Health Bill

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Dr. Murrison: I am particularly pleased to intervene, because it seems that the Minister was about to make a political point, and we would not want that, would we? As a matter of interest, do the sight test regulations include the need to screen for, say, glaucoma? Perhaps I should know the answer, but I do not. This is important, because most opticians carry out such a test as a matter of course, and I suspect that the Minister, who has referred to the sight test regulations, will know whether the regulations in fact include that need.

Caroline Flint: I do not think that they do, but I am happy to write to the Committee on exactly what the sight test regulations cover, if that would be helpful. I think that that is all.

Mr. Lansley: Tariff?

Caroline Flint: On the tariff point, I do not know whether payment by results would apply to these services, but some issues are totally separate. The dental contract, for example, is totally different from the payment by results service. My hon. Friend the Minister of State, Department of Health, has been very forward-looking in getting dentists away from the old system of payment simply for drill and fill rather than considering people's real dental health needs. That will contribute hugely to preventing unnecessary drilling and filling, and will give dentists more of an opportunity to provide a full service. I will write to the hon. Gentleman about that if there are any issues that connect those two areas.

Question put and agreed to.
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Clause 35 ordered to stand part of the Bill.

Clause 36

Persons performing primary ophthalmic services

Question proposed, That the clause stand part of the Bill.

Dr. Murrison: The clause should not detain us for too long. I know that I have said that before, but I really mean it this time.

I am very grateful for the Minister's lengthy exposition of the list held by the PCTs. She said that members of the Committee needed to be educated about the list, and I am very grateful for her attempts to do so. I believe, however, that we are really talking about two lists—I refer to the lists suggested in new subsection (2A).

Lists are obviously important to the clause. The first is a list of practitioners who are qualified, and the second is a list of contractors. Given the importance that the Minister places on lists, it would be useful if she outlined what she means by a list, how one becomes a member of that list, and whether there are indeed two lists, one of which is of contractors who may not be qualified to provide ophthalmic services in the way that I understand the Minister to mean, and the other of which is of persons who are qualified to provide those services as dispensing opticians, as ophthalmic medical practitioners and so on. That is important, because we have spent some time discussing how one might become a member of that list and how one might be disqualified from it, and we need to know which list we are dealing with.

In that context, it would also be useful to have the Minister's clarification of what is driving all this, as she seems to be concerned about the current level of opportunity for dispensing opticians and what she calls lay members to provide those services. Apart from the fraud issue, which we discussed earlier, much of this part of the legislation appears to be driven by the need to enhance the opportunity for the category of people who are lay members or dispensing opticians.

In the context of our discussion on the possibility of opening up the provision of enhanced and additional services to a range of providers, it seems that the Minister is exercised about potential providers that do not have someone who is currently qualified to provide primary ophthalmic services.

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If that is the case, the Minister should say so categorically. Perhaps she should also say what representations she has received from organisations that have a lay member or a dispensing optician who may wish to apply for contracts. The whole thing has been driven by their needs rather than by those of the rest of the professions who might deliver primary ophthalmic contracts or by those of patients in particular.

The clause makes reference to medical practitioners who might apply for inclusion in a list and to the fact that regulations may prescribe their qualifications and experience. I could find no reference to regulations
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that may prescribe the qualifications and experience of dispensing opticians and optometrists; none of that is laid out in the clause or elsewhere in the Bill.

That is strange and I wonder why ophthalmic medical practitioners, which I would understand to mean doctors who are qualified in ophthalmology and who are qualified to carry out primary ophthalmic services, are singled out to have their experience and qualifications defined whereas other professionals in the field are not. I am not making a judgment about whether that is a good or bad thing; I am merely intrigued to know why a difference is being established between those two groups: the ophthalmic medical practitioner, who is essentially a doctor who is additionally qualified, and dispensing opticians, optometrists and so on. It would be interesting to hear the Minister's rationale for that. I am sure that there is a good explanation in addition to her comments about the list.

Caroline Flint: As I said earlier, at present PCTs can contract with providers for NHS sight tests only if they are optometrists, ophthalmic medical practitioners or corporate bodies registered with the General Optical Council.

On the hon. Gentleman's other point, currently there are cases where dispensing opticians employ a qualified optometrist or someone else who is suitably qualified, and PCTs have to contract with individual clinicians. Lay people are in exactly the same situation. All we are doing is making sense of a situation that is already occurring. I gave examples earlier: a qualified optometrist might often provide services at a number of different business service providers. There are issues in relation to the roving person and the contract.

Clause 36 is entitled ''Persons performing primary ophthalmic services''. It aims to ensure that, as occurs in relation to medicine and dentistry, only practitioners on PCT performers lists will be able to undertake sight tests under NHS arrangements. That is because it is important that those who are performing the ophthalmic, clinical service meet the necessary clinical standards and that only professionals who are registered with the appropriate regulatory body and are otherwise fit and appropriate persons can undertake sight testing under NHS arrangements. It is important that that is clear and that we ensure that the regulations, on which there will be full consultation, are clear about it as well.

I come now to the qualifications that will be prescribed for practitioners on the performers list. As now, sight-test practitioners must be registered with either the General Optical Council or the General Medical Council. In the latter case, they must also meet prescribed requirements on qualifications and experience. The qualifications required to carry out either additional or enhanced services will be set out in regulations when the services are determined. The General Optical Council already has powers to establish specialists lists of practitioners who have an interest in a particular area and who have undertaken the necessary additional training, and we anticipate
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that those lists will provide the basis for the standards required.

The qualifications required of clinicians providing primary ophthalmic services other than the sight test will also be set out in regulations. PCTs must ensure that they contract with people who will be employing appropriately qualified professionals. The General Optical Council has powers, as I said, to establish specialists lists of optometrists or dispensing opticians who have undertaken additional training in particular areas, and we anticipate that optometrists and dispensing opticians undertaking additional or enhanced services would be drawn from the practitioners on those lists.

The clause is about those persons who perform clinical services, and ensuring through regulations and discussions with the appropriate councils and professional bodies that there is rigour in the system to protect public safety and the interests of patients. I hope that deals with the hon. Gentleman's points.

Dr. Murrison: I am interested in how the list will cope with locums. Optometrists often do locums. A requirement for them to be on the list will build into the system an inflexibility that may make it difficult to employ locums.

Caroline Flint: I am not sure why that would be the case. For example, once an individual is on the performers list of one of the PCTs in Doncaster, they could practise in any part of England. They are not limited in that respect. All things being equal, this one step covers the whole picture. A situation in which a clinical professional had to sign up on every performers list around the country would be ridiculous.

The difference between the performers list and the contractors list is that the contractors have to contract with each PCT area that they cover. In some cases, PCTs work across two PCT areas—that is a separate issue. However, once a clinical professional is on a performers list—whether with the hon. Gentleman's PCT, with your PCT, Mr. Illsley, or with my PCT—they would be eligible to perform services anywhere in England. I hope that that reassures the hon. Gentleman.

Dr. Murrison: Indeed it does, but another issue occurs to me in connection with the Minister's elegant explanation of the situation. Can the Minister assure me that a person's disqualification will be articulated throughout the whole of the PCT network, as an optometrist who is disqualified by one PCT could seek to get on the list of some other PCT?

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