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House of Lords

Tuesday, 27th January 1998.

The House met at half-past two of the clock: The LORD CHANCELLOR on the Woolsack.

Prayers--Read by the Lord Bishop of Lincoln.

The Lord Bishop of Manchester

Christopher John, Lord Bishop of Manchester--Was (in the usual manner) introduced between the Lord Bishop of Ripon and the Lord Bishop of Lincoln.

Academic GPs: Remuneration

2.43 p.m.

Lord Walton of Detchant asked Her Majesty's Government:

    Whether, in the light of the Richards report on the problems facing clinical academic medicine, they will make distinction awards available to teachers in general practice employed by the universities.

Baroness Ramsay of Cartvale: My Lords, the Richards report was commissioned by the Committee of Vice-Chancellors and Principals which, I understand, is considering at present its recommendations. The report has not been formally presented to the Government for a response and it would be premature for me to offer a view on any specific recommendation at this stage, including the recommendation regarding the remuneration of academic GPs, which raises complex issues as the report itself recognises, and about which I know the noble Lord, Lord Walton, is well aware.

Lord Walton of Detchant: My Lords, I thank the Minister for that reply. Does she accept that since the introduction of mandatory vocational training for general practice, the clinical academics who teach general practice and primary care are accepted as being in a specialty like any other clinical specialty; and that this is the only clinical specialty in which teachers in the universities are not at present eligible for distinction awards?

Is the Minister aware that there is at present a major recruitment problem in this field? If, as the Government wish, we are to have a primary care-led NHS, is it not important that incentives should be introduced to improve recruitment, in particular, since these are the people who will be teaching primary care to our medical students and doctors in the future and the BMA General Services Committee, while opposed to distinction awards for general practitioners who are independent contractors, now supports their availability to this group of clinical academics?

Baroness Ramsay of Cartvale: My Lords, the Government accept the importance of academic general practice given our commitment to a primary care-led

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National Health Service. We would not wish to see disincentives to able individuals entering academic general practice. However, pay is only part of the picture and access to the NHS consultants' distinction awards is only one option which could be looked at in addressing any perceived disparities in pay.

Introducing distinction awards for university employed general practitioners raises complex and difficult issues. Sir Rex Richards acknowledged this in November in evidence to your Lordships' Select Committee on Science and Technology which the noble Lord, Lord Walton, chairs. It is not new, but a longstanding issue to which there is no simple solution. However, we shall ensure that these issues are fully considered and possible solutions addressed. The Department of Health and the Department for Education and Employment look forward to working with the Committee of Vice-Chancellors and Principals to address the issues raised in the Richards report. We shall seek to ensure that there are no disincentives to entering academic general practice. We shall take careful note of the points made in both the Richards report and by the noble Lord, Lord Walton.

Earl Howe: My Lords, perhaps I may take this opportunity to welcome the noble Baroness to the Dispatch Box and to wish her well as one of the members of the health team on the Government Front Bench.

Is not the difficulty at the heart of the Question the fact that there are simply not enough medical graduates choosing to enter general practice? Does the Minister also agree that because of the shortage of GP trainees, the GP trainers often cannot be retained in the academic loop?

The noble Lord has proposed one answer to the problem. But what plans do the Government have for eliminating the shortage of trainee GPs?

Baroness Ramsay of Cartvale: My Lords, first, I wish to thank the noble Earl for his kind and courteous comments to me.

The Government very much recognise the importance of teaching general practice best practices to medical undergraduates and young doctors. However, as I understand it, Richards recommended that there should be discussions about the need to ensure that the terms of academic general practitioners match those of their academic colleagues in hospital practice. I accept that in the report there is acceptance of the fact that hospital colleagues with honorary NHS consultant contracts are eligible for distinction awards. But no other group of GPs receives distinction awards. We need to be clear about whether there is a disparity and, if so, how that might be addressed. We cannot assume that the issue is simply one of distinction awards. For example, a separate scheme could be more closely tailored to clinical academic GPs; or other changes could be made to the remuneration of clinical academic GPs which could also address the problem. We are planning detailed discussions with the Committee of

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Vice-Chancellors and Principals about all the implications and options arising from the report, and possible options for any necessary funding.

Lord Hunt of Kings Heath: My Lords, will my noble friend agree that, while we cannot look to the Treasury for a monopoly of all wisdom on matters concerning the NHS, its evidence to the Royal Commission on Doctors' Remuneration of 40 years ago still stands? It argued that distinction awards should be abolished as a blot on the landscape of public finance. Will my noble friend further agree that, while we must do everything we can to ensure that GPs who take part in academic medicine do not suffer financially, we should not seek to extend the range and scale of distinction awards?

Baroness Ramsay of Cartvale: My Lords, the Treasury may well have said that, but I could not possibly comment!

Lord Winston: My Lords, does my noble friend agree, in the light of recent evidence based on research by Dr. Hetherington and his colleagues about the perceived difficulties of ethnic minorities in consultant practice, that this is an issue the Government might wish to re-examine?

Baroness Ramsay of Cartvale: My Lords, this is indeed an important issue for the Government. Department of Health officials have recently held discussions with the Commission for Racial Equality regarding the number of awards granted to consultants from ethnic minorities. A number of measures are being introduced in the 1998 awards round to secure better data, monitoring of outcomes and representation of ethnic minority consultants on awards committees. Some changes to the criteria for awards were also suggested by the commission and accepted for implementation in the 1998 awards round. Those measures were welcomed by the commission. We are considering what further action might be taken to assist in addressing this issue.

House of Lords: Reform

2.52 p.m.

Lord Renton of Mount Harry asked Her Majesty's Government:

    Whether they will ask a committee of the Privy Council to consider substantial questions of constitutional reform, including the reform of the House of Lords.

The Lord Privy Seal (Lord Richard): My Lords, no.

Lord Renton of Mount Harry: My Lords, I find it somewhat difficult to thank the noble Lord the Lord President for that reply although that is the customary courtesy. Does the Lord President recall that

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the Falklands Islands Review of 1982 was conducted by a committee of distinguished Privy Counsellors, who were especially chosen, in the words of my noble friend Lady Thatcher, in order that the review should be seen to be conducted with integrity and independence, and that it should command widespread confidence? Do not precisely the same criteria apply to any review of the House of Lords? Will the noble Lord at least accept that the results of such a review would be far more credible were they to be conducted by a committee which drew on the wisdom and talents of all political parties? After all, constitutional change is not the whim of a five-year Parliament. It must last for generations.

Lord Richard: My Lords, I cannot avoid welcoming the conversion of the noble Lord--with which I hope the party opposite agrees--to the reform of your Lordships' House. I cannot also help but observe that over the past 18 years, when the noble Lord occupied a very prominent position in the previous administration, no proposals at all for the reform of this House were brought forward. We were elected on a manifesto which was quite clear: as a first stage in the reform of this House, we will remove the right of Peers by succession to sit and vote in this House. That remains our policy.

Lord Barnett: My Lords, will my noble friend accept that, when the first Bill comes before this House, based quite rightly on the manifesto, as my noble friend said, the House should have some idea as to what the Government propose thereafter? Perhaps my noble friend will tell me whether he agrees.

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