Meet the health secretary in waiting

Andrew Lansley has clear ideas about where general practice should be heading, writes Neil Durham.

Andrew Lansley
Andrew Lansley

Who is favourite to be health secretary after a 2010 election?

Welcome to Andrew Lansley, 51-year-old father-of-five, MP for South Cambridgeshire and shadow health secretary.

Speaking exclusively to GP from Portcullis House in Westminster, avid GP reader Mr Lansley backs our Valuing General Practice campaign.

'The government appears not to recognise the importance of the long-term relationship between GP and patient, and that GPs themselves should be key in managing the healthcare of their patients,' he says.

GPs' role could be undermined if they are salaried PCT employees, if patients register with PCTs or PCTs commission services, he says.

Mr Lansley says that SHA reports detailing how authorities will implement the Darzi Review emphasise PCT commissioning at the expense of practice-based commissioning, which he says has 'stalled'.

So far, so BMA, but Mr Lansley freely admits that the two differ on the role of the private sector in the NHS. Mr Lansley's only concern about commercial involvement in the NHS is if PCTs are allowed to make tendering decisions solely on a cost basis.

He adds: 'In the sort of world I'm talking about the PCT would not be able to allocate in that way.'

In Mr Lansley's world, patients would choose whom they wanted to register with and price would not be an issue.

Patient loyalty built up over long periods of time may give practices an advantage over commercial providers, he says.

He compares the situation to the relationship between small shops and superstores. 'Imagine if people locally could get meat at whatever shop they wanted and didn't have to pay for it. Wouldn't they go to the butcher who offered the best quality service?'

Mr Lansley admits that a small minority of 'Martini' (anytime, any place, anywhere) patients would benefit from private providers. Firms may also have a role in management or commissioning, he says.

How would a Conservative government differ to a Labour one on general practice?

Mr Lansley promises a 'GP-led health service', real budgets, practice-based decisions and power to re-invest savings.

Last year the Conservatives revealed plans for GPs to take back 24-hour responsibility but with a budget to commission the service from elsewhere.

He says patients and GPs are unhappy with out of hours, and the return of 24-hour responsibility would enable GPs to tackle this and coordinate care.

At the moment he says PCTs think of care in isolation: out of hours, accident and emergency, ambulances and extended hours are all separate.

'In the real world they are not separate, and nobody at the moment can bring them together,' he says. Doing so would increase the entrepreneurial opportunities for GPs.

'If you give commissioning responsibilities like this you don't get one size fits all, you get different solutions,' he adds.

Despite opposing polyclinics, if the Conservatives inherit them after an election, existing contracts will be honoured.

Mr Lansley says: 'The frustration of opposition is that the longer one has to wait for an election the more things that can be got wrong.'

Clinically, Mr Lansley welcomes the Darzi suggestion of greater NICE involvement with the quality framework and a re-think on top-up payments.

'We need to be clearer about the boundaries. Beyond that if people make private provision they shouldn't lose access to NHS care.'

Mr Lansley has a reputation for a keen grasp of his brief, and it's obvious from our 40-minute conversation that he has clear ideas about where general practice should be heading.

The next health secretary? You wouldn't bet against him.

Conservative plans

Shadow health secretary Andrew Lansley says Conservative Party plans would change the landscape for GPs. Key pledges include:

  • A GP-led health service;
  • Return of 24-hour responsibility;
  • Real budgets for GP commissioners.

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