GP `retailers' to offer their own brand of care: The Queen's Speech

The Primary Care Bill will consolidate the position of family doctors, dentists and pharmacists and the services they provide as the jewels in the crown of the National Health Service, health ministers have promised. Labour says the Bill will open the service to the horrors of commercialisation.

At its heart is a change in the way GPs are employed. It will provide opportunities for individuals or organisations, including private retailers or trust hospitals, to employ doctors and establish their own brand of primary-care practice, funded by the NHS.

Such "practice-based" contracts would speed the growth of super-surgeries or cottage hospitals, in a move designed to ease the burden on acute hospitals, and their costs. The health centres of the 21st century would offer services ranging from minor surgery, screening, X-rays and physiotherapy to health education.

Patients would be able to consult a variety of health-care professionals who will assume a wider role in the primary-care service and greater responsibility for patients, leaving GPs to focus on the most serious and complex cases.

Under present laws, every GP is an independent contractor with the Secretary of State for Health and must provide core services, which rules out "flexibility", the key to the forthcoming Bill.

Another significant development in primary care will be proposals for a single budget for general medical services, hospital and community health services and prescribing, which will, in effect, allow some fundholding GPs to become "mini-health authorities" with a legally binding contract to provide all services for their patients. This has been hailed by the National Association of Fundholding Doctors as the most exciting and radical idea in the forthcoming Bill.

Dentists are to be encouraged to contract with health authorities to provide high street services for a specific population. The Bill will also include incentives for health authorities to buy a wider range of pharmacy services.

While the health-care professions have broadly welcomed the Government's proposals detailed in the White Paper, Choice and Opportunity, published last week, they are concerned about new money for the service. Labour's fears that the Bill is prelude to some privatisation is not a predominant concern.

Doctors in particular have applauded the cautious approach of Stephen Dorrell, Secretary of State for Health, who has said that every development will be tested in voluntary pilot schemes and fully evaluated before any permanent, widespread change. The entrepreneurs among the professions could seize the initiative, he said. But the British Medical Association and the National Association of Health Authorities and Trusts have warned that without investment in primary care, the Government's plans would fail.

The Social Security Bill to tackle fraud being introduced by the secretary of state, Peter Lilley, was said by the Opposition spokeswoman Harriet Harman to have missed its pounds 2bn target. She announced her own measures to outflank the Government.

The Bill will establish an agency to put pressure on local authorities to curb housing benefit fraud and will give social security officials new powers to cross-check income tax and VAT returns with benefit claims.

Attacking the measure as "too little, too late", Ms Harman said the Government had been forced to act by the calls for action by Frank Field, Labour chairman of the cross-party Commons Select Committee on Social Security.

Mr Field and his committee warned that organised criminals were using Mafia-style intimidation, including murder, to carry out massive frauds on housing benefit, using "stolen" national insurance numbers and making multiple claims for tenants who did not exist.

Ms Harman said the fraud was running at an estimated pounds 2bn but it would go largely untouched by the measures announced by Mr Lilley at the Conservative Party conference. The Government was trying to "scapegoat" local authorities while failing to tackle the major problem, because it said it did not wish to add to the regulatory burdens on the private sector.

"Local authorities should have the power to refuse to pay direct to private landlords in all but exceptional circumstances," she said. "Local authorities should also provide details of payments to landlords direct to the Inland Revenue to ensure that they pay income tax."