In case Mr John Kelly should ask, I am not a medical doctor, so that should be all right. I thank Dr Hendron for giving us a timely opportunity to speak on the subject.

I want to focus on the local health and social care groups, because they are very much at the nub of the motion. As several Members have said, it is significant that many care professionals have expressed doubts about the proposed arrangements, notwithstanding the general support for the broad principles of primary care groups as set out in 'Fit for the Future'.

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Unfortunately, the current proposals from the Minister and the Department are inadequate to empower and resource, as Mr McGrady mentioned. For example, where, in the current proposals, is there clear, detailed guidance on the formation and function of local health and social care groups? Crucially, why is there is no meaningful involvement in commissioning from the outset? If that does not occur - and some of us doubt whether it will ever occur in the future - social care groups will simply become another talking shop in a sector that has too many layers of administration.

A more malign interpretation of what may be going on is that to the extent that the groups will include membership from the health boards, this change is, in effect, a way of entrenching the power and position of the health boards. That is something that should be subject to review, and I hope that it will be subject to investigation during the overall review of public administration. Furthermore, there seems to have been a complete lack of involvement of many of the grass-roots stakeholders, especially community nurses and professions allied to medicine.

Our primary health care system differs substantially from, for example, that in America and much of the rest of the EU. Many commentators have judged that features of our primary system, especially the way in which GPs and others act as gatekeepers to care elsewhere in the system, are good features that should be cherished and developed. The problem with the Minister's proposals is that instead of carefully prepared evolutionary change, we seem to have in the offing, from the beginning of next month, something that is, in effect, a diktat. Diktats may well be attractive when coming out of a revolutionary approach to politics, but, in general, they are not a sensible way in which to engage with the major stakeholders, civil society, and to make sensible, evidence-based approaches to policy. I have great pleasure in supporting the motion.

I support the motion. There are many people with cancer in my constituency, which has a predominantly elderly population. The GP surgeries are so packed that we must plan to be sick at least two weeks in advance. If, God forbid, we plan to injure ourselves, we must give one week's notice to the treatment room for an appointment with the practice nurse. Those are facts.

It is unbelievable that someone who has severe pain because of a genetic disorder cannot get relief from pain that has been debilitating him for at least three days, because that is the earliest that he can get an emergency appointment. Such patients know that they are not ill enough to attend casualty. Many also do not feel that they are ill enough to sit for four to 12 hours in a busy emergency department when all they need is a prescription for pain relief that could be easily taken care of with a ten-minute chat to their GP, who is familiar with their condition.

The NHS plan states that, by 2004, the Government will have revolutionised their primary care services. By 2004, many people will have encountered much pain and discomfort. Many will have resorted to incurring large bills for private treatment, so that at least they can see someone when they are ill and not two weeks after the event.

We have all heard of the baby twin across the water who died after NHS helpline staff told her parents that she had colic and how to treat her. The baby had meningitis and died in days. Believe it or not, the Government plan to use the helpline and an Internet site even more to reduce the number of people using the doctors' surgeries and the numbers in the waiting rooms of doctors' surgeries and hospitals. Is that just another way of fudging the figures? Many believe that that is a possibility. As elections approach, the need to reduce waiting times will help people to focus more.

Primary care, like every other part of the public sector, was underfunded by the Government for 20 years. The Conservative Government put the primary Health Service under self-management, and, to some extent, that worked. However, the population keeps growing, and the funding has stayed low.

Some GPs have found a better way of managing the money and do not want the new reforms, as they are now presented, to come into effect. They are just beginning to pull together under the strain that the last reforms caused. A surgery in Strangford took a long and incisive look at the patients that attend there. They found that they fell into two categories - the asthmatics and the elderly. The doctors put a major part of their budget into those two problems and set up a clinic for asthmatics to free some of the time that they spend with their patients. Patients with asthma now have an allotted time for seeing their doctor and the main nurses.

The doctors also set up an elderly patients' well-being clinic to deal with flu vaccines and other forms of preventative care to free space during the day for other patients. By giving those two groups weekly clinics, the doctors have seen great improvements in other areas of their practice. They have been able to see more of other patients, and they do not have these problems in greater number than before. Asthma is an increasingly common condition in modern society.

Those doctors, and many like them across the Province, took the initiative and made fundholding work for them. However, as usual the Government, instead of investing the money where it is needed, will restructure and shove this bit and remove that bit, and, lo and behold, we will have a new and improved "primary care service".

Doctors in my constituency have contacted me with complaints about the restructuring of the primary care sector of the Health Service. GPs have been told that this new scheme will be the answer to their prayers. Doctors disagree strongly. They believe that there has been no long-term vision, no medium-term plan and no short-term direction for putting the new scheme in place. Doctors have said that neither the Minister nor anyone from the Department can tell them, except in vague terms, what the strategy is. They fear that patient- focused primary care-led services are being replaced with cost-effective primary care.

The Health Service should not be about money. However, for certain conditions, a week's drug treatment can cost up to £1,000. Does the strategy take into account the time and energy that doctors need to face the problems caused by the inadequate system that is proposed for April? Doctors fear that because of the stress and strain of implementing another of the Department's schemes for cutting corners and money, they will lose colleagues with many years of experience under their white coats.

Doctors have finally got to grips with the fundholding strategy. Many have used it to further their practices by getting more nurses and other services such as physiotherapists, opticians, dentists and counsellors to join their units and form one-stop clinics for all their family needs. Other surgeries in my constituency have looked at other areas of the profession, such as patients with heart complaints and ECG monitors. These doctors do not think that the system is broken, and wonder why the Department is trying to fix it, and fix it in a way that will leave those who are trying to work in the new system, with only weeks to go before it is enforced on them, with only vague notions of what will happen?

Doctors whom I have talked to say that we should look at the system in England, and I agree. With my concerns and those of my constituents in mind, I call for answers to be given.

Go raibh maith agat, a LeasCheann Comhairle. It is right that Mr John Kelly should call on the Chairperson of the Committee for Health, Social Services and Public Safety, Dr Hendron, to declare an interest. That is part of the procedure in the House. He was not implying that Dr Hendron did not do that deliberately. He was saying that it was right that it should be declared.

Members have said that there are concerns among the professionals about the new arrangements for primary care. I also have concerns, and after Mr John Kelly and I met the professionals last week, I agreed to raise those concerns with the Department and the Minister. Many of us are not experts on what is happening. Several Members have admitted that, without going into detail on the establishment of the new arrangements because they are not members of the Committee.

We met with people who were in favour of the new arrangements and also with people who were opposed to them. Contrary to what many are saying, there are people who are happy with the new arrangements. The Committee should have allowed those groups to give their views. When changes are in the air, hard decisions must be made. People are concerned about taking that leap of faith. They have relevant concerns, and we should take them through those changes step by step.

The Minister gave evidence to the Committee for Health, Social Services and Public Safety on Wednesday 6 March, when she gave a presentation and answered questions. In the limited time that I have, I wish to place her answers on the record. The Minister said that the objective of the new groups is to reduce bureaucracy, promote inclusivity among primary care professionals and move resources into front-line services. She told the Committee that the groups' aim is for local people and local health professionals, using their expertise and knowledge of what is needed, to come together to ensure that those needs are met. I do not believe that anyone could oppose that.

Several Members spoke about the £3 per head for administration costs and the fact that in England and Wales it is £7 or £8 per head. I could not stand here and justify any more money being spent on administration. We have all spoken about the levels of administration in the Health Service. My conscience would not allow me to argue for more spending on administration and less on front-line patient care.

The Minister answered several questions on issues that have been raised in today's debate, such as the make-up of the primary care management boards. The Minister told the Committee that she was confident that the configuration of those boards was such that no single group would be dominant and that representation would be well balanced. I agree with that, because there should be no single dominant force. If we are to tackle collectively the needs of our communities, many people should be involved.

Ms Morrice mentioned the inclusion of midwives in the guidance. That was put to the Minister, who told the Committee that two posts would be available for nurses and that the use of the generic term "nurse" did not exclude midwives and health visitors.

Concerns were raised that some nurse-led services would be lost under the new arrangements. The Minister gave an assurance that all health care provided under GP fundholding would be maintained. The Royal College of Nursing also raised that. The Committee met with that organisation on 27 February, and I asked its representative to give me an outline of the services that it thought would be lost. To date, I have not received that information. We must approach this in a mature fashion. Many groups favour the establishment of the new primary care arrangements, and we must give them the benefit of our attention.

There are concerns that another level of bureaucracy is being created that will result in yet another talking shop. We were told in the debate on the Executive's review of public administration, which, in my view, should have started a long time ago, that the Department is confident that the new groups are flexible enough to be accommodated in any wider structural change. Were we being told to delay or that GP fundholding should not be changed until the outcome of the review while, in the same debate, we were told that we need to tackle the level of bureaucracy in the Health Service?

Several issues must be taken on board. GPs are an essential part of the new plans. However, up until now, they have not been a part of the Health Service in contractual, financial or employment terms. I commend GPs because they are doing tremendous work. However, they must be part of the group. They cannot drive the group, and they should not have the automatic right to chair the group. We can all tackle the need for services and promote health in our communities.

I commend the Minister and the Department for ensuring that community representatives and service users will be involved in the new groups. Go raibh maith agat.

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I support the motion. A year ago the Minister was intent on ending GP fundholding, with no system available to replace it. At that time, the Committee for Health, Social Services and Public Safety rightly refused to back what the Minister wanted to do in the timescale in which she wanted to do it. That delayed the ending of GP fundholding for one year. The intention of the delay was to give the Minister time to take into account the findings of the primary care review and the Hayes Report and to create what has been referred to as a "seamless robe of medical care". Sadly, the Minister has squandered the opportunity given to her by the Committee and the Assembly.

In the intervening year, she has managed to annoy virtually the whole spectrum of primary care professionals, including GPs, nurses, midwives and community care staff, not to mention the Health Committee. One has only to read the minutes of evidence given to the Committee by the groups that I have mentioned to gauge the level of annoyance that has been caused. I do not understand why the situation had to arise. If every other Minister and Department in the Assembly can work closely with their Committees, why is it that relationships between the Health Department, its medical staff and its Committee are in such disarray over this?

Will the Member give way?

No, I will not give way.

The Committee recently took evidence from those professionals, and the view is that the Minister has made minimum primary care proposals. She has missed a golden opportunity boldly to introduce what was envisaged in 'Fit for the Future'. That system would have seen a patient-led Health Service with money for services allocated to the primary care groups and professionals close to the ground, who could decide on the most appropriate forms of medical care. That, however, has not happened, and we are faced with the creation of yet another level of expensive bureaucracy that will take money away from what it should be used for primarily - investment in patient care.

Many Members are fully aware of the overadministration of medical services in Northern Ireland. The Minister needs to make immediate plans to stand down those organisations in order to bring about the devolution of medical funding to primary care groups.

Detailed guidance on the constitution, governance and accountability arrangements for local health and social care groups, and the remuneration arrangements for those groups, was issued only on 12 February 2002 for implementation by the boards by 1 April 2002.

That leaves an unrealistic six-week timeframe. Having had 12 months to do all this, the Minister has left only six weeks for those involved to establish the local health and social care groups. What a waste of a year. In the words of the Northern Ireland Multi-Disciplinary Forum

The Minister announced on 12 October 2001 that there was broad support for the preferred model proposed in the document entitled 'Building the Way Forward in Primary Care'. However, the facts speak differently. The Royal College of Midwives, the Royal College of Nursing, and the British Medical Association, in common with most other professional health organisations here, did not support the proposal to establish local health and social care groups as committees of the existing boards. They saw that as adding another layer of bureaucracy to an already top-heavy structure for health care provision. That has not been helped by the failure of real dialogue between the Minister and primary care professionals.

Many GPs believe that the arrangements the Minister intends to pursue will not enable primary care professionals to improve the quality or quantity of care for patients. GPs believe that fundholding was not perfect; however, nothing is. They rightly claim that we should build on the developments of the past and on recent innovations and start to protect services that have already been introduced. Their concerns - and they are genuine - are that no direction and no real additional moneys have been identified and that there is no capacity within primary care to increase services so as to reduce referrals to hospital and facilitate earlier discharge. In my meetings with GP representatives, they have often quoted the Hayes Report's call for primary care services to be provided more locally, so that a high-quality service can interrelate with hospitals and lead to a higher rate of successful outcomes for patients. General practitioners believe that that will not happen under the proposed system; indeed, they believe that it represents a retrograde step.

There is concern at the lack of clarity on the function of the local health and social care groups. The transition from the end of fundholding to local health and social care groups is only weeks away, yet the guidance issued to date focuses only on the establishment of the groups and is vague about their purpose and strategic direction. Many argue strongly that these groups represent another level of costly bureaucracy choked with red tape.

Boards will constitute the committees and from April 2002 will arrange the delegation of functions to local health and social care groups. Boards will be responsible for setting up the management boards of the local health and social care groups and for ensuring that they fulfil their primary care development. In collaboration with health and social services, the boards will develop the capacity to take on responsibility for commissioning hospital and community services.

The make-up of the local health and social care groups is also a matter for concern. Where GPs and other health care professionals have had some experience in primary care commissioning, it will be a completely new exercise for many others. Why did the Minister not use the last year productively? Why were no training exercises commissioned to enable primary care professionals to participate properly in the new groups? Who will make them up? Will they be based on the bottom-up philosophy, or will they be top heavy? It is proposed that GPs will have between three and five seats on each local health and social care group management board, depending on the size of population to be covered. Potentially, these boards will include up to six community trust representatives, one acute trust representative and up to two health and social services board representatives. At least three of the community trust representatives will be from director level, making a mockery of the bottom-up approach envisaged.

Many other valid concerns have been raised by representatives of all the professions involved in primary care. For instance, why have midwives been excluded or ignored as an independent profession involved in primary care? They have failed to become eligible for seats on the health and social care group boards.

What is to happen to the employees of GP fundholders and Eastern Multifund, whose contracts expire when the new arrangements come into effect? The Minister gave public assurances in the Chamber that she would be sympathetic to the needs of those people. At the time she claimed that to lose these highly skilled people and their experience would be terrible.

I support the motion because there were many features of great merit in the proposal. At the consultation in Omagh, local care groups were considered to be a good idea. Difficulties arose about what that excellent phrase "good primary care" meant. The consultation process showed that all GPs there seemed to have different levels of aspiration. Although they welcomed the principle and the idea, they wondered how it would translate into practice.

In my area the Dunnamanagh practice caters for a large rural area that includes Ballymagorry, Bready, Magheramason and the rural hinterland attached to that that joins with Plumbridge and moves into Foyle. The Irvinestown practice covers a great part of mid-Tyrone and is joined with County Fermanagh. The Castlederg, Strabane, Newtownstewart, Omagh, Drumquin, Dromore and Carrickmore practices have local health pathways. Joining up the whole conglomeration will not lead to concentric health pathways. It was pointed out that operating large geographical areas as one local health unit, such as in west Tyrone, will create difficulties.

The consumer aspect was also raised. Every consumer has a high regard for his GP practice, which is the first port of call for him and his family. Consumers want to protect their practices and be sure that they will not be financially decapitated by another layer of local administration, which would include a chairman, a chief executive and 18 staff who will have to be paid attendance fees for their work. The funding for that is to come from the local practice area money. People view that as another barrier between them and the provision of care by the boards. They deem that costly administration as a great enough hindrance.

I speak for an area where there is less-favoured provision to meet health requirements and which scores high on the scale of health needs, in every possible way. The idea was welcome, but the last thing consumers want is another quango between them and the delivery of services. They do not want any further curbs or restrictions, financial or otherwise, between them and the health care provision they need.

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To tell someone what to do, or to impose a solution, is not what is meant by consultation. The decapitation of the financial provision is not helpful. Therefore, the lack of guidance, and the BMA's and other health professionals' rejection of the plan, has left a potentially good idea in a quagmire.

I ask the Minister to re-examine the first idea for a seamless transition from the present system to one that is perceived to be good for local healthcare, but which appears to have no method of delivery. She must think again and allow time for change and for consideration of the guidance. We should learn from the mistakes that were made across the water, rather than repeat them.

In supporting the motion, I ask the Minister to give the medical practitioners the time and direction that they need to make a good job of what has always been a great primary care service in their localities.

Anything useful that can be said has been said, so, as usual, I shall take a slightly different line. I support the motion. No one can take issue with it. The motion expresses the grave concerns that the community, the Health Committee and the medical profession have.

I am slightly disappointed that several Members feel that they cannot support the motion. The Health Committee works extremely well under the fair and understanding attitude of its Chairperson, Dr Joe Hendron, and Deputy Chairperson, Mr Tommy Gallagher. The Minister is present for the debate, so I assume that she has concerns also.

To whom did the Member refer, when she said that some Members do not support the motion?

We shall know that when the vote takes place. I am not here to name people.

Surely there is no better way to deal with concerns than to deal with them immediately, not in six or seven months' time. I do not want the issue to be fudged; enough issues have been fudged already. However, we all agree that GP fundholding will end and that we must replace it with another system.

The objective of establishing the new groups is to reduce bureaucracy and promote inclusiveness among primary care professionals. I want the Minister to state, if she can, how much money will be saved when we move from GP fundholding to local health and social care groups. Some time ago, I asked the Minister how much money would be saved if we were to cut the number of health boards and trusts. The Minister said that we would save a moderate sum. However, I was not sure what the Minister meant by "moderate", because the word means different things to different people. Therefore I asked for an exact figure, but I am still waiting. I live in hope, as always, that she will provide that figure. If we were to have fewer boards and trusts, perhaps more finance would be available for the Health Service. The Minister should have examined all moneys that are spent directly on healthcare.

Finally, the new health and care groups may have to change. Pharmacists feel that having only one pharmacist on a board is not enough. It is inadequate and unequal. However, I assume that the membership is not written in stone. I hope that the Minister will agree that if money can be saved on bureaucracy, it should go towards healthcare, which is more important than trusts and boards spending money on, dare I say, luxuries that the Health Service could do with.

The Deputy Chairperson of the Committee for Health, Social Services and Public Safety (Mr Gallagher): Foremost in Members' minds today must be the fears and concerns referred to in the motion. I acknowledge the ever-demanding workload of primary healthcare professionals - GPs, nurses, physiotherapists, midwives, and many others. They are faced with that workload at a time when resources are scarce and the public's expectations are increasing.

Members must also recognise that in the past resources for primary care have not been allocated fairly. There have been variations, inconsistencies and inequalities in the delivery of primary healthcare - for example, response times for out-of-hour services are much longer in rural areas than in the towns and cities. Members must also bear in mind the wider picture - how the Health Service measures up to the rest of Europe. There is no doubt that Northern Ireland lags behind. In many other countries the quality of service is well ahead of the primary care currently being delivered here.

Local primary care teams have been set up in many countries in Europe and in the USA. Doctors, nurses and other professionals come together with community representatives and a wide range of other interested parties in order to deliver the service. Those primary care schemes have shown that when they are given responsibility for budgets, they are able to target resources at those who are most in need in their local areas. The new local health and social care groups that are being set up on 1 April 2002 can do the same in Northern Ireland.

However, that potential will only be realised if the Minister, the Department, the Health Committee and the Assembly ensure that the right foundation is there to tackle inequalities and deliver better standards of care to local people, regardless of where they live. If the Assembly gets primary care right, it will considerably ease the pressures that acute hospitals are presently experiencing.

That must include taking on board the valid concerns of health professionals and the general public. Accountability under the new arrangements is a major concern. The new groups will be subcommittees of the health boards. No elected representatives sit on the health boards. Members must understand, therefore, why people are concerned. Final decisions on primary care should not be left to the boards alone. There needs to be a Northern Ireland-wide steering committee involving those groups to manage the change and to build confidence in the new arrangements. Primary care needs a detailed and clear- cut timetable of what will be commissioned, by whom and when.

Local groups that will serve border areas must be able to work in a cross-border context if they are to properly address the needs of the local people. All aspects of primary care should be handled in the most open and transparent way.

There are other concerns, not least the deep anxieties about possible job losses or about the downgrading of jobs for those employed in an administrative capacity under the current GP arrangements. I acknowledge that the Minister has made some attempts to address those concerns, but more work must be done. The Royal College of Nursing, for example, does not believe that the new arrangements will support the principles in 'Building the Way Forward in Primary Care'. Those principles are designed to reduce bureaucracy, improve the delivery of the service and encourage grass-roots input into local health and social care.

There has been, as Members have said, insufficient time to digest all the new guidance that has been issued in the past few weeks. Training is a crucial issue if the capacity of the new local health and social care groups is to be maximised. We need an assurance that local primary care initiatives will continue and develop. I want the Minister to give a commitment that no services that currently operate under GP fundholding will be lost.

Go raibh maith agat, a Cheann Comhairle. Beidh dhá fheidhm shainiúla ag na grúpaí áitiúla sláinte agus cúraim shóisialta. Ar an chéad dul síos, beidh siad freagrach as pleanáil agus soláthar cúraim phríomhúil, ach sa deireadh thiar glacfaidh siad le freagracht bhreise maidir le seirbhísí cúraim thánaistigh a choimisiniú. Sin gealltanas a thug mé; seo iad na feidhmeanna a bheidh ag na grúpaí.

Local health and social care groups will have two distinct functions. They will be responsible for planning and delivering primary care in the first instance, but they will ultimately take on the added responsibility of commissioning secondary care services. I have given that undertaking, and I shall outline the groups' functions.

Local health and social care groups will be statutory committees - not subcommittees - of health and social services boards. They will have clear lines of accountability to boards for their actions. That will be especially important when groups assume responsibility for the substantial public funds that they will manage when they take on commissioning functions.

For an organisation of that nature to deliver on such a formidable agenda, it is essential that all health and personal social services sectors be represented, including people from trusts who will be able to deliver on the plans agreed by the group. It is essential that all those who were involved in the planning and delivery of services work together from the beginning.

Local health and social care groups are more inclusive than any other model in England, Scotland or Wales. Primary care professionals and services users will co-operate for the benefit of service users in their area. The involvement of primary care professionals and others in identifying local health and social care needs, and in deciding how those will be addressed, is an essential element of the commissioning process and is critical to the new groups' success. The management boards of the new groups will be responsible for devising effective mechanisms to ensure the involvement of other stakeholders and members of the wider group who are involved at grass-roots level. That will ensure a bottom-up and inclusive approach.

It is important to recognise that the Assembly's decision to delay the end of GP fundholding for a further 12 months tied up resources that could otherwise have been devoted to developing the new arrangements. The actual implementation process has not suffered any delay. When GP fundholding was extended last year, I agreed, when I was asked, to extend the consultation period on 'Building the Way Forward in Primary Care'. As I told the Assembly at the time, it was our intention to establish the new groups up to September 2001 as resources became freed up as a result of an end to GP fundholding.

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It was always the Department's intention that the resources released from fundholding would be used to meet the cost of the new arrangements. The extension of GP fundholding meant that finance, people and resources could not be made available immediately to work on the arrangements for setting up new groups. Managing and monitoring the scheme in its final difficult year has absorbed resources which otherwise would have been devoted to the development of the new groups. Nonetheless, guidance on the new arrangements was developed simultaneously, and many complex issues were resolved.

As the guidance was developed, it was also necessary to take soundings from the various stakeholders. Excellent progress has been made on the basis of the guidance issued so far. The groups' configurations have been determined, and management boards are being established. It will take time for the groups to become established properly, and they will develop at different paces. Commissioning will be a completely new experience for many of those involved in the groups. Moreover, it will take time for groups to learn to work together and to build up the experience and skills necessary to carry out effective commissioning. It is difficult to predict precisely how long it will take for all of them to be able to take responsibility for budgets for commissioning services. However, I have set a firm target for some groups to take on the commissioning of some services from April 2003.

From the outset, budgets for prescribing management costs and primary care development will be delegated to the groups, and they will begin to establish their infrastructure and to formulate their plans for the commissioning and delivery of health and social services. They will be expected to identify local health and social care needs and to draw up plans to meet gaps in services. They will use their primary care development money to commission local primary and community care services as appropriate. Next year I intend to deploy additional resources towards primary care development.

The groups must decide on local priorities, taking account of resource constraints and other factors. They will also contribute to their individual health and social services board's commissioning decisions, which will seek to reflect local dimensions.

One objective of the new arrangements is to reduce bureaucracy. Another objective is to move resources into front-line patient care. The new arrangements reduce the number of commissioning bodies from 150 - the number of existing GP funds, plus pilots - to 15. The ending of fundholding means that there will no longer be short-term or individual case contracts. That too will reduce bureaucracy.

By holding the administrative costs of the new groups to an average of £3 per head, £2·5 million can be diverted ultimately from administration to primary care front-line services. The level of management funding here is the same as level one funding in England. Those groups were at that level when they were first established. With regard to wider structures and what might emerge from the review of public administration, the financial impact will be examined as part of that review. The Executive have agreed that that examination is necessary.

The composition of the management boards of the new groups allows for representation of key interests, without its being too unwieldy. A Member raised that point earlier today. That does not mean that any profession that is not represented on the boards, or that has less representation than desired, will not be able to contribute fully to the work of the group. The facility to co-opt others onto the management board, and the opportunities for participation at subgroup level, should provide for the appropriate involvement of all professions and interests.

Many Members have mentioned the preservation of services. I give an absolute assurance that all services provided by GP fundholders will be maintained until the new groups can decide on their future. I expect those professionals who currently provide those services to continue to do so. Most administrative GP fundholding staff will be redeployed in the service or will remain in their GP practice but engaged in other work. Initially, there will be 30 job opportunities in the new groups. The advertisement clearly states that midwives who work in the community will be eligible to apply for posts.

Boards have expressed their support for the new arrangements, and they will be held to account for their role in the development of the new groups. I will shortly discuss the general managerial structure.

Those nurses, midwives, health visitors, social workers, professions allied to medicine (PAM) staff, pharmacists and community users or representatives who self-nominate will be paid for their work on these groups. Only those who are nominated by boards and trusts will not be paid, as it would be considered part of their ongoing work. Staff on pilot schemes will remain in place until they have had an opportunity to apply for posts in the new organisations.

Fears were expressed that certain interests might dominate the group management boards. Those fears are not borne out by the commissioning pilots, which also have board and trust staff on their management boards. Board and trust representatives will fill six of the 18 places on the new management boards, and GPs will fill five places. Therefore no single group or profession will dominate the new groups. Also, as part of their quota, boards and trusts must nominate a nurse, a social worker and a PAM representative. That means that there will be two nurses, two social workers and two PAM staff on each group. The generic term "nurses" refers to nurses, midwives and health visitors whose names are on the register of the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC). The management boards of the groups must then devise effective mechanisms to ensure the involvement of other stakeholders and members of the wider local health and social care group who are involved at grass-roots level. It will be up to the management boards of the groups to ensure that there is a bottom-up approach.

As regards the figure of £3 per head of the population for the new groups, the funding here is comparable to the funding of new groups elsewhere when they were being set up and before they took on greater levels of responsibility. I believe that this figure will be adequate for the initial stages of the groups' development, but it will be kept under review. Maintaining administrative costs at £3 per head will also enable me to divert £2·5 million to primary care services. That money will be shared with the groups, which will decide how it will be spent. It is important to note that the figure of £3 per head of the population, which amounts to over £5 million, simply meets administration costs. It will be spent on allowances for management board members, support staff and on supporting any additional infrastructure that the local health and social care groups decide to establish. It may also be used for some internal training and development. I will make additional resources available for the purpose of providing or developing primary care services.

From April 2003, local health and social care groups will be able to commission a wide range of health and social services and to draw down from boards the necessary resources. The commissioning role of the groups will grow over the years as the groups gain experience and confidence. I cannot foresee the end point now, because health and social services structures may change following the reviews of acute hospital services and public administration. Both reviews address the wider question of structures. However, I am sure that the groups will play a growing role in the planning and delivery of services and, to look at it in another way, I have put no restrictions on the way in which the groups may develop.

As regards the configurations in the Western Board area, the groups there were formulated following discussions with the primary care professions and service users. There is widespread agreement on the configurations in that area. Perhaps someone will convey that answer to the Member who raised the point but who has since left the Chamber.

On the importance of the overall allocation to health, I point out again that five sixths of the new resources for health and personal social services have gone simply to meet inflation - the rising costs of the existing services. The remaining amounts have been insufficient to keep pace with demand. The position has been exacerbated by real reductions in baseline funding extracted over the past two decades. Moreover, any available funding has been subject to the Barnett squeeze, which has led to lower levels of increases being made available here. During the 1990s, health and personal social services spending per head grew by some 25% in real terms. In England, growth amounted to 35%. Matters have worsened since then, and the allocations for the current spending review period widened the gap.

The service needs not just more resources but greater certainty about future funding levels, which will allow meaningful long-term planning. The NHS has had the advantage in recent years of greater resources and firm baselines for the future, and I hope that this year's spending review will give us the opportunity to achieve that and that we can work to make that happen.

The end of GP fundholding on 1 April will have no adverse impact on services. People will still go to their GP or primary care professional and receive the same services that they currently receive. It is important to reiterate that all the boards have agreed that all services currently provided by GP fundholders will be maintained until the local health and social care groups can decide on their future. We have held discussions with GPs, nurses, social workers, pharmacists, boards, trusts and others to discuss the detail of the arrangements.

The formal consultation on 'Building the Way Forward in Primary Care' ran from 11 December 2000 until 31 March 2001, and during that period departmental officials were involved in over 50 meetings, seminars and workshops. At that time I met the General Practitioners' Committee of the British Medical Association (BMA) and the Royal College of General Practitioners. I met the General Practitioners' Committee again in January 2002.

Prior to that, I was involved in a series of discussions with a wide range of health professionals and managers, including the BMA and the Royal College of Nursing, to listen to views about primary care arrangements, and there has been ongoing contact with officials. Many of the concerns that were raised have been addressed. Services will be maintained at the end of fundholding, staff will continue to be employed and professional staff will form a large part of the local health and social care group management boards. I have received a request from the BMA, the Royal College of Nursing and the Royal College of Midwives for me to meet them to discuss their concerns, and I have agreed to do so on Wednesday.

In answer to the point raised by Dr Hendron, that letter arrived by post on 7 March.

I shall proceed with the setting-up of the new local health and social care groups. The level of support expressed during the consultation exercise last year was extensive. Recent expressions of support have come from the Association of Directors of Social Services, the advisory committee for professions allied to medicine (PAM), the directors of nursing of the four health boards, the Foyle area nurse practitioners and general practice forum, community practitioners in the Health Visitors' Association, and Armagh City and District Health and Social Services Community Forum.

Dr Hendron mentioned opposition from Dr Harold Jefferson. However, I have also received support from some of the commissioning pilots, and there may be differing opinions on that. Many of those involved in the pilots have indicated that they will support the proposals that I am putting forward. I am proceeding because of the success of the commissioning pilots on which the new groups are based. I want to put more money into front-line services so that local people and local health professionals can work together in a multidisciplinary fashion to make local decisions about local services.

The issue of a wider structural change in health and personal social services remains firmly on my agenda. In developing health and personal social services that are fit for the twenty-first century, it is important to ensure that the organisational structure is appropriate for the efficient and effective delivery of services. Structures must support the close working of all parts of health and personal social services and also facilitate communications between health and social services and education, housing and other key public services. I believe that the new groups will allow that to happen.

The Executive's wish to review public administration here, and the issues surrounding the development of acute hospital services - and the mention made there of the wider structures - provide the wider context within which any proposals for organisational change must be developed. The new groups have been set up to be flexible enough to be accommodated within any wider structural changes.

Similar groups that were established in Wales, Scotland and England were originally subgroups of existing Health Service bodies. I am aware that if the new groups are to succeed, it is essential that funding be made available for the development of primary care services. Next year, I intend to deploy additional resources towards primary care developments. I have discussed my proposals with the Committee.

The amounts will increase by £2·5 million in 2003-04 once the balance of the money currently tied up in GP fundholding management allowance has been released.

2.00 pm

In conclusion, local health and social care groups represent the best option for primary care to assume a central position in health and social services. They provide the first important step towards a more inclusive and co-ordinated system for planning, commissioning, and delivering services. They will ensure that local people and local health professionals work together, in a multidisciplinary fashion, to make local decisions about local services. I hope that we can all work together in a spirit of co-operation, as we have been able to do on some of the wider questions, to ensure that the groups succeed. It is in the interests of patients and all the people that they do.

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