 6.30 pm to 11 pm, some service may be provided by nurses, but from 11 pm to 8 am, it looks as if the minor injuries unit will be closed. At the moment, people can look in at 2 am and get treated. As from 1 July, those
who want that treatment will have to drive 15 miles to Winchester to get it—by any reckoning, a reduction in service.
Finally, there is the operation of the new out-of-hours service to be provided by Primecare and funded through the PCT. At the moment, calls from patients in Andover are answered by a local nurse until 11 pm and thereafter by the on-call doctor in person. In future, the plans are to route calls initially to Birmingham and then to Southampton—the local hub—and if a GP is required, he will drive from Southampton or possibly Winchester. At the moment, cover in Andover is provided by a rota of local doctors and the response is obviously much quicker. However that is presented, it will be seen locally as a reduction in service.

I want to end on a theme that, I am afraid, I have mentioned previously. The reason for all this is that Hampshire, and particularly Mid Hampshire PCT, is simply underfunded. For every £100 that the average patient in England gets, Mid Hampshire gets £80. At that level, it is simply not possible to provide the quality of service that Ministers and I, as the local MP, want. That is why in all the debates on heath services in Hampshire, whether primary care or secondary care, we return to the underlying structural imbalance in the way that funds are distributed. Until Ministers address that fundamental point, they will continue to have difficulty persuading my constituents that the NHS is as good as they make out.

 
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