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5.17 pm
Mr. Gareth Wardell (Gower): I am obliged to you, Mr. Deputy Speaker, for calling me early in the debate to enable me later to attend a dinner with Madam Speaker. I am sure that the Government Front-Bench team will understand that I do not mean any discourtesy if I am unable to be here during the winding-up speech.
It is a great pleasure to follow the hon. Member for Chislehurst (Sir R. Sims) and my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith). It is nice to be in a forum where there is so much that we agree with, and, in particular, that the Minister for Health was so uncomfortable when he was being goaded almost and invited to respond to the points on section 12 of the Medical Act 1983. Being a lay member of the General Medical Council, like the hon. Member for Chislehurst, I want to develop in a little more detail both the points that he and my hon. Friend the Member for Islington, South and Finsbury have made on the matter.
It may be that, with a little persuading, the Minister will make an announcement in his reply to the debate. I am sure that, in his mind, he has almost reached the conclusion that, because of all-party support, he can very easily yield to requests for action. It is a discrete problem, and it stands as an issue on its own, quite apart from anything else that the General Medical Council is doing on its fitness to practice procedures.
As the hon. Member for Chislehurst rightly said, it is astonishing that only one university has managed to maintain a long-running scheme for pre-registration house officer posts in general practice. That one scheme is supervised by St. Mary's hospital medical school, at Lisson Grove health centre, in west London. The benefits of the scheme are well documented, and I am sure that the Minister--as he so regularly reads the British Medical Journal--will no doubt recall Joe Wilton's article of 11 February 1995, which documents that experience so well. If he cannot immediately recall the article, I am sure that he will be able to do so in the next few hours. Other arrangements to provide a spell in general practice have occasionally been made by universities--usually to deal with pre-registration house officers experiencing problems in their hospital training--with demonstrable educational benefits.
As the Minister well knows, the GMC is responsible for overseeing the pre-registration year. It wishes, as we all do, that year to be a high-quality experience for the
new graduate, setting the seal on basic medical education and providing an excellent foundation for a career in medicine. The council has long encouraged the use of general practice in the pre-training year, but the legal obstacle created in the 1983 Act and in previous legislation still remains, and it is a major blockage. Last November, the GMC consulted on new recommendations for the pre-training year, and many educational institutions commented on that technical provision of the law and asked the GMC to press for its abolition.
I shall give only one example of the obstacle in operation, from the many examples that the GMC received. It is from Dr. Jamie Bahrami, who is the director of postgraduate general practice education at the university of Leeds. He responded to the chairman of the GMC education committee by stating:
Figures recently issued by the joint committee on postgraduate training in general practice show a fall in the number of certificates of completion of GP training from 2,562, in 1981, to 1,866 in 1995. The joint committee has also drawn to the attention of the Department of Health evidence of problems of recruitment to general practice.
Today's debate and the Bill present the Government with a crucial opportunity in their drive towards primary care led by the NHS. They provide the Minister with a wonderful opportunity to tell the House that he is now no longer prepared to tolerate that outdated, anachronistic and antediluvian obstacle. Instead of finding an excuse--I am sure that he would be able to trump one up; it would not take him long to do so, if he wanted to--he can take positive action and give a commitment that will encourage universities and their medical departments to move ahead in offering a four-month training period to trainee general practitioners in their pre-registration year, should they wish to take advantage of it.
Mr. David Atkinson (Bournemouth, East):
I very much welcome the Bill and most of what it proposes--as do the majority of the general practitioners in my
Mr. Simon Hughes:
The hon. Gentleman is following a good example, I am happy to note.
Mr. Atkinson:
I will return to the matter of consultations by Conservatives a little later in my speech, for the benefit of the hon. Member for Southwark and Bermondsey (Mr. Hughes), as he recently placed a letter on that subject in my local newspaper, and his comments were entirely untrue. I will remind him about that later.
If my general practitioners are happy with the Bill, so are my constituents. Many hon. Members will recall occasions on which doctors have not been happy with changes proposed by the Government and have not hesitated to use their surgery power as a source of patient protest. I hope that such confrontation between a Conservative Government and the medical profession is in the past--except for the occasional broadside from the current British Medical Association Council chairman in office, which is probably essential to his re-election.
Such avoidance of confrontation has much to do with the Government's approach, and particularly with their ever greater preparedness to listen to the professions. Nowhere has that been better demonstrated than in the Government's approach to the future of primary care. I pay tribute to my right hon. Friend the Secretary of State, and I support the tribute that he paid today to my hon. Friend the Minister for Health for his listening exercise. I believe that he has conducted that exercise on such a wide scale that use of a Special Standing Committee, as requested by the hon. Member for Islington, South and Finsbury (Mr. Smith), is unnecessary.
I would normally have a great deal of sympathy for such a request, as I believe in the Special Standing Committee approach for very detailed and complex legislation--such as the Mental Health (Amendment) Act 1994, which used that approach and was much the better for it. On this occasion, however, because of the wide consultation exercise conducted, such an approach is not justified.
I believe that the Bill will consolidate the great success of the Government's reforms in primary care and build upon them substantially to provide the even wider range of services for patients which is its aim. It must be clear from what has been proposed in the two White Papers, much of which is provided for in the legislation, that primary care in this country will change considerably from next year: it will get even better, and will show that, through its national health service and general practitioners, this country continues to provide one of the finest health services in the world--a fact that is continually borne out by my constituents.
"I would, however, like to bring to the attention of the Committee that the restriction placed in the Medical Act on the use of Health Centre as the only suitable location for training in General Practice is outdated and requires urgent revision."
There is therefore a problem, although change has taken place and is taking place. General practitioners are increasingly practising in buildings that are not publicly owned, and the fact that those buildings are not publicly owned prevents medical schools from incorporating a four-month training period in the pre-registration year. Obviously, that situation cannot be continued indefinitely. It is an extraordinarily unsatisfactorily situation in which, out of 3,800 new doctors who graduate each year, only three have the option to do some of their pre-registration house officer training in general practice. That restriction to publicly owned premises no longer has any purpose or even any meaning.
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