Minister says GPs at heart of change

APMS will boost services in poor and unhealthy communities, health minister Andy Burnham told Nick Bostock.

Health minister Andy Burnham led the way into the office he inherited from his predecessor Lord Norman Warner.

He flopped into one of a semi-circle of armchairs, and leant forward over a tray of the DoH's best china on the glass coffee table in front of him. 'Help yourself to tea. How was your weekend?'

The offices were the same, but the style was different - with Lord Warner, armchairs were left vacant in favour of the formalities of the conference table.

The two are at opposite ends of their political careers - Lord Warner claimed his pension last year, shortly after stripping GPs of a sizeable chunk of theirs.

The 37-year-old Labour MP for Leigh in Lancashire, however, is 15 years younger than the average MP. Nonetheless, he has enough political mileage under his belt to feel 'on home territory' as DoH minister of state for health delivery.

Mr Burnham established a connection with health more than a decade ago, as a researcher for Labour's shadow health team in the mid 1990s, and during a spell at the NHS Confederation.

Rapid rise
After being elected in 2001, his first step was to join the Health Select Committee. 'It's always been my primary political interest, so I feel very comfortable on the territory,' he said.

The connection with general practice goes further back - his mother worked as a receptionist at a practice in the village where he grew up, in the constituency he now serves as MP.

Memories of that time, he said, give him something of an insight into the strain practices face as they 'manage the pressure on the front door of the NHS'.

His rapid rise has prompted speculation that he could replace current health secretary Patricia Hewitt if the axe falls when Gordon Brown becomes prime minister this month.

Mr Burnham refused to rule it out but said he was focused on his current role: 'Who knows? It was a long-held ambition to be a minister in this department and it's a huge thrill to have achieved that.

'But politics is a really uncertain game. Those who come a cropper are constantly writing their next CV without doing the job in hand - I'm just doing the job in hand.'

One thing he was certainly not prepared to do was speculate on whether GPs could expect a pay rise in 2008/9.

'I really would talk myself out of a job if I was to talk about next year's pay round. That goes well beyond my pay grade I'm afraid,' Mr Burnham said.

Although the DoH was widely held responsible for anti-GP spin portraying the profession as lazy and overpaid, he firmly backed rises under the GMS contract.

Asked if GPs were overpaid, he said: 'No, I don't think that. I look back at when I was a health researcher in the 1990s and at that time all of my discussions with the BMA were around what they would have called the recruitment crisis in general practice.

'If I look at the state of general practice and primary care today I am confident in my own mind it is light years away from what it was in the mid 1990s.'

The most exciting changes in the NHS in the next decade will happen in general practice and primary care, he predicted.

Chief among these will be the increasing shift of work into community settings.

'I'm thinking about GPSIs working in a much more vertical integration of services, so you see more pathway-type services developed. I think that's got huge potential for general practice,' he explained, apologising for his use of jargon.

Effect of lift
LIFT had only just started to have an impact, but could kickstart the changes, he said.

'We'll publish more thinking about how that might happen in the summer.'

The document is likely to set out a framework for collaboration with local authorities.

'It's about adapting the LIFT model to allow much greater involvement of local government,' he said.

This could lead to joint funding of new building schemes, but PCTs would be free to choose how they work with local authority partners, Mr Burnham said.

They would also be free, Mr Burnham insisted, to define locally how far they turned to the private sector to run health services. 'Sometimes people are sceptical about that.'

The DoH felt it was 'time to really push on' with APMS, but Mr Burnham said: 'For any of these services it is entirely legitimate for GPs or teams of GPs to bid as well. There is not a private sector agenda here, but there is a new public services agenda.'

He was passionate about making inroads into historic patterns of health inequality, and believed APMS had a key role to play.

'It seems to me the old model of how GPs were distributed around the country has not served the poorest and the unhealthiest communities particularly well at all.

'One of the things that really gets me out of bed in the morning is the idea that there are some communities where access to a GP is more difficult and they are also the areas where people's health needs are greatest.'

Alongside APMS, existing GPs should be encouraged to expand the services they offer, he said: 'There is nothing stopping GPs from extending what they do now. I would encourage them to talk to their PCT if there is a clear case to develop and expand their practice further.

'Where GP practices really want to get on, PCTs should be very encouraging and work with them to make it happen.'

Like more than one of his predecessors, Mr Burnham said the 'era of top-down targets was genuinely coming to an end'.

He said more targets and priorities should be set locally.

Many GPs will be relieved to hear he was sceptical about NHS Employers' plans for elements of the GP contract to be set locally.

'At this stage it would potentially further complicate things. There are things that can be properly set within any borough, but it becomes difficult if one organisation is offering different terms and conditions from another - it may come, but I don't believe the time for that is now.'

If Gordon Brown pushes him up the ladder, that tough decision could be waiting in his in-tray when he next moves office.

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