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Speech to National Association of Primary Care Conference

I am Mark Simmonds MP, Shadow Minister for Health with responsibility for GPs and Primary Care Commissioning and I am delighted to be addressing this conference today as I believe the time is right to debate the future of the NHS.

David Cameron has described the establishment of the NHS as one of the greatest achievements of the 20th Century and has pledged that improving the health service is our number one priority. We have demonstrated this commitment by pledging to match the Government's public services spending over the next three years.

David Cameron, myself and the Conservative Party fully support the objectives and ethos of the NHS and are completely committed to the principle that NHS services should be free at the point of delivery. We recognise that what makes the NHS the envy of the world are the highly skilled and dedicated professionals who work within the organisation and I pay tribute to their commitment and professionalism, in often difficult circumstances.

Under David Cameron we have committed to sharing the proceeds of economic growth between funding of our public services and ensuring a competitive tax framework in which our economy can thrive. We recognise that one of the most important calls on the proceeds of growth will be the NHS and we will provide our health service with the resources it requires, exposing criticism from our political opponents that we will cut services as patently untrue.

But our vision for the health service goes further than just resource commitments - we want to see the British NHS exceeding European averages in outcomes such as survival and recovery rates. We also want a patient centred system in which NHS professionals are able to exercise their professional judgement free from central controls and targets.

As I have seen in my own constituency, and across the country - all is not well in the NHS, whatever the Labour Party may say.

Within the important context of re-engaging health professionals Conservatives have put three issues at the heart of our health policy.

Firstly, a patient centred NHS, based on information which is consistent, understandable and easily communicated. Secondly, an NHS based on outcomes and not centrally-driven process targets. We want a service that looks outwards, not upwards, and focuses on what really matters - actually making people better. Finally, we would do more to tackle the public health crisis, evidenced today by the worrying obesity statistics. We believe more could be done to make people understand the link between lifestyle choices and their individual health.

Primary care and GPs are the main point of contact for most patients - 15% of the population will see a GP in any two week period, and that it why it is vital that GPs are involved at the very heart of the health system.

We have set out clearly that the NHS must put patients at the heart of its service. If we are to deliver continuously improving care for patients, we must empower doctors, nurses and other healthcare professionals. We must re-professionalize the professionals. By doing so, they will have the opportunity and the incentive to raise standards and enhance effectiveness. There is no shortage of enterprise, innovation and excellence in clinical care in this country. There is, however, a chronic shortage of clinical freedom and an excess of bureaucracy, targets and interference.

Professional autonomy is not incompatible with a patient-centred NHS. As compared with a current NHS which is a command-and-control system, professional autonomy and an NHS free from day-to-day top-down interference, will be far more directed towards the interests of patients.

Nonetheless, we have to entrench accountability for resources and outcomes, but accountability to the needs and choices of patients.

Central to this will be the transfer of greater responsibility to GPs. Family doctors are the most trusted public service professionals. They are close to patients and committed long-term to the communities they serve.

It is essential that within the NHS, we have a means by which clinical decision-making can be reconciled with budget consequences and resources.

Subject to the advice of commissioning guidelines from the NHS Board and NICE, I believe GPs and other primary care commissioners are the right place for this reconciliation to take place. Close to patients, clinically-led and evidence-based.

We cannot, however, simply hand over £100 billion to GPs to do whatever they wish. GPs as commissioners should be required to respond to the choices of patients, including choice of GP practice or healthcare provider; they should be responsible for determining priorities and patient pathways; and they should accept responsibility for commissioning local services.

Some practices will be large enough, but many will enter commissioning consortia or the model of federated GP practices.

In our recent policy documents, we have made it clear that, unlike the Labour Government, we are not interested in GP-bashing, or trying to claw back the remuneration under the GP contract. We want to engage with GPs and link responsibility to reward.

We will need more GPs. We will need leadership among GPs. We will need more GPs in deprived areas.

For patients, we will ensure that there is quality information on practices, a simpler means to choose GP practice; access to any practice, and the knowledge that their practice can commission the services that they need.

For GPs we will simplify the Quality and Outcomes Framework, focusing on outcomes more and processes less; use patient-reported outcome measures; provide clarity over the avoidance of conflicts of interest; commission services which integrate more effectively with their provision.

Inevitably, this will involve the renegotiation of the GP contract. Changes to the Quality and Outcomes Framework, removal of the concept of "controlled" hours, access to any 'open' list, and responsibility for commissioning services will all mean changes to the contract. The contract is being renegotiated now; the NHS employers have the mandate and are in discussion with the BMA.

Transferring responsibility for commissioning out-of-hours services from PCTs to GPs is a necessary part of GP commissioning. To do so is not a return to the past. GPs will not have the old individual legal responsibility for 24/7 cover. They will be free to commission from a GP, independent service provider or Ambulance Trust. But no longer will the out-of-hours service be divorced from the GP service. I can assure you that GPs will not be dragooned into 'polyclinics' against their will.

A primary care-led service needs GPs to escape from the mentality of 'fee for service' and 'controlled hours' and embrace the demands of commissioning and demonstrating outcomes.

A patient-centred service means that when patients want to know what their NHS will do for them, they will know that their GP or primary care commissioner will be accountable to them for the service, its quality and their outcome.

We recognise healthcare is changing rapidly, with new drugs and treatments becoming available. We recognise that the NHS can often be a challenging place to work, and we pay tribute to the dedicated and professional staff who provide a first class service across the country.

We believe that putting patients at the centre is the best way to improve care, drive up standards and allow the dedicated staff to focus on what they do best - making people better.

Conservatives are determined to maintain and strengthen the NHS, and have pledged to put the patients and professionals at the heart of the NHS, as we believe that they are best placed to make decisions about the treatment and care required.

The NHS is one of the country's greatest assets, and under a future Conservative Government the NHS will have a greater patient focus, it will be properly resourced, more productive and it will be free at the point of delivery.

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