Health and Social Care Bill

The amendments in this group all deal with the question of monitoring performance in primary care. The first amendment deals with the question of the Secretary of State providing, as part of the mandate, clear guidance on performance standards for primary care. The second amendment deals with the NHS Commissioning Board paying due attention to these standards and ensuring that data are collected with regard to performance in primary care. The final amendment deals with the role of clinical commissioning groups, with particular reference to assisting the NHS Commissioning Board in discharging those particular responsibilities. At the very heart of the Bill is an important and much welcomed understanding that, to deal with the demographic challenges and the change in the nature of clinical practice that our society will face in the coming years, there needs to be a move away from managing patients with chronic diseases in the hospital environment and ensuring that they are managed in the community and primary care environment. This, of course, is welcome and is an important recognition of the changing nature of disease that we will face in terms of delivering good clinical care in achieving the best clinical outcomes. There is no formal mechanism in the Bill as it currently stands to ensure that data on the performance of primary care practitioners are collected on a regular basis; that there is an absolute obligation, as part of the Secretary of State's mandate, to adopt a clear primary care outcome framework; that that framework sets clear standards which need to be achieved in primary care; and that data on the achievement of those objectives are collected regularly and transparently to enable patients to understand whether their general practitioners are performing to the highest standard. This is very important because, in hospital practice, there has been an emphasis on the collection of outcome data for some years, such that audit is an absolute obligation, particularly on those who work in craft specialities and undertake procedures that may be attended by poor outcomes. We also know that in acute services—such as those for patients with acute myocardial infarction and stroke managed in the hospital environment—there is an obligation to collect data on those outcomes, which are increasingly available to other clinical colleagues, to patients and the public. This helps in a broader and fuller understanding of the performance of acute care trusts. However, when it comes to performance in general practice, these data are not routinely available. As more practice moves to the primary care environment, it will be increasingly important to ensure that when patients are managed for a much broader range of diseases and conditions in that environment, the outcomes achieved by those individual practices are both properly understood and monitored or reported in such a way that if services are commissioned in a primary rather than secondary care environment, those commissioning decisions are taken on the basis of objective outcome data. It is therefore essential that the mandate deals with the question of performance in primary care. I know that, more broadly, the mandate will deal with the question and the obligation always to strive to improve the quality of care and, implicit in that, to achieve the very best clinical outcomes whatever the care environment. However, as there is now such an emphasis on transferring care out of the hospital and into the primary care environment, we need to be sensitive to what that environment will mean both for a number of practitioners and for their patients. Unlike the hospital environment, where large numbers of clinicians tend to work together and there is an opportunity for a patient to be reviewed by a number of clinical teams at different stages in the natural history of managing their condition, patients in primary care will often be managed in single-handed or small general practices where they will not have the opportunity to be reviewed by a number of different doctors, including those in training, and where shortcomings in care will often not be understood or recognised by the patients for whom the care is being provided. It is therefore vital that we set high standards in what is expected in primary care and that we ensure that the metrics applied can be measured objectively and that the data are not only collected as a matter of obligation but reported in such a way that other clinicians and patients can understand them. If the Bill's purpose is to be fully achieved—to ensure more movement from the secondary and tertiary care sectors into the primary care environment, particularly for the management of chronic diseases—it is essential that these types of data are made available; that the primary care outcomes framework sets specific standards; that there is an obligation to monitoring the achievement of those standards; and to have transparent reporting. It is important for the Government to try to ensure that those objectives are met. One of the safest and surest ways of doing so is to include in the Bill an obligation regarding these functions and obligations. I beg to move.