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Madam Deputy Speaker: With this it will be convenient to discuss the following:

Government new clause 27—General medical services contracts.

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And the following amendment thereto: (a), after 'appropriate', insert—


'(4A) No direction issued under subsection (1) shall involve payment based on rewarding contractors for reaching a target number or target proportion of treatments given.'.

Government new clause 28—Government medical services: transitional.

Government new clause 29—Abolition of pilot schemes.

New clause 40—Definition of personal medical service—


'In the 1977 Act, in section 29(2), leave out "adequate" and, after "attendance", insert "to meet their clinical needs".'.

Government amendments Nos. 270 to 299, 268, 269 and 300.

Mr. Hutton: Following the recent decision by doctors in the British Medical Association to approve the new general medical services contract for family practitioners, the Government are taking the earliest possible opportunity to legislate for the necessary implementation. These clauses were not laid during earlier stages of the Bill's passage because we did not want to prejudge the outcome of the BMA ballot. As it turned out, 79.4 per cent. chose to support the new contract: 31,945 GPs cast a vote, which was a 70 per cent. turnout. That indicates the strength of support for the change.

Mr. Lansley: Will the Minister tell the House when the clauses and amendments were drafted? It may not necessarily have pre-empted the ballot, but it would have informed the House—notwithstanding the requirement for a positive vote in the ballot—if the clauses and amendments had been available for scrutiny earlier.

Mr. Hutton: As the hon. Gentleman will understand, these amendments have been through several iterations in the Department and were not finally ready to be tabled until we were satisfied—as the BMA and the NHS Confederation were—that they provided the right legal framework to deliver the new contract. That was not until Thursday. I apologise to hon. Members and the House for the fact that the documentation that we sent out on Thursday did not reach them until Monday. That is regrettable and I apologise to the hon. Gentleman and other right hon. and hon. Members who take a close interest in these matters. We were genuinely trying to be helpful in that regard. I am sorry if it did not end up like that. To help Members understand the clauses, I wrote to them with an explanatory note last week. I hope that, despite the delays in reaching them, it has turned out to be at least some help for this afternoon's debate.

In general terms, the new clauses are designed to achieve two things: first, to implement the new GMS contract as agreed overwhelmingly by general practitioners; and, secondly, to make provision for putting personal medical services arrangements on to a permanent basis, as originally envisaged in the 1997 Act, in order to reflect the success of PMS as a means of providing primary care services.

In order to effect these changes, we need to give primary care trusts additional powers to commission primary medical services. In the process, our objectives

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have been to simplify the existing legal framework, to minimise the volume of secondary legislation—an inevitable by-product, I am afraid—and to make the new arrangements more straightforward for family doctors, patients and NHS organisations.

New clause 26 replaces the existing duty on PCTs and local health boards to make arrangements for the provision of general medical services with a new duty to provide or to secure the provision of primary medical services. The primary care trust or the local health board can meet this duty by entering into general medical services contracts, personal medical services arrangements, through providing the service itself, or by commissioning services from other health care suppliers. New clauses 27 and 28 provide for the making of the new GMS contract and for the necessary transitional regulations.

New clause 29 and amendments Nos. 278 to 282 will remove the pilot status of personal medical services arrangements and place PMS in the mainstream of delivering primary care services in the NHS. To do that, the power to make pilot schemes will be repealed, and sections 28C to 28E of the National Health Service Act 1977 will be commenced. As part of that process, several amendments will be introduced to sections 28C to 28E, simply to bring them up to date and, in particular, to reflect the changes made to the GMS provisions.

Amendments Nos. 284 to 291 will amend clause 166 to provide for a single list of performers in primary medical services to be held by primary care trusts, replacing the existing three-list structure set out in the Health and Social Care Act 2001. It is a helpful streamlining of those arrangements.

Amendments Nos. 292 to 295 will amend clause 167 to extend the assistance and support provisions to general medical services and personal medical services. Remaining amendments cover minor and consequential amendments and list the associated repeals.

That is what each new clause and amendment does in a nutshell. I would now briefly like to explain that while the new clauses make significant and important changes to the old GMS arrangements, the new GMS contract will retain many of the features of traditional general practice. For example, primary care trusts and local health boards will be under a duty to secure or provide within their areas the provision of primary medical services, to the extent that the trusts or boards consider that necessary to meet all reasonable requirements. It is that legal responsibility to ensure a comprehensive package of commissioning arrangements in respect of primary medical services that underpins the very important patient services guarantee described in chapter 6 of the agreement. We have made copies of the framework agreement available in the Vote Office for right hon. and hon. Members to consult.

Patients need to be assured that the new contractual arrangements do not deny them access to services, and they will not. The new arrangements do not envisage any diminution of the services currently provided under GMS contracts. Indeed, it is envisaged that most practices will continue to deliver the full range of additional services. Where they do not, the PCT must

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step in, and it is in those cases that a patient might need to go to another provider for certain services. The PCT will therefore have a power to commission services through other arrangements, including providing the services itself, if necessary. However, patients can expect the PCT to ensure that they continue to be offered at least the range of services that they currently enjoy under the existing GMS arrangements. That is the patient services guarantee.

All GMS contracts must include a duty to provide essential services, including the management of patients who are ill, or believe themselves to be ill, for the duration of that condition; care for those who are terminally ill; and the management of chronic disease. Where additional services such as minor surgery are provided for patients—that will be the case in all PCT areas, albeit that every practice may not provide such services—existing practices in the PCT or local health board area will start off with a preferential right to provide such services and will normally be expected to do so.

We are also retaining list-based general practice. In future, a patient will not be registered with an individual GP but will still be registered with a practice. A practice-based contract, rather than an individually based contract, will provide much more flexibility for the practice to decide how it delivers services. That will be a helpful degree of flexibility that we will provide for busy family doctors. For example, it will enable nurses to be contracting partners in the practice, which is not possible at the moment.

Once registered with a practice, the patient will continue to have the right to request to be seen by the doctor of their choice. That is important for patients who value seeing their own GP, and I certainly count myself among that number. The PCT will also retain its ability to help patients who, for whatever reason, cannot register with a general practice. It will retain the ability to assign patients to general practice but can additionally, for example, arrange to provide primary medical services itself where that is an appropriate solution.

Sir Patrick Cormack: My constituency has only two practices in which the doctors themselves provide all the out-of-hours services. All the rest contract out that provision. Will that situation change as a result of the Bill? I know from experience that patients prefer to see a doctor from the practice to which they are assigned, rather than some locum from far away.

6.15 pm

Mr. Hutton: I agree with the hon. Gentleman that those are important issues, and patients value that provision highly. The situation will change under the new contract that we have agreed with the BMA and the NHS Confederation. Essentially, it will be for GPs to choose whether to provide an out-of-hours service directly. The new contract will not remove the requirement to provide out-of-hours services, but it will change who has the responsibility to organise the delivery of that service. At the moment, GPs must provide it, and some provide it directly themselves. They will continue to be able to do so if they wish to, but increasingly, for a variety of reasons—including work-

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life balance and other lifestyle issues—GPs do not want that onerous responsibility to fall entirely on their practices. They are happy for the service to be delegated, which is what happens with GP co-ops and other providers. The agreement provides for the PCTs to take on the principal responsibility for organising local out-of-hours services. I hope that they will be provided by patients' own GPs in many cases, but that will have to be decided locally.


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