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Mr. Denham: One of the delicious ironies of serving on the Committee at this moment in history is that the casual visitor from Mars might have difficulty in identifying which Front-Bench spokesman was the product of the party of closed shops, trade union power and overbearing centralisation, and which was the representative of the radical, libertarian, free-market right. We have taken the unusual step of referring in the Bill to consultation with the BMA for the purposes of the clause. I can tell the hon. Member for Runnymede and Weybridge that that is not without precedent, because there is a similar measure in the 1999 Act, although it is unusual. The issue is one of great sensitivity among members of the profession, so we want to consult them, and that is recognised in the Bill. We intend to mirror, for PMS, the regulations across the different lists. It would not be satisfactory for GPs to have a different set of criteria on which to be judged unsuitable or for a different process to be in place. There is a wider issue. A distinction must be drawn between the common or garden use of the term ``to consult'', which means seek the views of or hear the opinions of, and the formal definition for negotiating purposes, which is what the amendments would bestow. Our view is that PMS is a voluntary, local contract, entered into by GPs at local level. It is perfectly appropriate for GPs who are considering doing that to be represented by the BMA through the local medical committee. Indeed, during the passage of the previous Act, we changed the legislation to enable PMS GPs to be members of the local medical committee and to be represented by them. Because of the voluntary nature of that contract, it would not be right for us to agree a framework in which the general practitioners committee nationally could determine the contract that someone could enter into at local level through his formal negotiating rights. That said, we are anxious to work with the BMA and a range of other organisations for the successful development of PMS. We have set up a PMS implementation group. Dr. Doug Naysmith (Bristol, North-West): I share the Minister's delight in hearing the hon. Member for New Forest, West arguing for what amounts to trade union negotiating rights. That is almost unprecedented in the House. I take everything that the Minister has said. It is important that people do not get the message that PMS is in any way second-rate compared with GMS. The Minister is sending the message that PMS is important to the 10-year plan for the NHS. Mr. Denham: The fact that 22 per cent. of GPs have opted to work on PMS pilots suggests that the more flexible way of working, under which remuneration much more closely reflects the clinical quality of patient service than in the GMS contract, is attractive to them. The BMA rightly has formal negotiating powers on the national contract, and we are seeking to agree a new contract with more emphasis on quality and outcomes. PMS is enabling innovative GPs throughout the country to find new ways of working and providing services that are popular with their patients. I have given assurances about the effect of the amendments on the regulations. We want uniformity across the list, and the Bill provides for consultation on GMS. I ask the Committee to resist the amendments. Dr. Brand: I listened carefully to what the Minister said, and I was thinking particularly about an earlier commitment that he made. He said that PMS was a voluntary arrangement and there would always be the opportunity to opt out of it and return to GMS. Can we have an assurance from the Minister that should that option no longer exist—and I believe that it could be extinguished without primary legislation—he will not extinguish the option of either staying in or returning to GMS without bringing in the necessary consultation powers, which are not unreasonable, proposed by the hon. Member for New Forest, West?
5.45 pmMr. Denham: The hon. Gentleman has made a fair point. There is a stage at which PMS pilots may become permanent in the future, and that is set out in the Bill. I would need to refer back to the 1977 Act to see whether it has the consequential effect of eliminating the possibility of removing GMS. I will look at that issue and write to the hon. Gentleman. Mr. Swayne: I accept what the Minister says about having taken the unusual step of putting the requirement to consult in the Bill. He has done that in 24 in respect of general medical services, but not respect of personal medical services. Precisely that omission gives rise to the suspicion that has always existed about the Government's motives for PMS. I can understand the Minister saying that a different kind of negotiation and consultation would be appropriate for PMS, although I disagree—for precisely the reasons that I set out in respect of the national infrastructure to which the national plan refers. I can understand the Minster deciding that the consultation on PMS should be different from the consultation in clause 24, but clause 27 contains no requirement for consultation. If the Minister has ideas about a different type of consultation before the regulations are made, perhaps he should have put something in the Bill. We have not found what the Minister has said reassuring, but because of the drafting errors in our own amendments, we will not press them. However, I give notice that we will seek to return to the matter on Report. I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Amendments made: No. 165 in page 26, line 12, leave out `8A' and insert `8ZA' No. 111, in page 26, line 40, leave out from beginning to end of line 41. No. 166, in page 26, line 46, leave out `by Health Authorities'. No. 112, in page 27, line 9, at end insert—
No. 167, in page 27, line 31, leave out `49k(1)' and insert `49k'.—[Mr. Denham]. Clause 27, as amended, ordered to stand part of the Bill.
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| ©Parliamentary copyright 2001 | Prepared 25 January 2001 |
