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Mr. Denham: The doctor still has to exercise his professional responsibilities under those circumstances. I may be missing the hon. Gentleman's point— Dr. Brand: If the Minister will allow me— Mr. Denham: If the hon. Gentleman will let me get two words out before he leaps to his feet, it may be best if he made another speech on the subject. To be perfectly honest, we have been through the matter several times already and I am struggling to understand the hon. Gentleman's difficulties. I would prefer a clearer exposition that I have heard so far in the hon. Gentleman's brief interventions. The hon. Member for Runnymede and Weybridge sought an assurance, as he always does, that we are not proposing some Machiavellian back-door way of doing away with independent contractor status— Mr. Hammond: It is eroding. Mr. Denham: No, it is about establishing a better framework for ensuring that doctors, particularly locums, are properly regulated and supported. The list means that for the first time we can develop a proper system of appraisal for locum doctors akin to the system that applies to GPs. That has never existed before and amounts to one of the greatest single gains from our proposals. Dr. Brand: The Liberal Democrats welcome the idea of bringing locums out from the cold and into a regulatory framework, but let me have a final go at explaining my difficulty with developments under PMS. When a PMS project is led by a person who is not on a list—it could be any employer—the doctor will have to work to directions, so it is the employer who determines the patterns of work. The employer will decide what activity is to be performed by doctors and what by nurses. If the doctor has no control over how the work is shared out within the PMS project, people who are not on any list will be carrying out duties usually done under the supervision or control of people who are on a list, such as principals. The professional doctor may have no control over activities for which he may be held accountable by a controlling authority. I am sorry if that is complex, but surely the Minister can understand that explanation, however inadequate, of my real anxieties. Mr. Denham: I am struggling a little. The hon. Gentleman is presenting a caricature of nurse-led PMS contracts and conjuring up an anti-nurse-led PMS contract vision of dictatorial nurses forcing GPs not to follow their usual professional responsibilities— Dr Brand rose—
Mr. Denham: Let me pursue this line of argument. Consistent with the hon. Gentleman's argument, it would be impossible for hospital doctors to carry out their responsibilities because they are employed by another organisation. I do not accept that. Under PMS, irrespective of whether doctors are the contract holder with the health authority, they are responsible for their patients. Nothing overrules that. We are simply ensuring that all PMS doctors are on a list. At present, unless they are principals, they are not. Dr. Brand: I hear the Minister's explanation, but hospital doctors are not on a supplementary list. They are accountable to their employing authority, the hospital, as are other practitioners within the team. I do not have an anti-nurse-led PMS worry, but a worry about PMS itself. That is why I developed the point about corporations running PMS services. Either accountability stops with the practitioner on the definitive or supplementary list, or the employer must become more directly accountable—in the same way as practitioners. The solution is to put either practitioners or the employing authority on a list. Mr. Denham: The hon. Gentleman is completely missing the point. Previously, he asked whether commercial companies would be allowed to provide a service in the same way as corporate dental bodies. I said no, that is not happening, but it does not follow that there is no accountability. The health authority has a contract with a nurse-led practice, which provides the line of accountability. It is a different issue from ensuring that all the health service practitioners covered in part II are on a list. Mr. Hammond: First, the Minister did not deal with the split between England and Wales. Secondly, throughout his remarks he referred to locums. I assume that the hon. Gentleman uses the term as a short hand because GP registrars and anyone either training or employed in general practice as a doctor will also be covered by the regulations. It irritates GP registrars enormously when patients refer to them wrongly as locums. Mr. Denham: The hon. Gentleman is right. I have used the term as a short hand for a larger group of non-principals. The term ``assistant'' is defined in the GMS regulations, where other definitions are also set out. The Welsh Assembly passes Welsh regulations made under the 1977 Act, so the lists are different. Amendment agreed to.
4.38 pmSitting suspended.
5.7 pmOn resuming— Mr. Denham: I beg to move amendment No. 134, in page 19, line 8, leave out `by health Authorities'. The Chairman: With this we will consider Government amendment Nos. 163 and 166. Mr. Denham: I can assure the Committee that this and the remaining Government amendments to the clause are essentially technical and consequential. Amendment agreed to. Amendment made: No. 99, in page 19, line 20, at end insert—
Mr. Denham: I beg to move amendment No. 135, in page 19, line 33, leave out `49K(1)' and insert `49K'. The Chairman: With this we will take Government amendments Nos. 136, 100 to 103, 147, 105 to 108, 164, 165 and 167. Mr. Denham: These are simply technical and drafting amendments. Amendment agreed to. Amendment made, No. 136, in page 19, line 49, leave out `8A' and insert `8ZA'—[Mr. Denham.] Clause 25, as amended, ordered to stand part of the Bill.
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| ©Parliamentary copyright 2001 | Prepared 25 January 2001 |
