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Earl Howe: My Lords, perhaps I may add to my noble friend's comments by putting another point to the Minister. I believe I am right in saying that this Bill is classed as a pre-commencement enactment. That means that any regulations laid under the provisions for regulation of the professions after the Bill is enacted will fall, in respect of Scotland, to the Scottish Parliament. Am I therefore right in supposing that there is no guarantee to this House or another place either that the regulations laid in the Scottish Parliament will be similar to those that may be laid south of the Border; or that the same professions will be regulated?

There could be a wide disparity between the rules applicable north of the Border and those applicable south of the Border to the same type of professional individual. I see that as something of an anomaly. I hope that I am not departing too far from the views expressed by my noble friend. I shall be interested in the Minister's comments.

Baroness Masham of Ilton: My Lords, coming from Scotland, I suggest that the regulations in Scotland may perhaps be better than those in England.

Baroness Hayman: My Lords, during earlier discussions on the Bill we dealt with the challenges--I shall not say "difficulties"--that were posed by this piece of legislation given the timing of the inception of the Scottish Parliament. We have to manage that transition. Being as close as we are to 1st July makes it particularly pertinent and relevant. But in the future, as regards the broad issue of whether the United Kingdom Parliament will legislate for Scotland on devolved matters, it will be for Scottish Ministers to decide whether they want to implement any part of the Bill. The UK Parliament will not, by convention, be legislating for the Scottish Parliament without its permission.

As regards the specifics of Commons Amendment No. 75, to which the noble Baroness, Lady Carnegy, referred, when NHS trusts were established in Scotland by the 1990 Act they took over a range of facilities--for example, hospitals and clinics--from health boards. Where facilities were transferred, the rights and terms of employment of the staff who worked in them were safeguarded and transferred to the new trusts by means of a staff transfer scheme under Section 12B of the National Health Service (Scotland) Act 1978. Paragraph 43 of Schedule 4 of this Bill sought to extend the

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protection that these orders give to staff to situations where functions transferred to NHS trusts after their establishment. The inclusion of new Clause 13 renders paragraph 34 redundant and we seek to delete it. The Government consider that setting out the provision in a self-standing clause rather than a series of detailed amendments would introduce some clarity into the Bill in this area.

As regards the order-making power in relation to Scotland, the Scotland Act 1998 provides that the regulation of the health professions, currently regulated by statute, is a reserved matter: that is, any profession regulated on 1st July 1999 by the Pharmacy Act 1954; the Professions Supplementary to Medicine Act 1960; the Medical Act 1983; the Dentists Act 1984; the Opticians Act 1989; the Osteopaths Act 1993; the Chiropractors Act 1994; and the Nurses, Midwives and Health Visitors Act 1997.

The regulation of other professions, however, is within the legislative competence of the Scottish Parliament. Nevertheless, the departments will work closely together on the development of professional self-regulation. It is in the interests of all concerned that, wherever possible, we have a UK-wide approach to professional self-regulation. That view was aired on all sides of the House throughout our discussions.

These working arrangements will be set out in concordats, agreements between the health departments. It is the intention to continue to make UK-wide provision for the professions so that patients, wherever they live, are afforded the same level of protection and there are no artificial barriers to the free movement of professionals within the United Kingdom.

On Question, Motion agreed to.

COMMONS AMENDMENT

11

Clause 9, Page 13, line 40, leave out from ("he") to end of line 45 and insert--


("(a) shall consult a body appearing to him to be representative of persons to whose remuneration the determination would relate, and
(b) may consult such other persons as he considers appropriate.").

Baroness Hayman: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 11. In moving this amendment, I shall also speak to Amendments Nos. 12 to 14, 77 to 80, 100, 121, 128 and 130.

When I introduced Clause 9 at Third Reading, I explained that the purpose of what was then a new clause was very simple. In essence, it was intended to put on a sounder legal footing the existing arrangements for remunerating the Part II practitioners who provide family health services. The clause will also enable the delegation to primary care trusts of the function of determining cash-limited payments to GPs. The clause will otherwise not signal any change to the existing remuneration system for GPS, dentists, pharmacists or opticians. None the less, the clause is complex, technical and long. Those features derive from the existing Sections 43A and 43B which the new clause replaces.

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We have chosen to retain the structure of the existing sections to help to demonstrate that the intention is to regularise and not to change existing practice. However, in considering the clause in Committee in another place, the Government and the Opposition identified a number of points in the clause that needed amendment, either to make the legal provisions fully consistent with established practice, or simply to tidy up the drafting. These amendments represent the fruits of that constructive deliberation.

The need to make the first amendment, Commons Amendment No. 11, was brought to our attention by the Opposition. Before a national determination of remuneration is made, we invariably consult the relevant representative body. That was also the practice of the previous administration. For example, before making changes to the GPs' statement of fees and allowances, we consulted the General Practitioners Committee of the BMA. However, in another place it was pointed out that the consultation requirements that paragraphs (a) and (b) of the new Section 43B(1) place on the Secretary do not quite reflect that practice.

Subsection (1) of the new Section 43B of the 1977 Act requires the Secretary of State to consult at least one of either a suitable advisory body or an appropriate representative body of the profession concerned. In practice, the Secretary of State could discharge the duty to consult by consulting an advisory body rather than a representative body. Since it is not our intention to do so we took the opportunity at Report stage in another place to make this clear on the face of the Bill. Amendment No. 11 requires the Secretary of State to consult the appropriate representative body for the profession concerned and allows consultation with others.

All the other amendments are technical or consequential and together they tidy up Clause 9. Amendments Nos. 12 and 13 provide consistent wording throughout the clause. Amendment No. 14 omits Clause 10(4) as the event for which this subsection provides cannot now occur. Amendments Nos. 77 to 80 repeat these changes for Scotland. The remaining amendments in the group, Amendments Nos. 100, 121, 128 and 130, are all minor or consequential. In particular, they secure the repeal of Section 10 of the 1966 Act for England, Scotland and Wales.

Moved, That the House do agree with the Commons in their Amendment No. 11.--(Baroness Hayman.)

Lord Walton of Detchant: My Lords, I express warm support for this group of amendments which I believe corrects an important omission from the Bill that originally left this place. The duty of consultation is extremely important. These amendments will be greatly welcomed by the professions involved.

On Question, Motion agreed to.

COMMONS AMENDMENTS

12

Clause 9, page 14, line 5, leave out ("revised") and insert ("varied").

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13

Page 15, line 24, leave out ("revocation or revision") and insert ("or revocation").


14

Page 15, line 39, leave out subsection (4).

Baroness Hayman: My Lords, I beg to move that the House do agree with the Commons in their Amendments Nos. 12 to 14.

Moved, That the House do agree with the Commons in their Amendments Nos. 12 to 14.--(Baroness Hayman.)

On Question, Motion agreed to.

COMMONS AMENDMENT

15

After Clause 9, insert the following new clause--

LOCAL REPRESENTATIVE COMMITTEES

(".--(1) Section 44 of the 1977 Act (recognition of local representative committees) is amended as provided in subsections (2) to (4).
(2) Before subsection (1) there is inserted--
"(A1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of--
(a) the medical practitioners providing general medical services or general ophthalmic services in that area;
(b) those medical practitioners and the deputy medical practitioners for that area; or
(c) the medical practitioners mentioned in--
(i) paragraph (a) above; or
(ii) paragraph (b) above,
and the section 28C medical practitioners for that area,
and any committee so recognised shall be called the Local Medical Committee for the area.
(B1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of--
(a) the dental practitioners providing general dental services in that area;
(b) those dental practitioners and the deputy dental practitioners for that area; or
(c) the dental practitioners mentioned in--
(i) paragraph (a) above; or
(ii) paragraph (b) above,
and the section 28C dental practitioners for that area,
and any committee so recognised shall be called the Local Dental Committee for the area."
(3) In subsection (1), paragraphs (a) and (b) and "the Local Medical Committee, the Local Dental Committee," are omitted.
(4) After subsection (2) there is inserted--
"(3) For the purposes of this section and section 45 below, a person who meets the condition in subsection (4) below--
(a) is a deputy medical practitioner for the area of a Health Authority if he is a medical practitioner who assists a medical practitioner providing general medical services in that area in the provision of those services but is not himself on a list;

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(b) is a section 28C medical practitioner for the area of a Health Authority if he is a medical practitioner who provides or performs personal medical services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another);
(c) is a deputy dental practitioner for the area of a Health Authority if he is a dental practitioner who assists a dental practitioner providing general dental services in that area in the provision of those services but is not himself on a list;
(d) is a section 28C dental practitioner for the area of a Health Authority if he is a dental practitioner who provides or performs personal dental services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another).
(4) The condition referred to in subsection (3) above is that the person concerned has notified the Health Authority that he wishes to be represented under this section by the appropriate committee for their area (and has not notified them that he wishes to cease to be so represented).
(5) For the purposes of subsection (3) above--
(a) a person is to be treated as assisting a medical practitioner or dental practitioner in the provision of services if he is employed by that practitioner for that purpose or if he acts as his deputy in providing those services; and
(b) "list" has the same meaning as in section 46 below."
(5) Section 45 of that Act is amended as provided in subsections (6) to (8).
(6) For subsection (1) there is substituted--
"(1) Regulations may require Health Authorities--
(a) in the exercise of their functions under this Part of this Act to consult committees recognised by them under section 44 above,
(b) in the exercise of any of their functions which relate to arrangements under section 28C above to consult committees recognised by them under section 44(A1)(c) or (B1)(c) above,
on such occasions and to such extent as may be prescribed.
(1A) The power conferred by subsection (1) above is without prejudice to any other power to require a Health Authority to consult any committee recognised under section 44 above.
(1B) Committees recognised under section 44 above shall exercise such other functions as may be prescribed.
(1C) A committee recognised for an area under subsection (A1)(b) or (c) or (B1)(b) or (c) of section 44 above shall, in respect of each year, determine the amount of its administrative expenses for that year attributable--
(a) in the case of a committee recognised under subsection (A1)(b) or (c)(ii) of that section, to the deputy medical practitioners for the area;
(b) in the case of a committee recognised under subsection (A1)(c) of that section, to the section 28C medical practitioners for the area;
(c) in the case of a committee recognised under subsection (B1)(b) or (c)(ii) of that section, to the deputy dental practitioners for the area;

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(d) in the case of a committee recognised under subsection (B1)(c) of that section, to the section 28C dental practitioners for the area."
(7) In subsection (2), "(including travelling and subsistence allowances payable to its Members)" is omitted.
(8) After subsection (3) there is inserted--
"(4) Where a committee has made a determination under subsection (1C) above, it shall apportion the amount so determined among the deputy medical practitioners, section 28C medical practitioners, deputy dental practitioners or section 28C dental practitioners, as the case may be, for the area and each such practitioner shall pay in accordance with the committee's directions the amount so apportioned to him.
(5) References in this section to administrative expenses of a committee include references to travelling and subsistence allowances payable to its Members; but the reference in subsection (2) above to a committee's administrative expenses does not include so much of the committee's administrative expenses as are determined under subsection (1C) above to be attributable to any practitioners mentioned in that subsection."").

Baroness Hayman: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 15. In moving this amendment I should like to speak also to Amendments Nos. 19 and 125. These provisions amend Sections 44 and 45 of the 1977 Act which provide for recognition of, and consultation with, local representative committees in respect of their statutory functions. The primary care Act made possible personal medical and personal dental services, and arrangements to pilot such services, but left untouched the provisions in the 1977 Act for doctors' and dentists' statutory consultation arrangements by which a committee is recognised by a health authority as being representative of medical or dental practitioners in its area.

My right honourable friend the Member for Darlington undertook to put right this obvious defect to ensure that any doctors who had opted to provide services under the primary care Act could be reintegrated into the local medical committee arrangements if they wished, and that undertaking is honoured by these government amendments. In the light of discussions during the Committee stage in another place my honourable friend the Member for Southampton Itchen had extensive discussions with the chairman of the General Practitioners Committee of the BMA. The chairman asked us to go further than the original undertaking in order to strengthen the role of local medical committees so that they can represent not only doctors working as principals in general medical services and doctors in primary care Act pilots but also the many other doctors who contribute to our high-quality family doctor services as assistants and deputies.

Having listened carefully to the arguments, my honourable friend brought forward government amendments to the clause to give effect to the more broadly based representative machinery; and after further discussions with the GDSC the Government took the opportunity to broaden the representative base of local dental committees in the same way. The details of the amendments were discussed with the national representative bodies of both doctors and dentists, and we understand that they have their support. A tidying-up amendment was also tabled to ensure that the statute

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is in line with long-established practice and with what successive Health Secretaries and the professions' representative bodies have understood the position to be for many years.

Section 45 currently requires local representative committees to be consulted but only where that requirement to consult is made in regulations. The requirement to make regulations to make or vary consultation requirements involves a very inflexible framework for developing a service which can, as now, evolve rapidly. In practice, successive Health Secretaries have made provisions for a health authority to consult locally on specific issues over and above any consultation requirements specified in regulations. These are mainly in connection with the questions of entitlement to certain fees and allowances and other matters to do with the remuneration of individual practitioners. Consequential Amendment No. 19 updates a cross-reference in Section 17A of the Act; and Amendment No. 125 details repeals consequential on Amendment No. 15.

Moved, That the House do agree with the Commons in their Amendment No. 15.--(Baroness Hayman.)


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