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Ms Jowell: The new clause has been introduced with cross-party support and is also, as the Minister made clear, supported by the General Medical Council, which is
responsible for overseeing the pre-registration year for medical graduates. As part of that pre-registration year, medical graduates can spend up to four months in general practice.
The need for the new clause is created by section 12 of the Medical Act 1983, which restricts the experience of general practice that may be counted towards the 12 months of general clinical training needed for full registration to that obtained in practices based in publicly owned premises. However, general practitioners are increasingly practising in buildings that are not publicly owned and that fact prevents medical schools from incorporating a training period in the pre-registration year.
Currently, of 3,800 new doctor graduates each year, only three spend part of their pre-registration time in general practice. The new clause, therefore, would amend the 1983 Act to broaden the scope for employment of pre-registration house officers to an approved hospital or approved institution.
Opposition Members believe that to be a practical way of starting to tackle the crippling shortages of GPs in many of our inner cities and of coping with the long-term recruitment crisis confronting general practice. We believe that, if medical students in training have more exposure to general practice and more opportunity to train in general practice, general practice and the opportunities offered by general practice as part of primary care will become more appealing. We cannot envisage the proper and well-grounded development of the health service with the shift from secondary to primary care without the ability to tackle the acute shortage of general practitioners.
We regard the measure as a way of improving standards in the long run and ensuring a better gender balance in the availability of general practitioners, which was mentioned by my hon. Friend the Member for Cannock and Burntwood (Dr. Wright) on Second Reading.
Mr. Simon Hughes:
As I said on Second Reading, this measure is welcome. There was lobbying from both sides of the House, and the Minister undertook to consider the matter. I am grateful for that. This welcome measure will allow further development of general practitioner opportunities. I am grateful to colleagues--one of whom I believe is about to seek to catch your eye, Madam Deputy Speaker--for the fact that they, on behalf of the General Medical Council, have ensured that we are aware of the strong view held by the General Medical Council on this subject.
Mr. Gareth Wardell (Gower):
I have great pleasure in welcoming what the Minister has said, and I am delighted to discover that this anomaly in the Medical Act 1983 will now be put right. Madam Deputy Speaker, as a lay member of the General Medical Council, I was pleased to catch your eye on Second Reading, and I was pleased that the hon. Member for Chislehurst (Sir R. Sims), who also sits as a lay member of the General Medical Council, made a valuable contribution to that debate.
Although I shall not press the new clause to a vote, I have one concern: I do not quite follow the logic of the new clause that the Government have tabled, because it does not seek to remove section 12 from the 1983 Act. Although the amendment contains three lines referring to
an order or regulation to be made by the Secretary of State to accomplish the objective that is sought, I do not understand why section 12 of the 1983 Act will remain on the statute book, given that it appears to be in conflict with the section that is sought to be amended.
Mr. Malone:
It might be helpful if I spell it out for the hon. Gentleman. Such regulations will not be in place for some time and several people are already undertaking training in such health centres. If we simply removed that section of the legislation, their future placements, some of which start in August 1997, might be in doubt. Section 12 remains merely to ensure certitude.
The GMC was seeking to enable future training arrangements to take place in a wider context, and that is what the new clause enables them to do. It would be ironic if, while opening up the prospects for training in primary care in general, allowing scope for substantial discussion about how that is introduced, we were to agree a provision that prevented the training that is already taking place under what, once the Bill is through the House, we could probably safely describe as "the old arrangements."
Mr. Wardell:
I am grateful to the Minister for that explanation. I now understand his rationale for seeking to proceed in this way; otherwise it would be a great disservice to the, albeit few, people who are currently in training.
Once again, I thank the Minister for the fact that he listened carefully to this point on Second Reading. I am very grateful to him, to Labour Front Bench Members and to the hon. Member for Southwark and Bermondsey (Mr. Hughes) for the fact that we have been able, on this occasion, through an all-party system, to agree on something that will benefit the national health service so much.
Question put and agreed to.
Clause read a Second time.
Madam Deputy Speaker:
Amendment (a) not to be moved?
Mr. Wardell:
No, not to be moved.
Clause added to the Bill.
Ms Jowell:
I beg to move, That the clause be read a Second time.
Madam Deputy Speaker:
With this, it will be convenient to discuss the following: New clause 3--Provision of personal medical or dental services (disqualified bodies)--
Government amendment No. 11.
Amendment No. 57, in clause 8, page 6, line 28, at end insert--
'.--(1) Notwithstanding anything in sections 2 or 3 above, an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may not be made by an authority with a disqualified body.
(2) For the purposes of this section, a body is a disqualified body if--
(a) it is a public limited company; or
(b) it is a person or body which provides medical or dental services other than within the National Health Service and does not fall within paragraphs (a) to (c) and (e) of section 2(2) or 3(2) above; or
(c) it enters into arrangements involving any special obligation or limit on clinical independence or choice, whether by virtue of a purchase, lease, discount or inducement, with any body concerned with the provision of medical, nursing or pharmaceutical services, or with
(3) For the purposes of determining whether a body is a disqualified body, it shall be sufficient proof that a body is not disqualified if the Secretary of State has issued a certificate that a body is not a disqualified body for the purposes of a pilot scheme specified in that certificate.
(4) A certificate issued under subsection (3) may be withdrawn or cancelled by the Secretary of State, and he shall inform the relevant authority of any such a withdrawal or cancellation.'.--[Ms Jowell.]
Brought up, and read the First time.
6.45 pm
'.--(1) In the 1977 Act, after section 28D (as inserted by section 21(1) above) insert--
"Persons with whom agreements may not be made
28DD.--(1) Notwithstanding anything in sections 28C or 28D above, an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme, may not be made by an Authority with a disqualified body.
(2) For the purposes of this section, a body is a disqualified body if--
(a) it is a public limited company, or
(b) it is a person or body which provides medical or dental services other than within the National Health Service and does not fall within paragraphs (a) to (d) of section 28D(1) above; or
(c) it enters into arrangements involving any special obligation or limit on clinical independence or choice, whether by virtue of a purchase, lease, discount or inducement, with any body concerned with the provision of medical, nursing or pharmaceutical services, or with the provision of medicines or medical or related appliances, other than a person falling within paragraphs (a) to (d) of section 28D(1) above.
(3) For the purposes of determining whether a body is a disqualified body, it shall be sufficient proof that a body is not disqualified if the Secretary of State has issued a certificate that a body is not a disqualified body for the purposes of the agreement specified in that certificate.
(4) A certificate issued under subsection (3) may be withdrawn or cancelled by the Secretary of State, and he shall inform the relevant Authority of any such withdrawal or cancellation."
(2) In the 1978 Act, after section 17D (as inserted by section 21(2) above) insert--
"Persons with whom agreements may not be made."
17DD.--(1) Notwithstanding anything in sections 17C or 17D above, an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may not be made by a Board with a disqualified body.
(2) For the purposes of this section, a body is a disqualified body if--
(a) it is a public limited company, or
(b) it is a person or body which provides medical or dental services other than within the National Health Service and does not fall within paragraphs (a) to (d) of section 17D(1) above; or
(c) it enters into arrangements involving any special obligation or limit on clinical independence or choice, whether by virtue of a purchase, lease, discount or inducement, with any body concerned with the provisions of medical, nursing or pharmaceutical services, or with the provision of medicines or medical or related appliances, other than a person falling within paragraphs (a) to (d) of section 17D(1) above.
(3) for the purposes of determining whether a body is a disqualified body, it shall be sufficient proof that a body is not disqualified if the Secretary of State has issued a certificate that a body is not a disqualified body for the purposes of the agreement specified in that certificate.
(4) A certificate issued under subsection (3) may be withdrawn or cancelled by the Secretary of State, and he shall inform the relevant Board of any such withdrawal or cancellation.".'.
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