Health and Social Care Bill

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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 pm

Sitting suspended.

5.7 pm

On 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—

    `( ) circumstances in which a person included in a supplementary list may not withdraw from it,'.—[Mr. Denham.]

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.

Clause 26

Suspension and disqualification of practitioners

Amendments made: No. 100, in page 20, line 10, leave out `section 19 of'.

No. 101, in page 20, line 19, after `practitioners' insert `and dental corporations'.—[Mr. Denham.]

Mr. Denham: I beg to move amendment No. 137, in page 21, line 2, leave out `49M' and insert `49MA'.

The Chairman: With this it will be convenient to take Government amendment No. 162.

Mr. Denham: The provisions of amendment No. 162 will prevent a practitioner who has been disqualified from a health board list by an NHS tribunal in Scotland or Northern Ireland from being included on any list in England or Wales. Specifically, it enables the Secretary of State to make provisions in regulations to recognise the decisions of Scottish and Northern Irish tribunals in England and Wales. It is essential to ensure that there are robust arrangements across the UK so that practitioners removed from lists in one area of the country do not appear in another area. Contractors who are unfit to practice in Scotland or Northern Ireland are likely to be unfit to practice in England or Wales. Indeed the FHSAA will not be able to overturn or review a decision of a Scottish or Northern Irish tribunal. I am sure that everyone will agree that this is an important provision to ensure patient safety. Amendment 137 makes a consequential change to the numerical reference in the clause to reflect the addition of the new section.

Mr. Swayne: I could have dealt with this point in an intervention, but I failed to catch the Minister's eye. I was wondering about the degree of discretion that the amendment appears to give the Secretary of State. I refer specifically to the phrase in parentheses and ``whether or not exactly'' the two things may correspond to what has happened in a health board in Scotland, for example, as against the circumstances in England. Can the Minister give an example to bring that to life so that we can understand precisely what is meant?

Mr. Denham: I believe, and I will certainly write to the hon. Gentleman if I am wrong, that because the tests that we are introducing on suitability, efficiency and fraud into the English legislation do not mirror directly the tests applied by the NHS tribunals in Scotland and Wales, which currently have the test of efficiency, they do not map on to each other directly. It will be necessary to allow one to be translated into the other to achieve the same effect.

Amendment agreed to.

Mr. Denham: I beg to move amendment No. 138, in page 21, line 23, leave out from `they' to `with' in line 26 and insert

    `so decide, they must impose such conditions as they may decide on his inclusion in the list'.

The Chairman: With this it will be convenient to take Government amendments Nos. 139 to 141 and 150.

Mr. Denham: This group of technical amendments clarifies the provisions of the Bill in relation to the health authority's power to make a contingent removal from its main practitioner list when dealing with inefficiency or fraud. The most substantial changes are made by amendments Nos. 138 and 139, but they essentially clarify the policy intention rather than change direction or add a new function. Amendment No. 138 makes it clear that if a health authority makes a contingent removal it must apply conditions on the practitioner with a view to removing any prejudice to the efficiency of the NHS or preventing further fraud. Essentially, if one limits a person's scope to practise because of a particular problem, one must limit it in a way that deals with the problem.

Amendment No. 139 clarifies that where a practitioner fails to meet any such conditions, a health authority can vary them, apply new ones, or remove the practitioner from the list. Amendment No. 150 is a consequential drafting amendment. Amendments Nos. 140 and 141 are technical amendments to ensure clarity of the powers in the clause. I hope that that is sufficient for the Committee.

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