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Mr. Hammond: We are not disagreeing on an issue of principle, merely on the mechanics. The Minister said that he would rather rely on the discretionary power to deal with such a situation as it arose, but is not the problem that in order to attract capital investment into under- provided areas, there will have to be a right up-front? Unfortunately, that may mean that rights are given in advance to a provider who subsequently turns out to be the reason why the pilot fails. If the Minister cannot give the necessary guarantees up-front, surely he will not attract the investment that he seeks.
Mr. Denham: I agree that people will not come forward with money unless they believe the investment to be reasonable. However, the way to deal with the problem is not by writing an absolute right into the Bill. It would be best dealt with case by case, scheme by scheme--otherwise, we will be issuing an open invitation to exploit the situation, not because people want to provide pharmaceutical services in an innovative way, but because that seems like a way round the normal restrictions on rights of entry.
Finally, amendment No. 32 would require the Secretary of State to consult appropriate organisations of PMS or PDS practitioners before making regulations about the lists. We intend to mirror in those lists the conditions that apply to GMS or GDS lists. However, as I said in Committee, we do not believe that we should put into the Bill formal negotiating rights in respect of personal medical services, for example.
PMS pilots are voluntary contractual arrangements entered into at local level. The existence of a core contract does not alter the fact that the arrangement is voluntary. Although we discuss arrangements for PMS with representatives of the British Medical Association and a great many other organisations, both informally and through the PMS implementation group, we do not believe that writing formal legal negotiating rights into the Bill is the right way forward.
Of course, GPs entering PMS have every right to be represented locally by the local medical committee. No one is saying that they should not be represented in negotiations at local level, but there is a difference between that and extending formal legal negotiating rights over PMS through the Bill, as the hon. Gentleman seeks to do.
Mr. Hammond: The right hon. Gentleman is saying that because PMS is a voluntary scheme, people who enter it should not have statutory negotiating rights. In Committee, the Minister could not rule out the possibility that PMS would cease to be a voluntary scheme, with single-handed practitioners, in particular, being forced into it at some stage. Can he give an undertaking now that if PMS ceases to be a purely voluntary scheme, he will take measures to give statutory rights of consultation to those who are to be included other than voluntarily?
Mr. Denham: Clearly, we would have to examine the position if the contract were national rather than local. As the hon. Gentleman knows, our approach with regard to single-handed practitioners is through agreed changes to the national contract. We shall discuss that with the general practitioners committee of the BMA in the months to come. The concerns that have been expressed about single-handed practices can be addressed through appropriate changes to the national contract. That is our preferred way forward.
'. After section 43 of the 1977 Act there shall be inserted--
"Conditional inclusion in medical, dental, ophthalmic and pharmaceutical lists
43ZA.--(1) The Secretary of State may by regulations provide--
(a) that if a person is to be included in a list referred to in subsection (3), he is to be subject, while he remains included in the list, to conditions determined by the Health Authority,
(b) for the Health Authority to vary that person's terms of service for the purpose of or in connection with the imposition of any such conditions,
(c) for the Health Authority to vary the conditions or impose different ones,
(d) for the consequences of failing to comply with a condition (including removal from the list), and
(e) for the review by the Health Authority of any decision made by virtue of the regulations.
(2) The imposition of conditions must be with a view to--
(a) preventing any prejudice to the efficiency of the services in question, or
(b) preventing any acts or omissions within section 49F(3)(a) below.
(3) The lists in question are--
(a) a list of persons undertaking to provide general medical services,
(b) a list of persons undertaking to provide general dental services,
(c) a list of persons undertaking to provide general ophthalmic services,
(d) a list of persons undertaking to provide pharmaceutical services.
(4) If regulations do so provide, they must also provide for an appeal by the person in question to the FHSAA against the Health Authority's decision--
(a) to impose conditions, or any particular condition,
(b) to vary a condition,
(c) to vary his terms of service,
(d) to remove him from the list for breach of condition,
and the appeal shall be by way of redetermination of the Health Authority's decision.
(5) The regulations may provide for any such decision not to have effect until the determination by the FHSAA of any appeal against it.".'.--[Mr. Denham.]
'.--(1) The Common Council may establish a committee which has, in relation to the City of London, the powers which under section 021(2)(f) of the Local Government Act 2000 a local authority's overview and scrutiny committee has in relation to the authority's area.
(2) Sections 7(3) to (6), 8 and 9 and Schedule 1 apply as if such a committee were an overview and scrutiny committee and as if the Common Council were a London borough council.
Mr. Denham: Amendments Nos. 140 to 143, although essentially technical, are vital for the scrutiny arrangements across London and for authorities that operate alternative arrangements under the terms of the Local Government Act 2000. Alternative arrangements will exist where overview and scrutiny committees are not in place.
First, the amendments make it possible for overview and scrutiny committees to join forces with the authorities that are operating alternative arrangements to OSCs under the Local Government Act 2000. Secondly, they give the common council of the City of London the power to establish a committee to scrutinise the NHS, giving the common council responsibility for scrutiny of the NHS in its boundaries. The committee will have powers and duties similar to the OSCs of other local authorities and it will be able to enter the joint arrangements provided for by clause 8.
We have been talking to the common council of the City of London and agreed that, although it is not covered by relevant provisions of the Local Government Act 2000, it should still be able to carry out the same scrutiny of the NHS as other social services authorities. Although the City might not be the most populated part of London, people do live there and important NHS services are provided there, notably at Bart's, which is within the City boundaries. The health services in the City of London need scrutinising, as do other health services.
The Greater London Assembly has made positive representations to the Government about its potential role in supporting the London boroughs in their new NHS scrutiny role. There are examples of NHS services, such as the London ambulance service, where the London boroughs may wish to work with the GLA and its structures to facilitate pan-London scrutiny. The Bill provides powers for the establishment of joint committees which would enable a pan-London committee to undertake scrutiny.
We will carefully consider the ideas coming from the GLA to make sure that it plays a positive role in Londonwide scrutiny of the NHS. The GLA raised a number of issues concerning independent advocacy,