|Health and Social Care Bill
Mr. Denham: I have considered that last point carefully. It is a matter of judgment for the Committee, but my view, on balance, is that quality need not be included. The Government's wish to have a contract that gives appropriate rewards for quality is shared by the profession. That is not in doubt. We have found in previous legislation that including such factors imposes constraints; it is a matter of judgment whether one should impose a further constraint, but I believe that it is unnecessary.
The hon. Gentleman is in something of a tangle with his interpretation of clause 20 and the 1977 Act. The effective interpretation of the 1977 Act has been that doctors are paid a fixed amount each year, including a sum that is based on capitation and must be more than 50 per cent. of the total remuneration. That is a restriction. The contract is to be renegotiated. I do not know whether a payment related to quality might replace it. It is conceivable that, as with some PMS contracts, a certain part of the payment should relate to maintaining a certain size of list, but one that is not related to capitation. A number of variations are possible.
Rightly or wrongly, I take reassurance from the fact that my officials have met with the General Practitioners Committee of the BMA and discussed the clause in some detail, as they have done the rest of the Bill. The GPC understands what we propose, and does not share the hon. Gentleman's concern. It is true that they would like a provision on quality to be included in the Bill, which I entirely understand. However, it has not raised with my officials the matter of remuneration being
I seek a clear statement from the Minister. If he is looking to replace capitation-based remuneration with fixed remuneration, he needs to repeal section 29(4) of the 1977 Act. If he proposes that GPs should have more than 50 per cent. of their remuneration by way of a fixed salary, without reference to capitation or anything else, he needs clause 20. My understanding, from the general tone of the Government's approach to GP remuneration, was that he intends that more than 50 per cent. of GPs' remuneration should be related to the quality of the service that they provide and the outcomes that they deliver. If, therefore, the most significant part of their remuneration will be dependent on the quality of service that they deliver, he does not need clause 20.
Nothing in section 29(4) of the 1977 Act would prevent the Minister from paying a general practitioner 49 per cent. of his total remuneration as a fixed sum, by reference to nothing, and the other 51 per cent. by reference to something like quality of outcome or patients' experiences of the services delivered. Will the renegotiated GMS contract provide for the payment of a fixed salary, without reference to capitation, which constitutes more than 50 per cent. of the total remuneration? If so, the Government are missing an opportunity to do something that their propaganda suggested they would do, which is to place quality patient experience and outcomes at the top of the agenda.
Mr. Denham: In a sense, capitation payments are fixed. They are not fixed in absolute terms, because they depend on the number of people on the practitioner's list, but they are fixed in that they must be more than 50 per cent. of the total. We are trying to remove that obstacle. The provision effectively requires a GP who has twice the number of people registered on his or her list as another GP to be paid twice as much. We are trying to escape the hook of a direct link to capitation. In the future, it is likely that remuneration will be linked less directly to the number of patients on the list. In some PMS contracts, the GP is required to maintain a list of a certain size, but the contract emphasises the quality of services provided to those on the list. It is conceivable that we may wish to cap that type of contract.
In this discussion, where there is no real difference between our objectives and those of the profession, it seems pointless to try to specify what elements might or might not constitute precisely 50 per cent. of the future remuneration. When we come to negotiate, it is likely that the number of patients will be a relevant factor, but we are trying to get rid of the provision that has effectively tied us to a capitation system.
Dr. Brand: It is true that before quality can be delivered, a basic practice must be assembled, so there is still a need for a basic practice allowance of some sort. I support what the Government are trying to do, and that is not necessarily because I am so trusting. I have spent my clinical professional life with drug addictspeople who are pathological liars.
Mr. Hammond: Like politicians.
Dr. Brand: I have been anticipated. Medical negotiators can certainly cope with the average politician.
Mr. Denham: We know that, but what we want to know is what the hon. Gentleman did before he became a Member of Parliament.
We have reached the stage in the debate where I have set out my view of the legislation and the purposes that lie behind the clause, and the hon. Gentleman has set out his views. I fear that we will simply go over the same ground again and again.
Mr. Hammond: I fail to be convinced by the Minister's argument. My interpretation of section 29(4) of the 1977 Act is that it would allow for a fixed salary, without reference to capitation, equivalent to 49 per cent. of the total remuneration to be paid. I see nothing in clause 20 that would stop a further amount, linked to capitation, being paid, and a further amount beyond that, linked to the fulfilment of other criteria.
The Minister is clearly basing his remarks on the advice that he has been given. I will go away and talk to people who are better able to dissect these things than I am. I do not pretend to be a lawyer. One of the problems under which we labour in this place is that we are expected to provide interpretations and advice for which people outside the House would expect to be paid a great deal more per hour than Members of Parliament or civil servants are. However, I hope that the Minister will think again if I come back to him, before the Bill is considered on Report, with an opinion that gives credence to what I am saying. We are simply seeking to look behind what he is trying to do and find out whether he has an agenda that requires the measure. Such an agenda might give some cause for concern, whereas his stated agenda, which we do not believe requires the clause, does not. We accept that that agenda is being discussed with the profession. Our only concern is to unmask any actual or potential hidden agenda for the future.
The Committee can move on now, but I hope to revisit the issue with the Minister later. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 20 ordered to stand part of the Bill.
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