GP Extended Access Services: Privatisation

Steve Brine Excerpts

Wednesday 17th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

It is a pleasure to serve under your chairmanship, Mr Hosie—it is the first time we have done this. I congratulate the hon. Member for Stockton South (Dr Williams), who I always enjoy listening to, on securing this debate on an important issue for him as both a Member of Parliament and member of the important Health and Social Care Committee, and—as I think he is still—a practising GP.

We know that primary care literally, by definition, comes first. It has always been and always will be the bedrock of the national health service. The Secretary of State and I have made that absolutely clear, and the long-term plan, when it is published later this year, will make it even clearer. As the hon. Gentleman rightly says—I think there is unanimity—we are committed to ensuring that everyone can see their GP at a convenient time by increasing the availability of routine evening and weekend appointments. Millions of patients have already benefited thanks to our investment of some £2.4 billion into general practice by 2021. I join him in paying tribute to his colleagues for making the leap and making that available to his constituents.

We have asked all clinical commissioning groups to ensure by March next year that patients have extended access to general practice across the whole of their registered population. That includes ensuring that access is available during peak times of demand such as bank holidays, and across the Easter, Christmas and new year periods. We have made great strides in delivering extended access, with the vast majority of England now offering weekend and evening appointments. Apologies to you, Mr Hosie—this of course is a devolved matter and we are talking about the English health service. That extended access will, as the hon. Member for Stockton South rightly says, help to reduce the pressures on general practice—it is not all squeezed into the original sessions—and, importantly, to reduce pressures across the wider NHS ahead of winter, which is creeping up on us.

Good access is key to improving quality and is not just access for access’s sake. Problems with access make it harder for people to get the right care from the right person at the right time. It is a publicly funded health service and it is there for the public, and that is what the public say they want. However, for us improving access is not simply about all GPs working seven days a week or doing more of the same. There was certainly a comms failure with the 2012 Act, in that it was allowed to be presented as saying that we just wanted GPs to just do more and to work seven days a week. Many people work seven days a week—all MPs certainly do—but improving access was not just about asking GPs to do more of the same. It can be and often is about practices coming together to offer services to a larger population—I have seen it most recently at the brilliant Granta surgery in Cambridge, which does it very well—using technology in different ways to make it easier for patients to access services, and broadening the skills mix. The hon. Gentleman and I have talked about the multidisciplinary team many times. It is also about working smarter in greater partnership across the health and social care system. The Secretary of State was at Granta just last week.

The hon. Gentleman mentioned the Health and Social Care Act 2012 and asked in effect why we do not just do away with the requirement in that Act—the section 75 rules—so that CCGs are, as he says, no longer required to tender for contracts. Let me assure the hon. Gentleman and you, Mr Hosie, that any fears of privatisation of our NHS are, we think, completely groundless. I do not accept the title of the debate on the Order Paper. The Government are fully committed to the NHS as a public service that is free at the point of need, as it has been since day one in 1948—70 years ago this year, of course—whether care is provided by NHS organisations, as the vast majority is, or by the private, voluntary or social enterprise sectors. That guiding principle remains absolutely the case today. The mechanisms for deciding who provides what service may vary, but the basic structure of our NHS remains exactly the same. The key question is, and will remain, the pragmatic one: how do we best secure the outcomes that we want for patients and the best possible value for the taxpayer? I completely respect the fact that the hon. Gentleman started his speech by saying exactly that. He is spot on, of course.

We should avoid the blanket assumption that one form or other of provision is always the best or worst, as the evidence does not support that sort of sweeping conclusion, which the hon. Gentleman understands. As long as patients receive care that is high quality, timely and free at the point of use, the status of the provider is of little if any significance. That has been the policy of successive Governments for many years. It was certainly the policy of the last Labour Government and was what Tony Blair believed when he was in office. I know that many Opposition Back Benchers do not share the ideology of those on their current Front Bench, which is to make those sweeping conclusions that one form of provision is bad and one good. Where healthcare is free at the point of use, people are not as concerned about who provides the care as we think and often hear in the House. The British social attitudes survey showed that 43% of people had no preference whatever between a private provider, an NHS provider and a not-for-profit organisation.

A clear framework for public sector procurement is both necessary and, we think, desirable, just as it has been since it was introduced in 2006, under a previous Government, to implement the EU procurement directive. It is necessary to ensure that where a local, clinically led CCG decides that it is in the interests of patients and taxpayers to look at a range of potential providers for a service, it is able to do so. That is in the best interests of patients and taxpayers. Securing the best possible treatment for a patient is what we all want to achieve, but we also have to use NHS resources for the good of all patients. Achieving value for money is not just about making the numbers add up. It is about how we ensure that everyone gets the quality of treatment that they deserve.

[Dr Paul Williams]

The Minister has said that the CCG puts things out to procurement when it decides that that is in the interest of patients. Do I understand from his words that the local CCG had the option within the law of not going out to procurement on this service?

[Steve Brine]

I might have to send the hon. Gentleman a note on that, but I will repeat what I said, just for the purposes of accuracy—I know he is seeing the relevant people later this week. Where the clinically led CCG decides that it is in the interests of patients and taxpayers to look at a range of potential providers for a service, it is able to do so. Those are the words I have for him. What we need and have is a sensible, proportionate framework that effectively balances the need of commissioners to secure the best-quality service at the best price with their need to ensure the security and sustainability of supply. It has worked that way and worked well for the past 12 years.

[Alex Cunningham]

rose—

[Steve Brine]

I will happily give way to the constituency neighbour of the mover of the motion.

[Alex Cunningham]

I wish to push this point. I know the Minister said that he might have to send my hon. Friend a note, but in putting the service out to tender, the CCG either is acting within the law or is not. Did it have the option within the law not to put this particular service out to tender? We need a very clear understanding of that.

[Steve Brine]

Let me repeat that the local, clinically led CCG absolutely decided that it was in the interests of patients and taxpayers to look at a range of potential providers for the service that they wanted to be provided. That is the process that it is going through. The hon. Member for Stockton South rightly said that he would not expect me to wade into the middle of the procurement process. I cannot do that, but I will say that sensible, dynamic commissioning will be central to the NHS meeting the challenges that it faces today and in the future despite the commitment to increase the funding by £20.5 billion a year. That is vital to ensure that the NHS delivers on our triple aim of improving quality of care, cost control and population health which, as I am the Public Health Minister and absolutely focused on prevention, is one of my and the new Secretary of State’s key priorities. It is central. To achieve that triple aim, NHS commissioning will need to continue to develop as it has done since its inception. NHS England has designed a new commissioning capability programme to support commissioning systems. The programme provides tailored support delivered through place-based solutions to equip NHS commissioners with the skills they need to deliver on the challenges of today and the future.

Let me stress one of the fundamental principles of the 2012 reforms of the NHS—I served for many weeks on the Standing Committee that considered the Bill. That principle is delegating power away from Whitehall and Ministers such as me, who come and go with political cycles, to local clinical commissioning groups. They are led by fantastic GPs and other local health experts, who are best placed to make the important decisions that matter to local people. Darlington CCG and the Hartlepool and Stockton-on-Tees CCG are rightly making the decisions about how best to ensure that people in their areas have access to a GP when it suits them. Bids for local extended access GP services are currently being closely assessed with a view to the contract starting in April 2019. I have faith that those local commissioners will award this contract in a way that, as I have set out, improves access and quality for patients. Let me say that very clearly: I have faith that those local commissioners will award the contract in a way that I think the hon. Member for Stockton South will find satisfactory.

[Dr Williams]

rose—

[Steve Brine]

We still have two minutes, so I will let the hon. Gentleman come in again.

[Dr Williams]

If the Minister had been asked for his advice as the Minister with responsibility for primary care by the CCG about whether it should put this out to tender, what would his response have been?

--- Later in debate ---

[Steve Brine]

My response would have been that the CCG needs to act in accordance with the law, with the Act, and I believe it is doing that.

Let me close by saying that I know the hon. Gentleman, and possibly his neighbour, the hon. Member for Stockton North (Alex Cunningham), are meeting regional representatives of NHS England later this week—probably on Friday, when they get back to their constituencies. Ultimately, these decisions are for the local NHS, not for Ministers. We merely set the legislative framework. They are absolutely the best people to discuss the concerns of the hon. Member for Stockton South. As I said, I have faith that the local commissioners will award this contract in such a way that he will be happy that it improves access and quality for local patients, as I have set out.

Question put and agreed to.