Health and Social Care Bill

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Mr. Denham: One of the delicious ironies of serving on the Committee at this moment in history is that the casual visitor from Mars might have difficulty in identifying which Front-Bench spokesman was the product of the party of closed shops, trade union power and overbearing centralisation, and which was the representative of the radical, libertarian, free-market right.

We have taken the unusual step of referring in the Bill to consultation with the BMA for the purposes of the clause. I can tell the hon. Member for Runnymede and Weybridge that that is not without precedent, because there is a similar measure in the 1999 Act, although it is unusual. The issue is one of great sensitivity among members of the profession, so we want to consult them, and that is recognised in the Bill. We intend to mirror, for PMS, the regulations across the different lists. It would not be satisfactory for GPs to have a different set of criteria on which to be judged unsuitable or for a different process to be in place.

There is a wider issue. A distinction must be drawn between the common or garden use of the term ``to consult'', which means seek the views of or hear the opinions of, and the formal definition for negotiating purposes, which is what the amendments would bestow.

Our view is that PMS is a voluntary, local contract, entered into by GPs at local level. It is perfectly appropriate for GPs who are considering doing that to be represented by the BMA through the local medical committee. Indeed, during the passage of the previous Act, we changed the legislation to enable PMS GPs to be members of the local medical committee and to be represented by them. Because of the voluntary nature of that contract, it would not be right for us to agree a framework in which the general practitioners committee nationally could determine the contract that someone could enter into at local level through his formal negotiating rights.

That said, we are anxious to work with the BMA and a range of other organisations for the successful development of PMS. We have set up a PMS implementation group.

Dr. Doug Naysmith (Bristol, North-West): I share the Minister's delight in hearing the hon. Member for New Forest, West arguing for what amounts to trade union negotiating rights. That is almost unprecedented in the House. I take everything that the Minister has said. It is important that people do not get the message that PMS is in any way second-rate compared with GMS. The Minister is sending the message that PMS is important to the 10-year plan for the NHS.

Mr. Denham: The fact that 22 per cent. of GPs have opted to work on PMS pilots suggests that the more flexible way of working, under which remuneration much more closely reflects the clinical quality of patient service than in the GMS contract, is attractive to them.

The BMA rightly has formal negotiating powers on the national contract, and we are seeking to agree a new contract with more emphasis on quality and outcomes. PMS is enabling innovative GPs throughout the country to find new ways of working and providing services that are popular with their patients. I have given assurances about the effect of the amendments on the regulations. We want uniformity across the list, and the Bill provides for consultation on GMS. I ask the Committee to resist the amendments.

Dr. Brand: I listened carefully to what the Minister said, and I was thinking particularly about an earlier commitment that he made. He said that PMS was a voluntary arrangement and there would always be the opportunity to opt out of it and return to GMS. Can we have an assurance from the Minister that should that option no longer exist—and I believe that it could be extinguished without primary legislation—he will not extinguish the option of either staying in or returning to GMS without bringing in the necessary consultation powers, which are not unreasonable, proposed by the hon. Member for New Forest, West?

5.45 pm

Mr. Denham: The hon. Gentleman has made a fair point. There is a stage at which PMS pilots may become permanent in the future, and that is set out in the Bill. I would need to refer back to the 1977 Act to see whether it has the consequential effect of eliminating the possibility of removing GMS. I will look at that issue and write to the hon. Gentleman.

Mr. Swayne: I accept what the Minister says about having taken the unusual step of putting the requirement to consult in the Bill. He has done that in 24 in respect of general medical services, but not respect of personal medical services. Precisely that omission gives rise to the suspicion that has always existed about the Government's motives for PMS.

I can understand the Minister saying that a different kind of negotiation and consultation would be appropriate for PMS, although I disagree—for precisely the reasons that I set out in respect of the national infrastructure to which the national plan refers. I can understand the Minster deciding that the consultation on PMS should be different from the consultation in clause 24, but clause 27 contains no requirement for consultation. If the Minister has ideas about a different type of consultation before the regulations are made, perhaps he should have put something in the Bill. We have not found what the Minister has said reassuring, but because of the drafting errors in our own amendments, we will not press them. However, I give notice that we will seek to return to the matter on Report. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 165 in page 26, line 12, leave out `8A' and insert `8ZA'

No. 111, in page 26, line 40, leave out from beginning to end of line 41.

No. 166, in page 26, line 46, leave out `by Health Authorities'.

No. 112, in page 27, line 9, at end insert—

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

No. 167, in page 27, line 31, leave out `49k(1)' and insert `49k'.—[Mr. Denham].

Clause 27, as amended, ordered to stand part of the Bill.

Clause 28

The Family Health Services appeal authority

Mr. Hammond: I beg to move amendment No. 185, in page 28, line 32, at end


    `(aa) medical practitioner providing personal medical services.'.

The Chairman: With this it will be convenient to take amendment no. 186, in page 28, line 34, at end insert—

    `(cc) dental practitioner providing personal dental services.'.

Mr. Hammond: Clause 28 establishes the Family Health Services Appeal Authority as an independent body, whereas it is currently set up as a special health authority. Most of the issues surrounding this provision would be best dealt with in a short clause stand part debate, so I shall focus my remarks narrowly on the amendments.

Amendments Nos. 185 and 186 seek to insert into the new schedule 9A to the 1977 Act two additional classes of member that must be included—a medical practitioner providing personal medical services and a dental practitioner providing personal dental services. Much of what my hon. Friend the Member for New Forest, West said in the previous debate is applicable again here. Whether we like it or not, it is clear that personal medical services will represent a growing share of family practitioner services. It seems rather inappropriate that the FHSAA that will be dealing with appeals in respect of GMS and PMS providers should have a statutory inclusion of a GMS or GDS provider, but no statutory inclusion of a PMS or PDS provider. We would all be wary of creating an unwieldy body.

Amendment No. 34, which we will discuss next, connects with the discussion because it deals with the overall size of a body if a percentage of its membership were laypeople. There is no robust reason for having statutory GMS and GBS representation but no statutory PMS and PDS representation. If, as the hon. Member for Bristol, North-West (Dr. Naysmith) said, that is not to send out the signal that PMS and PDS are somehow inferior cousins, the Minister must explain why those organisations are not to be represented on the FHSAA.

Mr. Denham: There is no good reason why they should not be, and we will address that in amendments tabled on Report.

Members of the Committee who have noticed that there are fewer Government amendments to the clause than to earlier ones may have drawn the erroneous conclusion that that part of the Bill was almost perfect. As I said in my letter to members of the Committee a few days ago, amendments will be brought forward on Report and some will address the issue raised by the hon. Gentleman. I will give my best indication of the other areas that need further attention in the stand part debate.

Mr. Hammond: As ever, I am grateful to the Minister for that indication. It is always nicer when he accepts our amendments, but I know that he specialises in giving credits on Report so we will live with that as a second best option. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Dr. Brand: I beg to move amendment No. 34, in page 28, line 39, at end insert

    `such number being equivalent to at least fifty per cent of the total membership of the FHSAA'.

The spirit of the amendment is the same as that of the amendments to the previous group. I am always slightly worried about setting out such prescriptions as specifying that a body must comprise six members but not specifying the size of an overall body. We could, for example, have a tribunal of seven—consisting of one layperson, one legally qualified chairman and five professionals—or a body of 40, but neither option would be satisfactory. Our probing amendment would require an appropriate lay input, which we consider should be slightly more than 50 per cent. because the body represents patients' interests. A reasonable solution would be to have 50 per cent. lay and 50 per cent. professional membership, with a lay legally qualified chairman.

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