| Previous Section | Index | Home Page |
Mr. Hutton: I warmly thank hon. Members who contributed to the debate for their remarks. I am grateful to the official Opposition and the hon. Member for Oxford, West and Abingdon (Dr. Harris) for their general support for the new contract. However, I am afraid that I shall lower the tone by saying that the hon. Gentleman's reluctance to express anything like enthusiasm for the decision taken by 80 per cent. of GPs to embrace the new contract was typically curmudgeonly. Although it has nothing to do with the amendments, it is not the case that patients would not have voted for the new contract, although neither the hon. Gentleman nor I can prove that.
The new contract represents a significant development for primary care that will allow us to provide a better range of primary care services than at present. The arrangement is good for GPs and everyone who works in primary care but it has been exclusively driven by our one simple desire to improve the range of primary care services available to the people of this country. I think that people would overwhelmingly vote for that if they were given the opportunity, but I hope that the hon. Gentleman understands from our previous debates that we do not suggest extending the democratic franchise quite that far—we have enough on our plate with NHS foundation trusts.
It is important to bear in mind one or two basic facts and figures about primary care. Much of the debate has been focused on the importance of out-of-hours services, and I agree that they are central to many people's perception of the comprehensive nature of NHS services. GPs and practice staff in primary care deal with about 250 million consultations each year, and 90 per cent. of all patient journeys in the NHS begin and end in a family doctor's surgery. The work done in primary care will certainly be central to the success of the national health service well into the future. I do not question the commitment of the hon. Member for South Staffordshire (Sir Patrick Cormack) to the national health service because he, like me, wants it to be a success. It is important that the issues raised by the hon. Members for South Staffordshire, for South Cambridgeshire (Mr. Lansley) and for Oxford, West and Abingdon are addressed properly as we move toward implementing the new agreement.
There is no doubt that there are risks. Perhaps the most difficult aspects of the agreement were the out-of-hours provisions. I know from my work as a constituency MP that our constituents place a high premium on around-the-clock access to a GP, 24 hours a day, seven days a week. It is a defining characteristic of our primary care services. I can give the hon. Member for South Staffordshire the assurances he seeks: we will implement the agreement to ensure that there is no loss of access to out-of-hours services. That is intrinsic in the agreement that we reached with the NHS Confederation and the British Medical Association. They recognise the importance of the service, too.
7.30 pm
I have had the benefit of talking to many GPs about the new contract. Without exception, they all want the out-of-hours services, and the quality of those services, maintained because doctors care deeply about the well-being of their patients. They will not accept for a second a diminution in the quality of out-of-hours services. I am sorry if my answer was not to the hon. Gentleman's satisfaction, but it will be the responsibility of primary care trusts, in discussions with their local practices, to finalise, over the course of the next year or so, the arrangements that will need to be put in place locally to provide comprehensive out-of-hours services. That will include a proper setting of standards to be met. The arrangements governing accessibility of the service, who comes out to deal with a call and how quickly he or she arrives are important and will need to be put in place. It is a big job, but we have worked actively with primary care trusts to ensure that the hon. Gentleman's constituents, like mine, are not put at risk or disadvantaged. I am sorry if my original answers were not precise enough, but I assure him that that is how we intend to proceed. We would not accept anything less.
The hon. Member for West Chelmsford (Mr. Burns) mentioned the technical aspects and asked me to give an example of how we are reducing the burden or the volume of secondary legislation. I gave him one example and am happy to give him others in due course. He asked how enhanced services will be provided if not through GMS or PMS. They can be provided through the additional third route of directly commissioned PCT services and the services of additional providers can also be used. He also asked whether the minimum practice income guarantee would be covered by directions under proposed new section 28T. It will be. The minimum income guarantee will continue beyond 2006. It is not time limited.
On subsection (4) of proposed new section 16CC, I can assure the hon. Gentleman that the duties are reciprocal. It is not one-way traffic. The duties are broadly designed to deal with some of the cross-border issues that he mentioned, including the need to move to single commissioning of primary care services in those areas if possible.
The hon. Member for Oxford, West and Abingdon asked a number of questions. I am afraid that I shall have to write to him. I hope that he does not mind. He did invite me to go down that path and I intend to take advantage of that get-out. He kept referring to "U2",
which is one of my favourite bands. I did not realise we were debating that today, and I am happy to discuss it with him another time.The hon. Member for South Cambridgeshire asked pertinent questions. Given the time left, I shall have to write to him with further details. I am more than happy to meet hon. Members who contributed to the debate to discuss primary care services at any time in the future. I am also happy to arrange for them to be briefed by my officials, if they would find that helpful. The hon. Gentleman referred to the difficult issue of removing patients from practice lists and how we could deal with that. He is right to refer to sections of the February agreement that attempt to deal with the problem. We intend to use the regulatory powers to set out some of those issues in secondary legislation. It is not an entirely satisfactory state of affairs for any patient to be declined registration or to be removed from a practice. As the hon. Member for Oxford, West and Abingdon said, professional practice guidelines have been set out and we hope people will follow them.
The debate has been helpful. I am grateful for the support expressed for the Government new clauses. I look forward to discussing related issues in due course.
It being six and a half hours after the commencement of proceedings on the programme motion, Mr. Deputy Speaker proceeded to put forthwith the Questions necessary for the disposal of business to be concluded at that hour, pursuant to Order [this day].
Clause read a Second time, and added to the Bill.
New Clause 27
General medical services contracts
'(1) In the 1977 Act, after section 28P (as inserted by section 163 above) insert—
"General medical services contracts
28Q General medical services contracts: introductory
(1) A Primary Care Trust or Local Health Board may enter into a contract under which primary medical services are provided in accordance with the following provisions of this Part.
(2) A contract under this section is called in this Act a "general medical services contract".
(3) Subject to any provision made by or under this Part, a general medical services contract may make such provision as may be agreed between the Primary Care Trust or Local Health Board and the contractor or contractors in relation to—
(a) the services to be provided under the contract,
(b) remuneration under the contract, and
(c) any other matters.
(4) The services to be provided under a general medical services contract may include—
(a) services which are not primary medical services;
(b) services to be provided outside the area of the Primary Care Trust or Local Health Board.
(5) In this Part, "contractor", in relation to a general medical services contract, means any person entering into the contract with the Primary Care Trust or Local Health Board.
28R Requirement to provide certain primary medical services
(1) A general medical services contract must require the contractor or contractors to provide, for his or their patients, primary medical services of such descriptions as may be prescribed.
(2) Regulations under subsection (1) may in particular describe services by reference to the manner or circumstances in which they are provided.
28S Persons eligible to enter into GMS contracts
(1) A Primary Care Trust or Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with—
(a) a medical practitioner;
(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied; or
(c) a company limited by shares where the conditions in subsection (3) are satisfied.
(2) The conditions referred to in subsection (1)(b) in relation to a partnership are that—
(a) at least one partner is a medical practitioner; and
(b) any partner who is not a medical practitioner is either—
(i) an NHS employee;
(ii) a section 28C employee or a section 17C employee;
(iii) a health care professional who is engaged in the provision of services under this Act; or
(iv) an individual who is providing services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements or arrangements under section 17C of the National Health Service (Scotland) Act 1978, or has so provided them within such period as may be prescribed.
(3) The conditions referred to in subsection (1)(c) in relation to a company are that—
(a) at least one share in the company is legally and beneficially owned by a medical practitioner; and
(b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2)(b)(i) to (iv).
(4) Regulations may make provision as to the effect, in relation to a general medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.
(5) In this section—
"health care professional" has the same meaning as in section 28M above;
"NHS employee", "section 28C employee" and "section 17C employee" have the same meanings as in section 28D above.
28T GMS contracts: payments
(1) The appropriate authority may give directions as to payments to be made under general medical services contracts.
(2) A general medical services contract must require payments to be made under the contract in accordance with directions for the time being in force under this section.
(3) Without prejudice to the generality of the power under subsection (1), directions under that subsection may—
(a) provide for payments to be made by reference to compliance with standards or the achievement of levels of performance;
(b) provide for payments to be made by reference to—
(i) any scheme or scale specified in the direction; or
(ii) a determination made by any person in accordance with factors specified in the direction;
(c) provide for the making of payments in respect of individual practitioners;
(d) provide that the whole or any part of a payment is subject to conditions (and may provide that payments are payable by a Primary Care Trust or Local Health Board only if it is satisfied as to certain conditions);
8 Jul 2003 : Column 1053 (e) make provision having effect from a date before the date of the direction, provided that, having regard to the direction as a whole, the provision is not detrimental to the persons to whose remuneration it relates.
(4) Before giving a direction under subsection (1), the appropriate authority—
(a) must consult any body appearing to the authority to be representative of persons to whose remuneration the direction would relate, and
(b) may consult such other persons as the authority thinks appropriate.
(5) Section 18(1) and (3)(b) apply in relation to directions under this section.
(6) References in this section to payments include fees, allowances, reimbursements, loans and repayments.
(7) In this section "appropriate authority" means—
(a) the Secretary of State, in relation to a contract made by a Primary Care Trust;
(b) the National Assembly for Wales, in relation to a contract made by a Local Health Board.
28U GMS contracts: other required terms
(1) A general medical services contract must contain such provision as may be prescribed (in addition to the provision required by the preceding provisions of this Part).
(2) Regulations under subsection (1) may in particular make provision as to—
(a) the manner in which, and standards to which, services are to be provided;
(b) the persons who perform services;
(c) the persons to whom services are to be provided;
(d) the right of patients to choose the persons from whom they are to receive services;
(e) the variation of contract terms (other than terms required by or under this Part);
(f) rights of entry and inspection (including inspection of clinical records and other documents);
(g) the circumstances in which, and the manner in which, the contract may be terminated;
(h) enforcement;
(i) the adjudication of disputes.
(3) Regulations making provision under subsection (2)(c) may make provision as to the circumstances in which a contractor or contractors—
(a) must or may accept a person as a patient to whom services are provided under the contract; or
(b) may decline to accept a person as such a patient; or
(c) may terminate his or their responsibility for a patient.
(4) Regulations under subsection (2)(e) may—
(a) make provision as to the circumstances in which a Primary Care Trust or Local Health Board may impose a variation of contract terms;
(b) make provision suspending or terminating any duty under the contract to provide services of a prescribed description.
(5) Regulations making provision of the kind described in subsection (4)(b) may prescribe services by reference to the manner or circumstances in which they are provided.
(6) A general medical services contract must contain provision requiring the contractor or contractors to comply with any directions given by the appropriate authority for the purposes of this section as to the drugs, medicines or other substances which may or may not be ordered for patients in the provision of medical services under the contract.
8 Jul 2003 : Column 1054
(7) Section 18(1) and (3)(b) apply in relation to directions under subsection (6).
(8) In subsection (6) "appropriate authority" has the same meaning as in section 28T above.
28V GMS contracts: disputes and enforcement
(1) Regulations may make provision for the resolution of disputes as to the terms of a proposed general medical services contract.
(2) Regulations under subsection (1) may make provision—
(a) for the referral of the terms of the proposed contract to the Secretary of State or National Assembly for Wales; and
(b) for the Secretary of State or Assembly, or a person appointed by him or it, to determine the terms on which the contract may be entered into.
(3) Regulations may make provision for a person or persons entering into a general medical services contract to be regarded as a health service body for any purposes of section 4 of the National Health Service and Community Care Act 1990, in circumstances where he or they so elect.
(4) Regulations under subsection (3) may include provision as to the application of section 4 of that Act in cases where—
(a) persons practising in partnership elect to become a health service body; and
(b) there is a change in the membership of the partnership.
(5) Where—
(a) by virtue of regulations under subsection (3), subsection (7) of section 4 of that Act applies in relation to a general medical services contract, and
(b) a direction as to payments is made under that subsection in relation to the contract,
the direction is to be enforceable in a county court (if the court so orders) as if it were a judgment or order of that court."
(2) Sections 29 to 34A of the 1977 Act (arrangements for general medical services) shall cease to have effect.'—[Mr. Hutton.]
Brought up, read the First and Second time, and added to the Bill.
| Next Section
| Index | Home Page |