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Madam Speaker: That seems to have sorted the record out, but I hope that the hon. Gentleman gave notice to the hon. Member for Croydon, South (Mr. Ottaway) that he was raising the matter today. It is usual to do so.
Mr. John Bercow (Buckingham): Did you?
Mr. Davies: No, I did not. [Hon. Members: "Disgraceful."] The hon. Member for Croydon, Southdid not give--
Madam Speaker: Order. I think that the matter has probably been resolved, but it is usual to give notice when invoking another Member in such an issue.
Orders of the Day
Road Traffic (NHS Charges) Bill
Dr. Evan Harris (Oxford, West and Abingdon): I beg to move, That the clause be read a Second time.
In previous debates on the Bill, we have heard the Government boast of the abolition of the emergency treatment fee as it applies to hospitals. The Liberal Democrats strongly support that on the basis that the fee was bureaucratic and on the basis of the Government's further justifications for the move, which are that it is offensive to patients arriving in hospital to be asked to pay a fee and that the amount raised does not compensate for the bureaucratic nightmare of collecting it.
The Bill, in its current form, is inadequate because it does not remove the emergency treatment fee as chargeable by general practitioners. Liberal Democrats see hardly any difference between the bureaucracy involved in collecting the general practitioner emergency treatment fee and that involved in collecting the hospital emergency treatment fee. There is also very little difference between the difficulties of approaching people who may have been injured in an accident, albeit always the driver in the case of the GP fee, and patients arriving in hospital for treatment following a road traffic accident. There is certainly no difference in the lack of information about whether it is worth while for the fee to be collected by front-line health service staff.
I wonder whether the Government, even at this late stage, will consider accepting the new clause on the basis that it fits in with the rationale of their original motives in the Bill.
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton):
As I understand it, the hon. Gentleman is seeking to remove the right of independent contractors--GPs--to claim the emergency treatment fee. Has the hon. Gentleman sought the views of the British Medical Association on this matter and what opinion has it expressed to him?
Dr. Harris:
I intend to deal with those points during my presentation of the rationale behind this new clause.
Two questions need to be answered by those proposing the new clause. First, should GPs receive a fee for the treatment given and, secondly, if they do, should that come direct from an individual patient? General practitioners receive a fee for giving contraceptive advice. That fee comes not from the person to whom they have given the advice but from the health authority and it is in addition to their capitation fee. They are also rewarded
for meeting screening targets. The normal way for GPs to be reimbursed, other than through their capitation fee, is through an item-of-service claim.
General practitioners are used to claiming from health authorities for specific items of service. Those proposing this new clause are not suggesting that GPs should not be reimbursed for their time, but that the current method is discriminatory because, in the first instance, GPs must approach a patient or even a third party for the fee. That does not fit in with the current arrangements for GP reimbursement. I can assure the Minister that, if an alternative mechanism of claiming for a GP's time and effort in a roadside attendance can be arranged through regulation, no GP need be out of pocket.
In case the Minister is not aware of this, I shall remind him of the difficulties that GPs face currently when collecting the fee. I asked the BMA for its view on the collectability of the fee and, in the first instance, it could not find any GP who regularly made an effort to collect it. My hon. Friend the Member for Isle of Wight (Dr. Brand), who is a practising GP, although on a part-time basis because of his onerous parliamentary duties, said that during his time as a GP, he has never found it worth the effort to collect the fee. He said that he does know some people who do put in the effort, but they question whether it is worth while.
If I explain the procedure that GPs have to follow to collect the fee, the House will begin to see why it is not worth retaining, even if there were not strong arguments for the principle being wrong. The BMA has produced a guidance sheet for GP members on the Road Traffic Act 1988 emergency treatment fee. Section 158 of that Act applies and that is what the new clause would abolish. The guidance says:
Mr. Andrew Dismore (Hendon):
The hon. Gentleman is making a mountain out of a molehill. As a personal injury solicitor, I have had to deal with cases on behalf of accident victims many times, and it was a straightforward matter. If a claim is made, the docket is passed to a solicitor, who will either pass it to the driver's insurers or claim it back from the other insurance company. It is a
Dr. Harris:
Lawyers involved in processes in which they are paid always claim that the process is smooth and easy. If the hon. Gentleman will be patient, I shall explain the advice that the BMA gives to its doctors on how to claim the fee, with or without the services of the legal profession. I should say that I know of no solicitor who would charge a lower fee. Perhaps the hon. Gentleman is particularly generous--which is why he is no longer practising--in being prepared to do such work for less than the £21.30 plus 41p per complete mile in excess of two miles, assuming that a doctor is the first person to reach an accident. Another invidious principle is the requirement to work out who is the first doctor on the scene, and therefore who can claim the fee. If the hon. Gentleman is patient, I shall explain the process as GPs see it.
The BMA advice continues:
The advice goes on to say that, if an oral request is not made,
"Under the Road Traffic Act 1988 doctors may generally claim a fee for providing emergency medical or surgical treatment to a person suffering bodily and/or fatal injury arising out of the use of a motor vehicle on a public highway.
We therefore have a situation in which GPs are approaching drivers of vehicles who may or may not have been injured--presumably they have survived--to ask for 41p per mile, perhaps after quickly hammering out the figures on a calculator. Such a situation is highly inappropriate, as the Government have recognised elsewhere in the Bill by abolishing the hospital emergency treatment fee.
A fee of £21.30 may be claimed for rendering treatment to an individual involved in a road traffic accident; and a fee of 41p may be claimed for each complete mile and additional part of a mile for any distance in excess of two miles which a practitioner must travel in order to provide the emergency treatment.
The payment may be claimed by any doctor whenever he or she is the first person to provide treatment.
The person who is using the vehicle at the time the event occurred out of which the bodily injury arose is the person responsible for the payment of the practitioner's fee."
"Practitioners should take the following steps to recover their fees:
That presumes that the person is alive, conscious and able to hear such an oral request. I suspect that any GP who pauses at the scene of an accident to make such a request is being forced by the current regulations--if he or she is obeying them--to put secondary considerations before his or her duty of care to patients.
(i) An oral request may be made to the person who was using the vehicle at the time of the occurrence which led to the provision of the emergency treatment."
"A written request must be made to the above-defined person. This request must be served upon that person within seven days from when emergency treatment was given. It must be signed by the claimant, stating his name and address, the circumstances in which the emergency treatment was effected, and that the claimant was the first person to provide such emergency treatment. The request may be served by delivering it to the person who was using the vehicle, or by sending it by recorded delivery addressed to him/her at his/her usual or last-known address."
The amount of administration that such a process involves for a GP, or for his or her staff, makes it not worth while to collect the fee. A greater consideration is the offence that might be caused to a person in hospital who receives such a request within seven days of an accident. Nothing could be better calculated to damage doctor-patient relationships.
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