Brian Mawhinney, the Minister for Health who is leading the review of hospital closures or mergers recommended by Professor Tomlinson, was confronted by campaigners at Bart's yesterday on his second visit to the hospital to discuss his health care plans.
The Tory MPs affected by the Tomlinson report include Peter Brooke, the Secretary of State for National Heritage, whose constituency is affected by the closure of the Westminster hospital and the threat to Bart's, and David Mellor, whose constituency is served by the Chelsea hospital, which is new but is seen by some as too big for future needs.
John Bowis, the Tory MP for Battersea, whose local hospital, St Thomas's, is expected to merge with Guy's, said: 'The important recommendation in Tomlinson is aimed at improving primary care in London. The key to that is an early announcement of actual investment to be committed to community health centres.'
Amid clear signals of a compromise on Bart's, the Tory group of London MPs held two private meetings with Virginia Bottomley, Secretary of State for Health, to voice their concerns. Dr Mawhinney has also met individual MPs with London seats.
Dr Mawhinney has insisted on the primary care package to minimise the threat of a revolt over the plans. He has told officials and ministerial colleagues that the credibility of the changes will be challenged without these plans, and the funding for them.
Ministers are keen to match the figure of pounds 140m which Professor Tomlinson estimated would be needed for the changes, but that budget will be spread over a number of years.
It will be targeted at primary care services to change the habits of London's population, many of whom prefer to go straight to hospital rather than a GP. Dr Mawhinney has found evidence that about half of all emergency out-patients at some hospitals could have been treated by GPs.
Dr Mawhinney yesterday met GPs from Hackney, the area covered by Bart's, to discuss plans for boosting primary health care services with professors from the teaching hospitals. The package is likely to include the offer of salaries to GPs, enhanced deprivation payments to improve run- down premises, secondment of GPs from the provinces, and a challenge fund, for which GPs could compete, although this is not a front-runner. Dr Mawhinney is keen to copy an initiative from his Peterborough constituency, with a 'hospital-at-home' scheme for the terminally ill.
He has also discussed measures with the TUC and health bodies about easing the job losses. The BMA said no estimate could be made of the number of jobs at risk in the changes, to be announced in mid-February.
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