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Baroness Andrews: My Lords, I shall start with the positive: yes, work is under way through the NHS Modernisation Agency's Options for Change field sites to test the new commissioning and remuneration models, among other innovations to improve NHS dental services. Indeed, the 20 field sites are looking at no fewer than 150 different practices. They are considering different ways of paying dentists' remuneration packages. Further, the teams will receive their existing spend from the GDS budget in exactly the same way as will practices from April 2005. We are intent on learning from this and the first complete field site draft contract templates will be made available in January of next year. They will have a two-year lifespan, going beyond April 2005.

The point of outlining the background was to reiterate, as the noble Earl remarked, that this is very much a developing programme. We shall learn from and

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draw on that programme to ensure a smooth transition and the Department of Health will be working closely with the BDA and the NHS to develop a simple and robust base contract that all PCTs and practices will be able to put in place from April 2005.

Under these arrangements, from April 2005, unless any local variations are agreed, the DPB and its successor body, the special health authority, will continue to pay dental practices contracting with PCTs broadly the same levels of income for broadly comparable levels of activity, increased by any nationally agreed uplifts following the recommendations of the DDRB.

The noble Earl has asked again whether we see fit to provide affirmative regulations on this part of the Bill. Clause 168 provides for PCTs and local health boards to negotiate, subject to the regulations covering GDS contracts, the detailed terms of a general dental services contract with individual practices seeking to provide primary dental services under such a contract.

The general dental services contract will replace the existing statutory arrangements for the provision of general dental services that are set out in the NHS GDS regulations, SI 1992/661. A general dental service contract is a contract for primary dental services, but it may also include services which are not primary dental services such as, for example, specialised services such as orthodontics, if that has been agreed with the commissioning PCT. Further, there is to be an obligation under a GDS contract to provide a specified range of routine dental care and treatment.

The reason for going into the background is to make it clear that these equivalent provisions and their many amendments since 1992 have always been subject to the negative resolution procedure, in common with other provisions under the 1977 Act. We feel that the procedure has provided the necessary flexibility and has served the development of the provisions very well. Further, it appears that no other regulations made under the 1977 Act are subject to the affirmative resolution procedure.

Amendment No. 389 seeks to amend new Section 28K, to be inserted into the 1977 Act by Clause 168, which provides for a PCT or local health board to enter into a general dental services contract. However, I should tell the noble Earl that new Section 28K provides no regulation-making power, and so I am afraid that the amendment is flawed. However, even if that were not the case, there is no reason to change the existing tried and tested arrangements for parliamentary scrutiny. We believe that they have served us well. In addition, no support was expressed by the Committee on Delegated Powers and Regulatory Reform for making such a change. I am sorry to disappoint the noble Earl yet again.

Earl Howe: My Lords, the Minister disappoints me in such a charming way that I do not know that I can come back at her with any force. She spoke of the need for flexibility as a reason for rejecting the affirmative procedure. Flexibility is often a good argument for retaining the negative procedure when the

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Government have to move quickly on something, but I do not think that it is a good reason when it is applied to something like this, where speed is clearly not of the essence.

I am sorry that what I had hoped was a good halfway house between the Minister's position and ours does not find favour and that it will not break the regular rule of the negative procedure, except in the first instance when the regulations are introduced. Again, however, I do not see that I shall get much further at this point. I thank the Minister for her comprehensive reply, which was helpful. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Warner moved Amendment No. 390:


    Page 85, leave out lines 1 and 2.

The noble Lord said: My Lords, in Committee I gave a commitment to bring forward amendments on Report which dealt with the response of the Delegated Powers and Regulatory Reform Committee and amendments tabled by noble Lords on the discretionary nature of the patient choice powers. These amendments, in a nutshell, provide that regulations must, rather than may, make provision concerning the rights of patients to choose from whom they receive their NHS dental or medical services.

The regulations must also provide for the circumstances in which a person providing services under either a general medical services or a personal medical services contract must or may accept a patient, may decline to accept a patient and may terminate his responsibility for a patient.

I indicated in Committee that it was our intention that the regulations would make clear a responsibility not to discriminate against patients in the process of registering and deregistering. The regulations would also require a reason to be given in writing to the patient as to why patients are removed from a practice list.

At that time further discussions were taking place with the British Medical Association concerning the question of reasons for patients being refused inclusion on a list. I can now confirm that the regulations will also include provision that a contractor who refuses an application for inclusion in its list of patients should notify patients of the decision and the reason for it.

During those discussions I also gave an assurance that there would be consultation on the regulations. The intention is to consult with patient representative groups on those aspects of the regulations relating to patient choice and patient registration which will be made under Section 28V(3) and the new subsection (5A). I hope that this process will begin in the very near future.

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I am sure that these amendments deal with the findings of the Delegated Powers and Regulatory Reform Committee. I am grateful for the support given by the Opposition Front Bench to Amendment No. 396. I beg to move.

Earl Howe: My Lords, in Committee, the Minister kindly gave an undertaking in the middle of the night or the very early morning, depending on one's perspective of our marathon committee day, and we were delighted to find our names in company with his on Amendment No. 396. We welcome the other amendments in the group.

On Question, amendment agreed to.

Lord Warner moved Amendment No. 391:


    Page 85, line 13, at end insert—


"(3A) Regulations under subsection (1) must make provision as to the right of patients to choose the persons from whom they are to receive services."

On Question, amendment agreed to.

Clause 170 [Provision of primary medical services]:

[Amendment No. 392 not moved.]

Clause 171 [General medical services contracts]:

[Amendment No. 393 not moved.]

Baroness Barker moved Amendment No. 394:


    Page 89, leave out lines 21 to 44.

The noble Baroness said: My Lords, I return to a matter which was raised by my noble friend Lord Clement-Jones at an earlier stage of the Bill. It is one on which we on these Benches remain somewhat unconvinced by the Minister's reply then.

The amendment concerns the GMS contract and the elements within it relating to prescriptions and the provision of drugs. It is an important statement of principle, as well as one of practice, that within a GMS contract general medical care providers should have the freedom to exercise clinical judgments over the range of treatments they seek to provide. That is as important as patient choice because patients, who are ultimately the recipients of those services, need not necessarily know when they sign up with a general practitioner that they may inadvertently or indirectly be signing up to a limited choice of provision.

We on these Benches believe that the arbitrary national control of prescribing runs counter not only to good practice for GPs but to the philosophy in the Bill that a health service should be granted as much freedom and decision making as possible at local level. Put simply, GPs and other people working under GMS contracts should be in the best position to make such judgments. We do not see why there needs to be such continual manacling of such judgments as there is under the national controls set out in the clause. That is the reason for the amendment. I beg to move.

9.30 p.m.

Lord Warner: My Lords, we do not believe that the measure is arbitrary at all. The amendment would remove a revision in the Bill for directions to be made

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that set out the drugs, medicines or other substances that may or may not be ordered for patients. It is essential that the Government retain the capacity to influence prescribing by general practitioners in a direct way through the new contracts, because there are circumstances in which expenditure on particular drugs or products will detract from the provision of other services or treatments with a higher priority.

That is best exemplified by the action that the Government have taken with regard to the provision of impotence treatments on NHS prescription. It is estimated that around 2 million men in the United Kingdom suffer from complete impotence and a further 8 million are thought to be partially affected—10 million in all. There are no objective means of diagnosis, so the condition is largely self-diagnosed. In the absence of the current restricted prescribing regime, we estimate that tens of millions of pounds of scarce resources could be diverted from treating other conditions such as cancer and mental health. That is not a situation that we as a government could possibly countenance.

Therefore, by way of reiteration, the Government are of the firm belief that the powers being taken are a necessary component, alongside the work of bodies such as the National Institute for Clinical Excellence, to ensure the most effective use of the resources made available to the NHS. Therefore, we cannot accept the amendment.


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