John Hutton – 2004 Speech to NHS Alliance Conference


Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 20 October 2004.

I’d like to start by thanking the NHS Alliance for giving me this opportunity to say a few words at your annual conference this morning. The NHS Alliance continues to play a very important role in the national debate over the future of the NHS. We share common ground over the values the NHS should continue to espouse. And we agree that the NHS can never afford to stand still – to rest on its laurels. We all know there is more we need to do if the NHS is to become the service we all want it to be. So the dialogue between us should continue because the process of change has not come to an end. For our part, we want the debate on the long-term direction of travel for the NHS to be informed by the views and opinions of those working on the frontline. That is why we value your contribution and your opinions.

And the future of primary care remains central to the future of the NHS.

Nearly all of our patients begin and end their treatment in a GPs surgery. The relationships we all forge with our GPs and other healthcare professionals working in the community form a re-assuring presence in the lives of each and everyone of us. Primary care has a proud record in public health and health promotion. And despite what people say, NHS primary care is still the envy of every other developed health care system and a model respected right across the world.

All of this adds up to an outstanding record of achievement for primary care in the NHS over the last fifty years. But we all know that primary care can do more provided the resources are in the right place and that we encourage primary care professionals to have more say over the shape and design of local services. Because primary care must never be seen simply as a set of organisational structures. Like the NHS itself, it is instead a set of values that reflect a particular concept of care. It can be delivered by different types of providers – some in the public sector, some in the private sector. What matters is the quality of care being provided rather than who is providing it. It is the sense of care being designed around the needs of the individual in settings that are convenient and accessible that really matters most to patients. These can and should be the hallmarks of modern Primary Care services

So we are on a journey. Services are going to change. The boundary between primary and secondary care is going to shift. And not before time.

These changes will represent a significant challenge to the NHS as a whole and to Primary Care Trusts in particular. Every member of staff needs to be fully engaged in this process of change because they will all be affected by them. So the nature and purpose of these changes will need to be spelt out clearly in every part of the service. Patients and the public will need to be involved too. And our resources will need to be put to the best possible use. So I am not going to minimise the scale or the importance of the work that lies ahead of us. But I believe we have every reason to be positive and optimistic about the future of primary care in our country because we have a solid platform on which to build.

There are more GPs and nurses working in primary care than at any time in the history of the NHS. More doctors than ever before want to work in general practice. As a result, people can see their GPs more quickly and there are more services available to patients. Many GP surgeries have been improved and modernised – creating a better environment in which both to work and to treat patients. And there is a steady increase in resources going in to primary care. Helping to build up capacity and capability even further.

So we’ve come a long way. But clearly not everything is perfect. Not every part of primary care in our country has seen all of the benefits of these improvements. The pressures are still there and they are experienced every day by hundreds of dedicated staff and thousands of frustrated patients. Not everyone working in primary care feels that their views are heard and listened to.

So it is not my argument today that every problem in primary care has been solved. We all know that isn’t true. Nor am I saying that primary care cannot improve further still, because we all know that it can. My argument today is that primary care has an extraordinary opportunity to build for the future. To play a leading role in shaping our definition of healthcare. To make Britain a healthier place to live for all of our people and for those in the poorest health most of all.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake because we don’t want to do that. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings. GPs will have more direct access to diagnostics. Health professionals like physiotherapists will be taking more direct referrals from GPs and more self referrals from patients. We will be able to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based care. Bringing our services closer to where people live and work.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

New contractual frameworks will, for the first time, allow both for improvements in the quality of services to be properly rewarded as well as encourage new providers to enter primary care and help deliver a wider range of NHS services. Expanding choice as well as accessibility for patients.

Developments in out of hours arrangements following the introduction of the new primary care contracts give PCTs the opportunity to design improved unscheduled care services that are more integrated with other parts of the NHS. Helping to manage demand more efficiently and raise both the quality of the care as well as the choices available to patients.

The introduction of new information technology applications in primary care through the National Programme I hope too will herald further improvements to the quality, safety and convenience of the service we provide to the public. And here too, PCTs have a critical role to play in introducing the new electronic booking systems and building up the national care records service. Because without the successful introduction of the National Programme, the NHS will never become the service we all want it to be.

All of these changes are designed to improve the service available to patients in primary care and are going to be backed up higher investment in primary care – up by a third over the next few years with more to come. And who better to lead this process of change than our family doctors and our primary care staff who have always been at the forefront of innovation in the NHS.

That is why I believe the engagement and involvement of front line professionals themselves is going to be essential to the success of these reforms.

Thousands of doctors and nurses are currently engaged in designing new ways of working and are helping therefore to reshape the boundaries between primary and secondary care. We see the fruits of this hard work all over the country where many practices have been working with local PCTs and acute sector providers to make sure our services are as efficient and effective as they possibly can be.

I want this to be the norm everywhere in England. I want GPs and their practice staff to be properly enabled and encouraged to fashion services around the needs of patients. Where we do look critically at all of the care pathways patients follow to ensure we offer the best possible configuration of expertise and resource.

To make this happen, I don’t think we need another re-organisation, and I want to make this clear. Because this is not about organisational change. But it will require a new balance of responsibilities in primary care, with new powers for general practices to work creatively with their local NHS partners in sharing in the key decisions that affect the delivery of frontline services.

Now as I’m sure all of you know, earlier this month we published guidance to the NHS on practice based commissioning. From next April, every practice will have the right to hold a practice level commissioning budget. From elective care to prescribing, from chronic care to diagnostic screening, practices will be better able I think to help determine the future shape of the NHS.

This will be a bottom-up process. Led by GPs and their practice staff and working alongside PCTs and NHS Trusts to deliver the best possible services that we can provide. We want to see local innovation resulting in flexible high quality services for patients. And, if innovation leads to money being freed up, which I believe it will, then it will be ploughed back into patient care to further improve the services that patients receive.

There will be no new national targets. People can decide their own pace of change. They can chose to share their commissioning budgets with other practices. But it will be a level financial playing field for everyone. And the national tariff will guarantee that practice level commissioning does not become a bargain basement competition between those who can provide the lowest price for treating patients, because it is quality that must always come first.

I said a few moments ago that I believed the future of primary care was a very positive one. A rising share of the NHS budget coupled with a greater influence over the future shape of the NHS will allow primary care to play a leading role in improving the quality of the care we provide to our patients.

The journey is not over yet. We still have a great deal to do. But there are real and tangible signs of progress right across the country. Shorter waiting times. Reduced mortality from cancer and coronary heart disease. Newer hospitals and better GP premises. Faster access to the latest drugs, treatments and equipment that can help us improve our ability to diagnose and cure our patients. A great deal of this is down to the work you are doing. So I want to conclude my remarks by expressing my own appreciation for your commitment to the NHS and for the values it stands for. Those values have never been more relevant to our society than they are today. Our challenge is simple. It is to make these values meet the aspirations of the British people for the best possible healthcare that money can buy. Work with us to meet those aspirations. Help us to make the NHS the service we all want it to be.

Thank you.