Health and Social Care Bill

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Mr. Swayne: I acknowledge that the purpose of amendment No. 180 is achieved by Government amendment No. 152. Before I ask leave to withdraw the amendment, I want to put it in on the record that we tabled our amendment first.

The Chairman: Order. The only amendment moved in a group is the first on the list. The hon. Gentleman's amendment was not moved.

Amendment agreed to.

Amendments made: No. 152, page 23, line 14, at end insert—

`( ) to vary his terms of service (under section 49G(4)),'.

No. 153, in page 23, line 15 after `review' insert `of a contingent removal'.

No. 154, page 23, line 19, at end insert—

`( ) If the FHSAA decides to remove the practitioner contingently, the Health Authority and the practitioner may each apply to the FHSAA for the conditions imposed on the practitioner to be varied, for different conditions to be imposed, or for the contingent removal to be revoked.'.

No. 108, in page 23, line 21, leave out `conditional' and insert `contingent'.—[Mr. Denham.]

Mr. Denham: I beg to move amendment No. 155, in page 23, line 31, leave out `and'.

The Chairman: With this we may take Government amendments Nos. 156 and 157.

Mr. Denham: In new section 49K in clause 26, there is already provision for the appeals authority to decide to nationally disqualify a practitioner from the principal and supplementary lists of all health authorities; it was referred to earlier as national disqualification. However, in the Bill as drafted there is no reference to national disqualification from the PMS or PDS lists, which we shall discuss in clause 27. Amendment No. 157 inserts a reference to those services lists that correct that anomaly and therefore enables the FHSAA to disqualify a practitioner from all lists. Amendment No. 155 is a consequential amendment that corrects the grammar and amendment No. 156 is similarly a drafting amendment.

Amendment agreed to.

Amendments made: No. 156, in page 23, line 32, leave out `practitioners' and insert `individuals.'

No. 157, in page 23, line 34, at end insert—

`and

( ) any services list of individuals of the practitioner's description prepared by any Health Authority under section 28DA above or under section 8ZA of the National Health Service (Primary Care) Act 1997,

or any such list (or lists) of a description (or descriptions) specified by the FHSAA in its decision'.—[Mr. Denham.]

Mr. Denham: I beg to move amendment No. 158, in page 24, line 4, leave out from beginning to end of line 7.

Subsection 49K(5) provides that if following an appeal by a practitioner the appeals authority decides to revoke its decision nationally to disqualify that practitioner, the FHSAA must also confirm or revoke the original health authority decision to move the practitioner from its list or to substitute a contingent removal. There is no reason to revoke the original decision and the amendment therefore deletes the unnecessary wording.

Amendment agreed to.

Dr. Brand: I beg to move amendment No. 32, in page 24, line 8, leave out `may' and insert `shall'.

The Chairman: With this we may take Government amendment No. 159 and amendment No. 33, in page 24, line 9, after `profession', insert

`and all other Health Authorities'.

Dr. Brand: I apologise to the Committee as the amendment seems to have gained something in translation. It should have read—I realise it makes the amendment slightly incompetent—

delete `or in prescribed cases may'.

I am anxious that even using all the safeguards built into the clause, it may take up to six months before a suspension is resolved. It would be against natural justice if that practitioner does not continue to receive remuneration in that time. I should be grateful if the Minister would explain in what prescribed cases the payments were not to be made.

5.30 pm

Mr. Denham: I listened with care to what the hon. Member for Isle of Wight said and to the questions he asked, but I thought that his amendment was about something entirely different. I shall deal with my interpretation of what it would do, and I shall briefly talk about the question that he has raised, which will save us dealing with it in the stand part debate.

The issue that I thought we were dealing with is that of notification of health authority decisions to remove and suspend practitioners from their main list. It is obviously important, in the system that we are setting up, that robust mechanisms are in place to inform all health authorities of the removal or suspension of practitioners, so that people cannot be moved from one list simply to re-enter the NHS in another part of the country without anyone knowing anything about it.

We intend to put in place a comprehensive alert letter system ensuring that health authorities, regulatory bodies and the Department of Health are fully appraised of the removal and suspension of primary care practitioners. We also intend—and this is what I understood to be the import of the amendment—to introduce regulations to underpin an alert letter system. The provision in amendment No. 159 will go further than that proposed in amendment No. 32 in ensuring that all relevant bodies are properly informed of these key decisions.

The hon. Gentleman raised an important issue, which we may be able to debate at greater length on stand part. Provision will be made to protect the financial position of a suspended principal or a member--for example a GP--of the practice. We will also need to make provision for locums who are under suspension, which will require a different route to be constructed because clearly they are not directly on a payroll—if I can use that expression.

The importance of appropriately protecting the financial position of somebody who has been suspended has been recognised, and I can reassure the hon. Gentleman on that point. I am sure that these amendments are not the place to discuss the matter in detail.

Dr. Brand: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdraw.

Amendments made: No. 159, in page 24, line 9, leave out

`the body which regulates the practitioner's profession' and insert `prescribed persons, or persons of prescribed descriptions,'

No. 160, in page 24, line 10, at end insert—

`Withdrawal from lists

. Regulations may provide for circumstances in which a practitioner—

(a) whom a Health Authority are investigating in order to see whether there are grounds for exercising their powers under section 49F, 49G or 49H, or

(b) who has been suspended under section 49H,

may not withdraw from a list in which he is included.'.

No. 161, in page 24, leave out line 22 and insert

`any right of appeal which he may have'.

No. 162, in page 24, line 25, at end insert—

`Corresponding provision in Scotland and Northern Ireland

49MA.—(1) This section applies where it appears to the Secretary of State that there is provision in Scotland or Northern Ireland under which a person corresponding to a practitioner may be dealt with in any way which corresponds (whether or not exactly) with a way in which a practitioner may be dealt with under this group of sections.

(2) A decision in Scotland or Northern Ireland to deal with such a person in such a way is referred to in this section as a ``corresponding decision''.

(3) If this section applies, the Secretary of State may make regulations providing for the effect to be given in England and Wales to a corresponding decision.

(4) That effect need not be the same as the effect of the decision in the place where it was made.

(5) The regulations may not provide for a corresponding decision to be reviewed or revoked in England and Wales.'.—[Mr. Denham.]

Clause 26, as amended, ordered to stand part of the Bill.

Clause 27

PMS and PDS lists

Amendments made: No. 109, in page 25, line 10, leave out from beginning to end of line 11

No. 163, in page 25, line 16, leave out `by Health Authorities'.

No. 110, in page 25, line 28, at end insert—

`( ) circumstances in which a person included in a services list may not withdraw from it,'.

No. 164, in page 26, line 3, leave out `49K(1)' and insert `49K'—[Mr. Denham.]

Mr. Swayne: I beg to move amendment No. 182, in page 26, line 9, at end insert—

`(7) Before making regulations by virtue of this section, the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services or dental practitioners providing general dental services, as the case may be.'.

The Chairman: With this it will be convenient to take amendment No. 183, in page 27, line 37, at end insert—

`(7) Before making regulations by virtue of this section, the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services or dental practitioners providing general dental services, as the case may be.'.

Mr. Swayne: The purpose of clause 27 is to extend the health authority lists to personal medical services to mirror the provisions in clause 24 with respect to general medical services. There is, however, a key difference between the two clauses in that under clause 24, the Secretary of State is required to

consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services.

In effect, that means the general practitioners committee of the BMA. He has to make that consultation before he makes the regulations.

In clause 27, there is an omission with respect to the regulations being made for personal medical services, in that there is no requirement to consult in the same way. What is sauce for the goose should be sauce for the gander. We have lifted the wording of our amendments directly from the provision in clause 24. Members of the Committee may have spotted that, so eager were we to use the exact words of the Bill, we left a small inconsistency in the wording of the amendment—a drafting error—in that it refers to ``general medical services'', when, to be pertinent to the clause, it should refer to ``personal medical services. However, the principle is sound.

If PMS general practitioners are to have confidence in the system, it is essential for them to have the same rights and protection nationally as their general medical services colleagues. That principle should also extend to other medical practitioners, such as dentists, who provide personal medical services.

The BMA's general practitioner committee must apply itself equally to GMS and PMS issues. The BMA states:

This is a matter of fundamental importance to the BMA.

It is happy for the Government to consult others, either informally or through the Department of Health's personal medical services implementation group, but not as a substitute for negotiation with the BMA's GP committee, which is the sole recognised body for negotiating on the rights of general practitioners. That recognition predates the arrival of personal medical services.

A lack of national consultation and similar rights to those enjoyed by general medical services practitioners will cause alarm and may influence general practitioners in their stance on personal medical services. At a time when constructive co-operation is at a premium and co-operative dialogue is in everyone's interests, it is essential to minimise suspicion about personal medical services and the introduction of the clause.

Personal medical services seem increasingly to have a national dimension. The third wave and all future waves of personal medical services contracts will operate within a nationally specified core contractual framework. Paragraph 8.9 of the NHS plan states:

By 2004 both local Personal Medical Services and national arrangements are set to operate within a single contractual framework that will meet the key principles and requirements of a modern NHS.

We believe that the same negotiating framework and requirement for the Secretary of State to consult before making regulations should apply equally to PMS and GMS. Does it? A suspicion will remain if the Government do not reassure us in that respect. Is the intention to use the roll-out of PMS as a vehicle to weaken existing consultation methods with the medical profession?

 

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Prepared 25 January 2001