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At the heart of general practice since 1960

GPs say pay up on pensions

In the run up to polling day, Pulse interviews the three main parties' representatives on health and reports from their leaders' back yards. This week Ian Cameron questions health minister John Hutton and Emma Wilkinson visits GPs in Sedgefield.

Next week: the Conservatives

John Hutton gives the impression he has had just about enough of GPs. Asked whether he is bothered that a massive number of previously Labour-voting GPs plan to desert the party at the election, he sighs heavily and looks to the heavens.

'It's a democracy. People can vote the way they choose. What do you want me to say? It's a free country.'

He maintains this defiant tone throughout. Reports that Labour wants to scrap GP registered lists are rejected as 'bollocks'.

GPs' concerns about greater private sector involvement in primary care are similarly dismissed.

GPs, Hutton says, are independent contractors who run a business. Their status is no different from the companies Labour wants to bring in.

A source of Mr Hutton's evident irritation and impatience could be a desire for pastures new.

Brought in to health in 1999 alongside Alan Milburn, Hutton took over as the minister of state dealing with GPs in 2001. Three and half years on he is still there, the details man with an undoubted mastery of his brief, but in the shadow of the arch politician John Reid.

But political aspirations aside, it is also clear Hutton nurses a profound sense of frustration that GPs still seem to have so much to grumble about, even though the vast majority of them endorsed their new contract.

'GPs were given the opportunity to say yes or no to it and 80 per cent said it was a contract they wanted,' he says. 'I've not been to a practice in England since the new contract came into effect where GPs have not said it's changing the way we deliver

services, and for the better.'

GPs should not forget that the Tories imposed a contract on them in the early 1990s, he adds.

Hutton is clearly proud of the contract. It has dominated his time at the department and GP negotiators speak highly of his role in developing it.

He says it has given GPs a 'unique opportunity' to build a

successful future in the NHS. The quality framework, he adds, is now the subject of global interest.

Asked about his department's comments that GPs have 'over-

delivered' on the quality framework, Hutton says he does not believe this.

He adds that he has no worries over the £100 million-plus gap

between the money the department gave to PCTs to fund quality and GPs' final achievement.

'Quality costs doesn't it? I have no qualms or concerns about the QOF and the fact it is delivering

improvements, and if it's delivering them more quickly I only have three cheers for that.'

Future investment in the framework will be along similar lines to the 36 per cent increase that was

attached to the first three years of the contract, Hutton says.

But he is defensive when asked about the review of the framework and what extra work he wants GPs to do to earn their quality pay in future. 'If I answer that question you will misinterpret my answers,' he snaps.

'I want the QOF to continue to be evidence based and to reflect the best practice standards that are properly based on that evidence. As long as QOF does that I don't think anyone can complain.'

On the issue of introducing more private sector involvement in primary care, however, Hutton is back on the front foot. In commending the policy, he also gives a revealing assessment of how the Government views GPs' place in the NHS. GPs, he says, are independent contractors, not its employees. They can choose to provide new services but they do not hold a privileged position.

'Anyone in primary care is able to participate in this capacity-building expansion, but we are not making any distinction between established providers and new entrants because that would be stupid.'

So that's clear. What is less clear is what this policy, allied with the Government's centrepiece agenda of increasing choice, means for GPs' position at the heart of the NHS.

A recent Labour mini health manifesto made clear that the party wants to allow patients to register with more than one practice and force GPs to 'attract patients'.

Hutton vehemently denies this is the end of registered lists. 'That is simply bollocks,' he says. 'It's a million miles away from that.' Registration, he adds, is the 'cornerstone of primary care'.

'Look, we've got to find ways of taking our services out to patients who find it difficult to use them.

'If rules for registration make it difficult for commuters, for example, to see a GP at work or during lunch-breaks we have to change those rules.

'Rules have to serve a purpose and that purpose is to make sure people have access to a GP when they need to see one. I'm not going to allow bureaucracy to get in the way of that.'

One conclusion GPs can certainly draw is that the regulations around full and closed lists will be coming under close scrutiny.

On the concerns of GPs which form the basis of Pulse's manifesto for general practice, Hutton makes only one concession.

He admits there needs to be better engagement with GPs about IT changes. But he is exasperated at the level of criticism from GPs about the NHS care records.

'No one is going to compromise on confidentiality. It's fundamental and systems have been designed to enshrine that principle.' Hutton adds that the lumping together of Choose and Book and practice-based commissioning is 'entirely appropriate'.

On premises, he sidesteps criticism that Government is not investing enough and that NHS LIFT is the only option being offered to GPs.

'There's a massive amount of money going into GP premises,' he says. 'LIFT has been a success and we intend to continue with it.'

And GPs' demand to allow exception reporting of childhood vaccine dissenters is flatly rejected. 'We are not going to change the arrangements.'

Then, after 23 minutes of a supposed half-hour interview, agreed at the last minute and on the proviso that no GP attended, a press officer eager to wrap things up says Hutton will only answer one more question. Hutton cuts his previously detailed answers to one word. 'No', he says, the Government does not have an agenda against singlehanders.

John Hutton refused to have a GP present at the interview, so we asked our medical editor Dr Alistair Moulds, a GP in Laindon, Essex, for his verdict.

It must be frustrating and quite depressing being a politician in charge of the NHS in general and GPs in particular.

Expenditure on health has markedly increased and there is no question that the new contract is having beneficial effects for GPs and for patients.

Yet where is the feel-good factor? The gratitude? The votes? Largely lost I'm afraid ­ for a variety of reasons.

Benefits only seem to come after a fight ­ without MPIG the new contract would have left GPs worse off and would have been voted down.

Ministers exhort GPs to be evidence based, yet their own actions are often anything but. Significant and costly changes are introduced largely because they look good electorally.

Soundbites, gimmicks and spin are not good ways to deal with people who are worldly wise and privy to all the gaming hospitals get up to to meet their myriad targets.

Despite Mr Hutton's own bonafides, he belongs to a party whose leader in particular is now viewed by many as untrustworthy.

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