Dr. Howard Stoate: I am sure that the hon. Gentleman is aware that the NHS Confederation actually negotiated the GP contract. If it was so upset about those issues during the negotiations, it should have driven a better deal. The hon. Gentleman is concerned that the confederation is worried now—but it negotiated the contract.

Norman Lamb: I do not care what the GPs think about the situation or whether it is of concern to them— [Interruption.] Listen to the answer. I am concerned about whether sufficient numbers of GPs are working in deprived communities. The statistics show that there are fewer GPs per 100,000 of population in poor communities, in which there are greater health problems, than there are in the wealthier suburbs. That is a fact, and it is unacceptable. It is ludicrous that the GP contract should provide disincentives for GPs to work in deprived communities.

Dr. Stoate rose—

Mr. Chaytor rose—

Norman Lamb: I shall not give way now, although I shall in a moment. Let me finish my point about the GP contract. The quality and outcomes framework—the method of incentivising GPs through further payments—also works to the disadvantage of practices working in deprived communities. The NHS Confederation confirmed that under QOF, rates of achievement in deprived communities are lower than those of wealthier suburbs, so practices in the former end up getting paid less.

Under QOF, GPs get paid more working in a wealthy suburb than if they work in a deprived community. Remarkably, QOF remunerates at a lower rate practices with a higher disease prevalence. The NHS Confederation gives an example of that. The hon. Member for Dartford (Dr. Stoate) looks bemused, but he should read the confederation’s report on health inequalities.

Dr. Stoate: I am not bemused about that, but about the fact that the hon. Gentleman is talking about the NHS Confederation, which is the body designed to negotiate such issues with the British Medical Association. If it has such issues, it should involve itself in the QOF talks, which are carried out each year to ensure that the GP contract is modernised.

I have one further point. The hon. Gentleman talked about deprived communities, and I entirely agree with him, but Lord Darzi has proposed 100 new GP practices and 150 new GP-led health centres for deprived areas. That is precisely to meet the problems that the hon. Gentleman has raised.

Norman Lamb: I have no idea whether the NHS Confederation is culpable, but ultimately the Government are in charge. The confederation now says to the Government that they ought to change the GP contract to remove the disincentives to practices working in deprived communities. What is the hon. Gentleman saying? Should we ignore the confederation? That is a ludicrous proposition.

Dr. Stoate: The hon. Gentleman is being generous in giving way. The NHS Confederation should be negotiating; if it does not like the GP contract, it should renegotiate it. I assure the hon. Gentleman that GPs would be happy to look at the GP contract again to improve on some of the issues that he has raised.

To read the debate in full please visit http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm071113/debtext/71113-0007.htm