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Baroness Cumberlege: Perhaps I can start by thanking the right reverend Prelate the Bishop of St. Albans for his insight into this subject. I take the opportunity to express a personal regret that this is the last day that the right reverend Prelate will grace this Chamber. I am very unhappy therefore to have to disappoint him on this occasion.

The noble Baroness, Lady Masham, through this amendment, seeks to empower the committee on professional performance to impose conditions on a doctor's practice which would require him to undergo remedial training or to be supervised by another doctor. Making continued registration conditional on remedial training will usually only be appropriate where the doctor refused to take any remedial action and there has been no improvement in his performance. The performance procedures are designed to allow a doctor's standards of practice to be assessed and, where that standard is deficient, to allow him the opportunity to remedy the deficiency. That point should be reached long before the case is considered appropriate for the Committee on Professional Performance, the committee which can impose conditions on a doctor's registration.

Where a case does reach the committee, it may wish to make registration conditional on retraining or supervision, or both, in many of the cases where it imposes sanctions. However, the powers that already exist in the Bill will allow the committee on professional performance to impose just those types of conditions. The powers for the committee to impose conditions are similar to those which govern the Health Committee and the Professional Conduct Committee which have, in the past, included making registration conditional on retraining or supervision.

I hope that that explanation meets the points made by the noble Baroness, Lady Jay, and the noble Lord, Lord Rea. We feel that there is no need for this amendment and hope that the noble Baroness will withdraw it.

Baroness Masham of Ilton: My Lords, I thank all noble Lords who have spoken and explained their views. I thank particularly the right reverend Prelate the Bishop of St. Albans and wish him well. I hope we see him back here, perhaps not on duty but as a visitor.

I wish also to say that there is a likeness between the ministry of the Church and the ministry of medicine. There is a feeling that the health service, which belongs to the people, should be an open service. We shall consider carefully what has been said—we have the

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Summer to digest it—and may come back at the next stage of the Bill. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Jay of Paddington moved Amendment No. 3:

Page 2, line 14, at end insert (", the costs of compliance with any such requirements to be paid out of money provided by Parliament").

The noble Baroness said: I beg leave to move Amendment No. 3 which stands in my name and that of the noble Baroness, Lady Robson of Kiddington. This amendment follows closely the previous one moved by the noble Baroness, Lady Masham, and was in fact originally grouped with it. I hope that when I have explained my reasons for moving it, the Committee will understand why we decided to ask for it to be considered separately.

The amendment is designed to ensure that those doctors who are required by the General Medical Council to undertake remedial training will not be financially penalised by paying for that retraining themselves. If the amendment is accepted, the cost will be borne by public funds.

As I understand the present proposals, doctors who hold hospital contracts—those employed by NHS trusts—may expect retraining costs to be paid for by the relevant employing trust; they at least have the opportunity to apply to their employer for that financial help. On the other hand, GPs (family doctors) as independent contractors with the health service, will be required to pay from their personal budgets. The British Medical Association is very concerned that this creates an unfair distinction between the two categories of doctor, both of whom are liable to be judged professionally deficient on the same basis but who will then be differently treated. On these Benches we believe that this is an anomaly in the Bill which should be prevented by amending it as Amendment No. 3 suggests.

I mentioned at Second Reading that there has been correspondence between the British Medical Association and the Minister for Health, Mr. Malone, about this question since the Bill finished proceedings in another place. The BMA has now asked that the Family Health Services Authority, or presumably from next April the successor Health Authority, should reimburse GPs for any costs incurred. As the noble Baroness, Lady Robson, established at Second Reading, these might include the costs of employing a locum practitioner while the GP attended courses and so on, as well as the GP paying for those courses.

Unfortunately, the noble Baroness, Lady Robson, cannot be with us today, but as the Committee will have seen, she supports this amendment and her name is to it as well. However, so far it seems that the Government are not prepared to act on this apparent anomaly. In his most recent letter, dated I believe 5th July, to Dr. Ian

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Bogle, who is the chairman of the British Medical Association's General Medical Services Committee, Mr. Malone said:

    "GPs are not employees of the NHS, but independent professional contractors. They are responsible for meeting their own practice costs including the cost of maintaining their professional skills and knowledge. The GMC's guidance is quite clear that it is a doctor's professional duty to maintain his standard of performance by keeping his knowledge and skills up to date throughout his working life ... Where a GP fails to do so and his professional performance becomes seriously deficient it is not for the taxpayer to have to spend yet more money on that doctor".

I have two reasons for disagreeing with those points, and I hope that the Minister in this House will accept the amendment. First, it seems to me to be inappropriate to equate the special retraining proposed under this Bill with the general continuing medical education now available to all doctors, and indeed in many cases required of them. Continuing medical education is offered to the profession as a method for maintaining their general knowledge and development in the relevant areas of both science and technology, as indeed Mr. Malone agrees in his letter to Dr. Bogle.

If successful, it is of course very important in preventing some of the failures of competence which could lead to a doctor being reported to the GMC under the new procedures which we are discussing today. However, the continuing medical education programme is not designed to address particular gaps in knowledge or skill, or indeed to counteract any of the more subtle problems of attitude and outlook which several noble Lords raised at Second Reading and which the Minister agreed were covered by the terms of this Bill.

As described, the remedial training which a doctor may be required to undertake under the new procedures will be specifically designed to assist that individual to bring his or her professional performance up to standard. It could be intensive and conducted full-time on a short-term basis. Indeed, the Minister said in her very helpful letter to noble Lords who took part in the Second Reading debate before this stage of the Bill that it could take six months in order to get a doctor back onto the right track.

This obviously will not be the same as attending afternoon lectures or weekend seminars, which often constitute continuing medical education and for which the postgraduate educational allowance exists. The costs will be high. It has been calculated that they may be as much as £20,000 including locum cover.

My second argument for this amendment is about the size of those costs. As I say, it has been calculated that they could reach something in the region of £20,000. As the Bill stands, a professionally deficient GP will face what amounts to a very substantial personal fine of many thousands of pounds, as well as being compelled to undertake retraining. This appears to be in contradiction to the general spirit of the new measures, which is to be remedial and not punitive. It has been responsibly suggested to me that the size of the personal costs which may be directly incurred by an offending GP may actually reduce the effectiveness of the procedures because, for example, colleagues of a doctor

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who may judge that he is performing badly will hesitate to start investigations which could lead to such harsh financial penalties.

It is particularly important to the health service that this legislation should succeed so that standards of patient care are maintained and improved. In the view of most Members on this side of the House, the NHS responsibility for success should include bearing the costs of remedial retraining for all the doctors concerned. I beg to move.

11.45 a.m.

The Viscount of Falkland: I rise briefly on behalf of my noble friend Lady Robson of Kiddington, who is unable to be with us today, to support the amendment of the noble Baroness, Lady Jay. It seems to my noble friend Lady Robson and to other Members on these Benches that it is unfair and possibly damaging to make the distinction between consultants who are going to be fully reimbursed for their training and GPs. Although the arguments in the letter from the noble Baroness' department say quite correctly that doctors are responsible for all the costs involved in running their practices and so on, and indeed for most of their training, it seems to us that to achieve the standards that we wish in primary care—and it is only fair to patients in particular—there should be a high standard of performance by GPs. To achieve that, remedial training is obviously of vital importance and GPs should be assisted in the same way as consultants.

The noble Baroness, Lady Cumberlege, was kind enough to write to my noble friend on the subject of costs which, I understand, range between £6,000 and £22,000. She confirmed in the letter that the locum costs, which are quite a considerable part of the remedial training, are included in those figures. I hope that the noble Baroness will respond positively to the noble Baroness's amendment. It seems to us that her amendment is consistent with the aims of the noble Baroness and her department to achieve the highest standards for both consultants and GPs.

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