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Lord Pearson of Rannoch: My Lords, with the leave of the House, would it be possible for the guidelines to be available further down to the general public than local health boards and so on? It is at the general public level that the people about whom I am worried need guidelines in clear language.

Baroness Jay: My Lords, before the Minister replies, could the guidelines also be in language which is understood by members of the public, who may also be members of the health authorities or community health councils?

Baroness Cumberlege: Yes, my Lords, I am aware of the NHS jargon which permeates every document that we try to produce. My noble friend and the noble Baroness have made a good point. Perhaps we could take it away, think about it and come back at Committee stage. I am sure that we would wish to involve people like community health councils, other organisations and consumer bodies because it is clearly no use having good systems when people do not know about them and when they are hidden from public view. I am sure that our intention is shared, and perhaps we could come back with more practical proposals during the course of the Bill.

I should like now to address the issue of whether the hearings should be in public or in private. Our intention is that the hearings of the committee on professional performance will be held in private unless the doctor wishes otherwise. I know that comparisons have been made with conduct procedures where hearings are held in public. However, the conduct proceedings address specific wilful acts and omissions by doctors and the standard of proof is different. We therefore feel that at

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this time it is not appropriate to draw such comparisons, and the performance procedures are more akin to health proceedings.

The GMC has already consulted specifically on the merits of public and private hearings. The result is generally in favour of private hearings, but at the Commons Committee stage a clear commitment was given that the GMC would review the operation of the committee on professional performance three years after the first hearing. That commitment remains and I am sure that the issue will be addressed again.

The noble Baroness asked about standards of personal conduct—rudeness and those kinds of issues—and whether that would also trigger the new procedure. In principle, yes, it would. But it is unlikely that isolated incidents would do so. The complaint would need to suggest a pattern of behaviour which was offensive to patients. No one would surely want to suggest that occasional instances of, say, impatience would call a doctor's registration into question. It is a matter of getting the balance right.

On the question of voluntary removal and whether doctors facing a performance committee hearing could lie low, as it were, for a few years and hang on, the amendment that we intend to bring forward at Committee stage will give the GMC powers to prevent a doctor taking his name off the register. This will be done where professional conduct, not performance proceedings, are contemplated or are in train. In performance matters, it is intended that doctors should be able to remove their names from the register if they so wish. Conduct is wilful and performance may not be. Therefore, a doctor whose performance is deficient should be able to come off the register because the aim is the protection of the public, not a public example being made of the doctor.

The noble Baroness also asked how long allegations will be kept on file. The GMC has set no time limit at this moment. Any arbitrary cut-off point would, we think, be undesirable; rather, the seriousness of the complaint should in part govern how long such information should be kept on record and reconsidered when the doctor applies for re-registration.

I wish to thank the noble Baroness, Lady Robson, for her warm welcome to the Bill. I know that she speaks from a distinguished career as a former regional chairman. I agree with her that the Bill is overdue. She asked, among other things, about remedial training costs, as did my noble friend Lord Colwyn, the noble Lord, Lord Walton, and other noble Lords. Our view is this and it is quite straightforward. We feel that doctors have a responsibility for ensuring that they keep up to date with current practice. The handful of doctors who will come under the GMC's new procedures should not expect the taxpayer to pay extra costs if they fail to maintain the standard of professional performance and level of competence achieved by their colleagues. Hospital doctors can discuss with their employer the need for support to undertake remedial action. That might include time off and the cost of courses, but it is entirely at the employer's discretion.

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GPs are in a different position. They are independent contractors, responsible for meeting their own practice costs, including the costs of maintaining their professional skills and knowledge, as are doctors in the private sector. Doctors are already eligible to receive a postgraduate education allowance if they undertake regular training. In our view, the few poor performers should not expect to be paid more if they fail to take advantage of what is already available.

Baroness Robson of Kiddington: My Lords, will the Minister allow me to ask a question? The fact that a doctor has taken advantage of the postgraduate education allowance and used it will never prevent him from not performing according to the medical practice that is expected. It is a completely different type of education. It is not remedial for something that is wrong with his whole outlook; it is general postgraduate education and it is different.

Baroness Cumberlege: I accept that, but the point that I am making is that there is an annual provision for GPs in order to have training. I do not know what the cost of the remedial training will be in every instance over the course of a year. It may well be that the allowances for that year would cover those costs. However, we are saying that if they do not, we feel that it is reasonable that the general practitioner should carry the costs—as indeed I am sure other professionals in other walks of life who require career development, or as in this case additional training, would carry such costs.

The noble Baroness also asked whether there was a better system for sharing information about doctors, especially about locums, who face the GMC procedures. All NHS employers should check a doctor's references, including his or her contract with the General Medical Council. The NHS guidance is very clear on this matter. We have recognised particular concerns about locum doctors. Indeed, the Chief Medical Officer chaired a locums working group to address the problems to which the noble Baroness referred. The working group's report has been issued for consultation. Officials are currently assessing comments made on it. Among the report's recommendations is a UK-wide alert system which would trigger procedures should there be concern about a locum's performance. The GMC may also be advised of that.

We share the sentiments of the noble Lord, Lord Walton, in praising previous presidents of the GMC, and not least the noble Lord, Lord Richardson, who so changed the remit of the council when he prompted Parliament to introduce the Medical Act 1978. The noble Lord knows the issues so well, and his encouragement for the Bill is therefore very highly prized. I know that behind the scenes over many years he has influenced some of the thinking behind the Bill. I hope that through his many positions of influence the noble Lord will disseminate these proposals.

The noble Lord asked about doctors suspended on performance grounds and whether their NHS employment contract will be preserved. A number of other noble Lords raised the same issues. The answer is yes, in the sense that the suspension does not terminate

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any contract of employment, or indeed arrangements with GPs, to provide general medical services by operation of law—that is, automatically. Rather, the matter is left in the hands of the relevant FHSA or employer. If the facts leading up to the suspension are serious enough, they may lead to a doctor's dismissal or de-listing. But this is not automatic. The whole matter is left to the FHSA or the employer, as is the case in connection with suspension, for instance, by the health committee.

My noble friend Lord Colwyn, the noble Baroness, Lady Robson, and a number of other noble Lords raised the question of costs. The explanatory memorandum states that the cost to the NHS is £530,000 a year. The costs of administering the new procedures will be met by the General Medical Council. Costs will arise from the running of the two new statutory committees, the setting up of the assessment panels and the general support provided by GMC officials. These costs will be met by the medical profession through the annual retention fee. It is expected that when the procedures have been fully implemented, the net increase in the retention fee to cover these costs will be something like £8. For GPs, because of the operation of the GP contract, part of that rise, amounting to about £250,000 per annum, will be met by the NHS. Our estimates of the total cost to be met by the NHS are higher: £530,000 a year. That is because some of the costs of remedial training will, as I have said already, be met by the NHS.

My noble friend Lord Colwyn also asked whether other professions should introduce similar provisions for self-regulation, as did the noble Baroness, Lady Masham. The answer is yes; but it really is up to them to do the preparatory work. In this case the Medical (Professional Performance) Bill arose from the GMC initiative, following a lot of consultation and debate with the medical profession. Should the General Dental Council, or indeed any other health professional regulatory body, wish to develop proposals for change, the Government will of course be interested in them.

I sensed that a degree of frustration was exhibited by the noble Lord, Lord Richardson, in having his fox shot by the noble Lord, Lord Walton. I know that feeling very well indeed: I followed the noble Lord, Lord Walton, on many a platform. I do not think that the noble Lord, Lord Richardson, need have been so modest. His perceptions and insights have greatly enriched this debate, coming as they do from someone who has had a remarkable, distinguished and honourable career in medicine.

My noble friend Lady Macleod is right to paint a picture of the NHS when her husband, Iain Macleod, also a remarkable man, made such an impact on the service. He is still extensively quoted—indeed, as recently as last week, when my right honourable friend the Secretary of State for Health made a major speech at the Royal Society of Medicine.

My noble friend asked who will be able to report a case to the GMC, as did the noble Lord, Lord Rea. We expect anybody to be able to make a complaint: patients, professional colleagues, NHS Trusts—anybody. It is an open door. My noble friend asked how many complaints

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were expected. The GMC feels that the number of cases referred to it requiring assessment will be between about 100 and 150 per annum.

I am not quite sure that I fully understood the points made by my noble friend Lord Harmsworth. I am very happy to discuss them later should he wish. If he wishes to table amendments at Committee stage, we shall consider them fully. I believe that my noble friend wondered whether Clause 2 as drafted gives the GMC the powers to make rules as it considers necessary. Following consultations with the professions as to the details, the GMC has said that it will make the rules under Clause 2 once the consultation has taken place. Perhaps I may clarify this later with my noble friend.

The noble Baroness, Lady Masham, raised the issue of doctors with alcohol problems and whether that constitutes serious professional misconduct. Alcohol problems are generally taken under the GMC health procedures and are dealt with already through that mechanism.

The noble Baroness also asked whether the GMC would decide whether a complaint related to misconduct or poor performance. Basically, it is the screener who will first consider whether by its nature a complaint falls within the scope of serious professional misconduct. That is concerned with one or more incidents or events which are in themselves sufficiently serious. Performance procedures, on the other hand, will generally be invoked by a pattern of deficiency within which each incident or event is not itself sufficiently serious to challenge a doctor's registration.

My noble friend Lord Milverton gave us a graphic account of some of the problems that can occur. Of course we try to ensure that mistakes are not made; and that is where training is so important, both initially and at postgraduate level. I am sure, however, that my noble friend, who probably has more experience of dealing with human frailty than most of us, will recognise that we cannot all be perfect.

The noble Lord, Lord Pearson, raised the issue of how difficult it is to bring a complaint, especially perhaps in a rural area where the GP is well known by individual members of the population. I believe that that issue was also raised by the noble Lord, Lord Rea. In principle, there is nothing to stop a patient remaining anonymous, at least in the early stages. The focus of the procedures is on the assessment of a doctor's performance as a whole, not on a particular complaint. But if there is a hearing, the patient need not appear if he or she does not wish to do so.

The noble Lord also raised the issue of whether doctors should know the name of the complainant. I believe that that will depend on the case, but I shall come back to the noble Lord as I do not know the answer.

I am sure that there are a number of points that I have not addressed. I shall read Hansard very carefully, pick them out and write to individual noble Lords if I have missed some of them. In conclusion, the Government believe that self-regulation is the best way to govern a

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profession. It is perhaps a question of "Physician, heal thyself". The profession itself knows what standards its members should meet.

I am sure that your Lordships will wish to support the medical profession in its vigilance to uphold standards and its desire to have the powers to exclude those who jeopardise the integrity of their profession. I believe that it is immensely encouraging that doctors have recognised that the empathy between doctor and patient is even more important when scientific and technological advances enable doctors to offer treatments that are at the bounds of comprehension and the limits of moral and ethical acceptability.

This is an important Bill. It is part of our commitment to make sure that the National Health Service delivers the highest possible standard of care and professional performance. Our changes mean that patients in future will have even greater confidence than they had before in the treatment that they receive and, once this Bill is enacted, in the doctors who deliver that care both within the NHS and outside it. I commend the Bill to your Lordships.

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