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Baroness Noakes: I thank the Minister for taking the trouble to attempt to give me a comprehensive reply. I cannot pretend that it is wholly satisfactory. I asked, for example, about the incentive mechanisms that would exist to ensure that dentists collected the correct money for PCTs. That is still on the table. I asked about the freedoms of PCTs and I did not get an answer.

Much of what the Minister said took me back to our first couple of Committee days when we debated foundation hospitals. The ongoing theme was that the Government were making it up as they went along. I feel that that is the case with these dental arrangements because so many of the details are not worked out. It is almost not the time to consider the Bill.

Nevertheless, I thank the Minister for attempting to answer the questions. I shall of course read what she said before deciding what to do at the next stage.

Amendment, by leave, withdrawn.

[Amendment No. 441A not moved.]

Lord Warner moved Amendment No. 441B:


The noble Lord said: This group of amendments makes a number of minor, technical changes. Many of the amendments cover personal medical services and personal dental services in Northern Ireland. References to "Article 15B employee" and "Article 15B arrangements" are inserted into Clauses 168, 171, 173, and so on. This is a UK-wide contract and the amendment seeks to treat Northern Ireland primary medical services and primary dental services employees in exactly the same way as Scottish and English employees in equivalent schemes.

Amendment No. 459E makes clear that any regulations made under Section 28E may include provision for the resolution of disputes as to the terms of any proposed Section 28C arrangement. This allows for equivalent provision to be made in primary medical services as applies in general medical services.

Amendment No. 461A amends the power in new Section 28W to make regulations in respect of payments to be made to a person suspended from the list. As written, the power is restricted to payments made by a PCT or local health boards. However, in

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certain circumstances, it will be necessary for other bodies to be able to make such payments—for example, in respect of GP registrars, where payments would be made by the strategic health authority.

Amendments Nos. 464ZG and 477ZC make changes to allow the National Assembly for Wales to make regulations giving community health councils the power to enter and inspect the premises of persons providing services under Part 1 of the 1977 Act in England. That is equivalent to the provisions for the Secretary of State in respect of patients forums. I beg to move.

On Question, amendment agreed to.

Lord Warner moved Amendments Nos. 441C and 441D:


    Page 83, line 26, leave out from "individual" to end of line 31 and insert "falling within section 28D(1)(bc) above"


    Page 83, line 44, leave out "and section 17C employee" and insert ", "section 17C employee" and "Article 15B employee""

On Question, amendments agreed to.

[Amendment No. 442 not moved.]

Earl Howe moved Amendment No. 443:


    Page 85, leave out lines 15 to 17.

The noble Earl said: In moving Amendment No. 443, I shall speak also to Amendment No. 455. Subsection (3) of the new Section 280 contains what appears to be a draconian provision. It allows for regulations to enable a PCT or LHB to impose a variation of the terms of a GDS contract. There is a similar provision in new Section 28U relating to the GMS contract.

If a dentist or a doctor has entered into a contract, it seems to me that he is entitled to regard that contract as binding on the commissioning body. We all understand that no contract can be set in concrete for all time and that it must be adapted to meet changing needs. However, I should be grateful if the Minister could explain what might justify a provision permitting one party to the GDS or GMS contract, but not the other, to override it. If changes are made to the contract, those should surely be by agreement. I beg to move.

Lord Warner: These amendments would remove a PCT's powers to vary GDS and GMS contracts respectively. For primary dental services, it is essential that PCTs have the power to vary GDS contracts in their area. The main need for the power is to ensure that any future changes to the contract regulations can be taken through into the contract. An example might be learning from field sites about patient information requirements. We might also propose a variation where it is necessary to meet a European Court of Human Rights obligation or where the failure of a PCT and contractor to reach an agreement would prevent the PCT fulfilling its statutory duty. That might be the case where the PCT was under a duty to provide certain information in the hands of the contractor.

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For primary medical services, it is also essential that PCTs have a power to vary GMS contracts in their area. The same arguments as I outlined apply. The new GMS contracts will reflect the national agreement that has recently been reached between the BMA and the NHS Confederation. Experience teaches us that future discussions will be needed to update the national contract in the light of changing circumstances. Without that power, we have no effective means of ensuring consistent implementation of new national arrangements.

Within the context of the national rules, GPs will have greater local flexibility around what services they provide and they will also have the choice of leaving the national GMS contract and entering into local primary medical service contracts. It is also recognised in the agreement document that negotiations may not always reach agreement. It is noted in the new agreed GMS contract document that failure to reach agreement would not prevent the Secretary of State or health ministers discharging their statutory obligations or exercising their statutory powers. The amendments would prevent the Secretary of State fulfilling those statutory duties. Therefore, I suggest that these amendments are not pursued.

4 a.m.

Earl Howe: I thank the Minister. That is a helpful reply. It casts some light on the subsection. The question posed by my amendment is: when is a contract not a contract? When is a practitioner entitled to regard his contract as one on which he can rely? The key word in the subsection is "impose". I still think from the examples given by the Minister, apart perhaps from the example of the judgment of the European Court, that in most instances there will be alterations of contract by agreement. I take his point. I am grateful to him for what he has said and no doubt the regulations, as and when they emerge, will specify in greater detail the circumstances that will allow contracts to be varied in the way in which the clause presupposes. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 168 agreed to.

Clause 169 [General dental services: transitional]:

Lord Colwyn moved Amendment No. 443A:


    Page 86, line 26, at end insert—


"( ) A contractor or an employee of a contractor will be entitled to existing pension arrangements that were available to her or him at the time of enactment."

The noble Lord said: The amendment safeguards the existing pension arrangements of practice owners, associates and employees during transition to the new contracting arrangements. The dentists making the transition from the old to the new GDS arrangements may feel vulnerable and the issue of pensions is understandably important. I would like clear and unequivocal confirmation that pensions will be protected. A particularly vulnerable group is that of

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associates who face the potential change to their employment status as a result of the Bill as they may move from being self-employed practitioners to employed officer status.

While the details of associate employment status are still being worked through, there is a danger that some options on the table could significantly financially disadvantage those individuals. Others at risk are contractors who make a decision to vary their mixture of clients—for example, from mostly NHS to mostly private—at a point that coincides with the introduction of the new funding arrangements. The crude pension contributions of such contractors need to be protected, regardless of their new number of NHS patients. The Government need to send a strong signal that dentists' existing pension arrangements will be protected.

I had a very helpful letter from the Minister in which he said that the changes to pension arrangements as a result of local commissioning will not be to the detriment of any dentist currently working in the NHS. The way that he said that makes me think that they are planning to make changes to the pensions and I would like confirmation that they are considering the different demographic groups in dentistry: assistants, associates, those just starting out in the profession, those who have been in it for some while and those who are semi-retired. It is important that that differential element is carefully considered. I beg to move.

Baroness Andrews: Many dentists will have made a significant contribution to NHS dentistry and a considerable personal investment in their practices. We must ensure that they are able to continue to do so. Perhaps I could explain the context. Clause 169 sets out the framework for a transitional scheme which must be established by order to ensure that those dentists who are providing general dental services under the existing statutory arrangements are entitled to continue to provide primary dental services under the new GDS contracts.

It further enables those dentists who run practices limited to specialist treatments, for example orthodontics, where it would be inappropriate to provide the full range of dental treatments required by a GDS contract, to be entitled to continue to provide those services under a PDS agreement.

It may not have been possible for all dental practices to reach agreement on all the terms of a GDS contract by the time the new regime comes into being. So, as I have said previously, subsection (3) provides for there to be a "default or base contract", which is more closely related to the service previously provided under the GDS.

It would be unfair to expect dentists to accept contractual arrangements which are significantly less favourable than those on which previous GDS had been provided. Provision will be made to offer protection of legitimate practice earnings. That may be achieved under nationally determined GDS

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contract payments under Section 28N or by an order made under Clause 169 or achieved by using both powers.

Amendment No. 443A specifically raises the important issue of the entitlement of dentists working under GDS contracts, and for that matter under PDS contracts, to membership of the NHS pension scheme. Membership of the NHS pension scheme is increasingly seen as a major benefit of being part of the NHS family and can be impacted when dentists or doctors migrate between salaried posts in hospitals and independent contractor posts in general practice. We have recognised that. We have made an amendment to the NHS pension scheme regulations that will ensure that the scheme operates more flexibly in the future when dentists or doctors move between salaried and independent contractor status. The amendment will apply to the benefits of all dentists and doctors in post on or after 1st April 2003.

The letter sent by my noble friend has already been quoted. It states that changes to pension arrangements as a result of local commissioning will not be to the detriment of any dentist currently working in the NHS. The noble Lord asked me about the range of dentists, associates and so on. Clause 169 deals with transitional provisions. Subsection (1) ensures that a new contract must be offered to all principal dentists. That includes associates. I hope that reassures the noble Lord.

I can also give the noble Lord an important commitment in response to Amendment No. 443A. Changes to pension arrangements as a result of local commissioning will not be to the detriment of any dentist currently working in the NHS. I hope that with those reassurances the noble Lord will feel able to withdraw the amendment.


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