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Exclusive interview: Andrew Lansley on the Tories' plans for general practice

Shadow health secretary Andrew Lansley talks to pulsetoday about polyclinics, pay shake-ups and the private sector

By Gareth Iacobucci

Shadow health secretary Andrew Lansley talks to pulsetoday about polyclinics, pay shake-ups and the private sector

Shadow Health Secretary Andrew Lansley is fresh from the bear pit of the House of Commons.

In the past few days his party has been busy savaging the Government's central primary care polices and he meets Pulse immediately after a fierce debate over the future direction of general practice.

His motion, condemning the Government's imposition of polyclinics across the country, may have just been defeated but Mr Lansley is undaunted.

He and his leader David Cameron hope to have inflicted major damage on the Government after uncovering Department of Health documents which they say prove ministers plans a huge re-configuration of general practice, which will lead to hundreds of surgery closures.

But it is one thing to be an effective attack dog, and another to be a Health Secretary in waiting. Do the Tories have concrete policies of their own.

Mr Lansley, who has been shadow health secretary since 20O4, the year of the new contract, claims that should his party come to power, it would be willing to roll back a number of key Government policies. And it would start with the imposition of polyclincs.

‘That model breaks down the traditional model of general practice, which is about locally accessible GPs who know their patients, and risks undermining continuity of care,' he says.

‘The whole structure of polyclinics would mean that general practice, like so much else in healthcare, becomes episodic.'

Mr Lansley says the plans have the potential to ‘undermine the independent contractor status of GPs', with general practice increasingly becoming a salaried profession.

‘When you look at what they're trying to do, it looks like one contract per polyclinic - that's from the material that shows how the Government sees it working. If that's the way, it will mean a complete restructuring of general practice, so that there's a much smaller number of large contracts.

‘Sometimes, in an area, they'll be a single provider. So we know what that means, a single provider with GPs effectively as the salaried employee. That, I think is giving us real cause for concern.'

But could the Conservatives really axe the entire polyclinic rollout, and close down centres that may already be established by the time they might be elected? With Lord Darzi having instructed all PCTs to put new polyclinics out to tender by the end of the year, is it not a case of stable doors and horses?

‘Clearly, we start with the situation we inherit,' admits the Tory health chief, a man with a reputation for knowing the detail, if not necessarily as colourful as his current opposite number Alan Johnson.

‘There will be circumstances where contracts have been agreed to, which we will have to honour, but if PCTs are in effect ‘pushing' patients to be registered at polyclinics, as opposed to being free to choose, then we'll stop that.'

The fight against polyclinics is just one element of the Tory plans for primary care. Mr Lansley was also credited by David Cameron with drawing up proposals to hand back control over opening hours to GPs. Practices ‘should be free to determine the opening hours, size and locations of our practices' says the Tory think tank proposal on the subject, which Mr Johnson has described as an ‘astonishing admission' that could just as well have been drawn up at BMA House.

So good news then - or a hollow pledge? Would the Conservatives really be prepared to scrap the Government's current target of having half of all GP practices offering extended hours within the next three years?

‘Yes we would,' says Mr Lansley.

‘Senior professionals providing a service who are accountable to patients should not have their hours controlled by Government. They should be accountable to patients for the quality of service they provide.

‘The corollary of not controlling hours is the Government will not pay for a given level of opening. If we don't specify the access we're not paying for it. What we're paying for is the outcomes, the number of patients and the complexity and case-mix you're dealing with, and the quality and outcomes that you deliver.'

With extended opening being voluntary, Mr Lansley says the Tories will look to reinvest money currently set aside for extended opening elsewhere.

‘There is a sense that the money will go into the development of the QOF. The rewards should go on patient-reported outcomes, and delivery of a quality service.'

A big Tory theme is also handing more responsibility for commissioning decisions to GPs, such as management of out-of-hours services.

The Conservatives have joined the NHS Alliance in calling for GPs, through commissioning, to take back control of 24-hour care, which they say will solve the existing chaos. Yet this has led to much anxiety in GPs, who fear a return to the pre-contract days of 4am callouts.

‘I think people get a bit carried away,' says Mr Lansley. ‘We're not saying, go back to pre-2004.

‘GPs will not be personally responsible for the delivery of services. But they would be responsible for ensuring there is a contact with a provider, for delivering out-of-hours care. Many GPs are unhappy with the services being provided in different parts of the country. The best way of dealing with that is for the GPs to take responsibility for commissioning.'

This shadow health secretary does, however, seem to be in the mood for turning when it comes to another apparent Cameron pledge, to slam the brakes on private sector involvement in primary care.

Many could be forgiven for rubbing their eyes in disbelief at a Conservative leader accusing a Labour Government of being ‘blinded by the private sector', but Mr Lansley is quick to dismiss any notion that the party are against private sector involvement in the NHS, and backs the ‘any willing provider' route recently adopted by the Government.

‘It's not being against the use of the private sector as such. Not only do we believe in the role of the independent sector, we understand the importance of competition.

‘It's the way that Labour has handled it. He [Cameron] used the example of independent sector treatment centres. Frankly, the Department of Health, in the contract it had with ISTCs, ended up paying too much. But I am happy with an "any willing provider" policy.'

It appears that leopard may not have changed its spots completely, but the Tories are nevertheless trying to mark out clear territory on which to fight the next election. So where so they stand on another area of fierce dispute between GPs and the Government – that of pay. The million dollar question to any potential secretary of state for health is, are GPs paid too much?

‘Where we think the Government has failed is not that it's paying GPs too much. It should, but the responsibility should go with it, and it hasn't. Practice-based commissioning has completely stalled. GPs who have lost control of their working environment and are not in charge of what they do become very de-motivated.'

Mr Lansley is unwilling to commit to the inflationary pay rises that have eluded GPs for the past three years, and says the process will remain subject to independent pay reviews.

But he does reveal, intriguingly, that in terms of contract changes, the Tories are ‘looking for a structure of remuneration that clearly differs from the current one'.

GPC leaders will wait to see if the Tory proposals amount to more than ‘political banter', as deputy chair Dr Richard Vautrey suggested last week.

With the profession increasingly thrown into conflict with ministers in the run-up to the Darzi review, what the potential Government-in-waiting has to say about general practice may increasingly become the subject of debate in GP surgeries, as well as on the floor of the House.

Andrew Lansley: "GPs will not personally have to deliver 24 hour care, just ensure there is a provider." Andrew Lansley

GPs will not be personally responsible for the delivery of services. But they would be responsible for ensuring there is a contact with a provider, for delivering out-of-hours care.

It looks like one contract per polyclinic. If that's the way, it will mean a complete restructuring of general practice...

The Tory GP manifesto

Polyclinics: claim imposition will lead to closures of hundreds of surgeries and that GPs have been frozen out of consultation. Pledge to step in if PCT plans put local surgeries at risk

Private Sector: Accuse Labour of being ‘blinded by the private sector' but admit they would continue with the policy of bringing in new providers

Opening hours: Pledge to allow GPs to decide on own opening hours and scrap the target that of 50% of GP practices offering extended hours appointments in the evening or on a Saturday mornings. Money to be diverted to patient care areas of the QOF

Pay: No guarantee of inflationary pay rises, but plans for a ‘clearly different' system of remuneration

Out-of-hours: Would make GPs take back responsibility for commissioning 24 hour care, but claims it will not be a return to pre-2004 situation

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