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Baroness Masham of Ilton: I take this opportunity to ask the Minister whether she will tell the Committee how the doctors will be retrained. What will be the position of the medical deans over retraining? Who will assess the doctors before they are put back on the register?

Lord Walton of Detchant: I very much support the arguments which have been set out so very clearly by the noble Baroness, Lady Jay of Paddington, in relation to this issue. At Second Reading I made it clear that the costs of the very complicated procedures which will arise from the passage of this Bill will be borne by the General Medical Council. All of the assessment costs will be covered by it. That means that effectively the medical profession as a whole, through its payments of the annual registration fee, will be paying the costs of the procedures. But I made the case, which the noble Baroness has put so clearly, for suggesting that, while consultants and junior hospital staff, as employees of the National Health Service who come under these

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procedures, will have their retraining costs paid for by the NHS, that will not be the case in relation to general practitioners, who are, as the noble Baroness said, independent contractors. Therefore, I urge that the case which has been put so strongly by the British Medical Association should be reconsidered by Her Majesty's Government.

Having said that, I find it is difficult I fear yet again to support this amendment for purely technical reasons. The Committee should recognise that this Bill is concerned with the powers of the General Medical Council as defined by statute. The council is not a negotiating body; it is not a body which has any political responsibilities whatever. The issue of payment in this situation therefore is to be raised by a body such as the British Medical Association, which negotiates with government on terms and conditions of service. Solely for that technical reason I would find it difficult to support this amendment.

Baroness Cumberlege: During the passage of the Bill both here and in another place we have debated how the costs of the new procedures are to be met. At the heart of the Government's argument is that doctors are members of a profession. All members of professions have a duty to maintain their skills and knowledge and to keep up to date with the latest developments. Where a professional person is employed, he can reasonably look to his employer for support in maintaining his professional competencies. Where, as is the case with GPs, they are self-employed these costs are part of their practice costs and should be met from their income, as the noble Lord, Lord Walton, has said.

As the noble Baroness, Lady Jay, said, GPs are entitled to a postgraduate education allowance of £2,150 a year. The costs of other training is treated as a legitimate practice expense and is tax deductible. Expenses including training are included in the total amount of remuneration agreed by the Doctors and Dentists Review Body. All GPs will benefit from this whether or not they have undertaken training: they are not reimbursed on an individual basis. The doctor who has failed to take up training opportunities in the past will not have borne those costs met by his colleagues who have kept their training up to date. The money is already in his bank and we think it unreasonable that he should expect more for this purpose.

The cost of complying with conditions imposed by the General Medical Council's fitness to practice committees has always been seen as a cost for the individual doctor to bear. It does not seem right that this cost should fall on either the profession as a whole or the public. Are we to make the same provision for other professions as well?

The noble Baroness, Lady Masham, asked whether the postgraduate medical deans would be involved in this exercise with the General Medical Council. I can give her a definitive reply in writing but from a personal point of view I would think it inconceivable that the GMC would not work closely with the postgraduate medical deans. Regarding assessment, it is up to the GMC as to when a doctor is fit to return to practice.

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I cannot support the amendment and I do not recommend it to your Lordships. I hope that the noble Baroness will withdraw it.

Lord Rea: Perhaps I may ask the noble Baroness to think about the kind of doctor who gets into these difficulties. On the whole, this will be someone who may have various failures in his life and he will probably not be in a financial position to find extra money. I am told by a former secretary of the inner London medical committee that the benevolent funds that are available to doctors—general practitioners particularly—in difficulty (the Royal Medical Benevolent Fund and the Cameron Fund) are completely stretched and have no further resources to offer to doctors who might be in such a difficulty. I can imagine that bank managers might not be all that keen to help someone who has been suspended from carrying out his professional duties. It would be useful to have from the Minister some word which suggests that the department might be able to offer some assistance, if only for these doctors to get a loan to pay for the cost of their retraining.

Baroness Cumberlege: That is a matter for the individual doctor to negotiate with his bank manager or whoever. We are very clear on this point, as I said in my remarks opposing the amendment. We feel that the medical profession, as other professions, has a duty to maintain its skill and knowledge and to keep up to date with the latest developments. We do not feel it is appropriate to give financial help for the individual case because we give it already in term of the doctor's total remuneration.

Baroness Jay of Paddington: I am grateful to the Minister for her reply and to other Members of the Committee for taking part in this short debate. I am not convinced by the reply. The noble Baroness has still not made the distinction between continuing medical education of a very general kind and of a rather relaxed and part-time nature and the intensive retraining which will be required of doctors who are judged under the new procedures to be seriously professionally deficient. There is also an obvious disparity in the cost. If the allowance for continuing medical education is in the region of £2,000 a year and the cost of retraining is in the region of £20,000, as has been suggested as an outside figure, there is clearly a considerable disparity between what is given for continuing medical education, which I do feel is the equivalent of the specific retraining, and the £20,000 a year which may be expected to be paid for the specific remedial courses.

When the noble Baroness speaks, as she does, of the responsibility of individual practitioners to maintain their personal skills and expertise in developments in medical science, we all appreciate that and would expect it ourselves. However, as I said in moving the amendment, that does not address those difficult and subtle issues which we debated at length at Second Reading of a doctor whose professional attitude and professional relationship with his patients—not his professional skills—may be deficient and which the noble Baroness agreed at Second Reading might be the subject of the kind of proceedings proposed under the

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new arrangements. I am not aware of there being continuing medical education in changing the bedside manner of doctors, yet that may be something which is the subject of these kind of proceedings.

I suspect that behind the Minister's reply and the attitude of the Government is precisely the rather regrettable attitude to the individual responsibilities of general practitioners, their personal budgets and their personal concerns, and not the collective responsibility for standards in the health service which I would have hoped to see. As I said in moving the amendment, I feel that the effective working of the procedures proposed by the Bill is crucially important to the National Health Service and crucially important to the maintenance of good patient standards and the improvement of patient care. That should be the responsibility of the Government. Therefore, the costs of the retraining should be borne by those who are responsible for what is still the National Health Service. We may need to return to this matter at a later stage. However, for the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 1 agreed to.

Clause 2 [Voluntary removal from the register]:

The Chairman of Committees (Lord Boston of Faversham): In calling Amendment No. 4, I should point out that if it is agreed to, I cannot call Amendment No. 5.

Baroness Cumberlege moved Amendment No. 4:

Page 3, leave out lines 25 to 29 and insert ("—
(a) providing for the erasure by the Registrar from the register of medical practitioners of the name of any person who applies, in the manner prescribed by the regulations, for his name to be erased from the register;
(b) providing for the refusal by the Registrar of applications under paragraph (a) above in such cases and circumstances as may be prescribed by the regulations;
(c) making provision").

The noble Baroness said: In moving this amendment, I should like to speak also to Amendment No. 6. Clause 2 gives the doctor the option to remove his name voluntarily from the medical register. If a doctor decides he cannot maintain a good standard of performance or does not wish to undertake remedial training, he should be allowed to remove his name from the register. Clause 2 provides for this and other similar circumstances in which a doctor may simply no longer wish to be registered; for example, if he is going to work abroad. It also has the effect of providing a quick and easy way for a doctor to remove himself from practice.

The effect of the amendments is to enable the General Medical Council, when making regulations allowing a doctor to remove his name voluntarily from the register, also to provide for the registrar to refuse an application in such circumstances as may be prescribed in those regulations. The GMC intends to refuse an application for voluntary removal only where the doctor is likely to be subject to the professional conduct procedures. Regulations will be made under Clause 2 requiring the approval of the relevant GMC committee before a doctor could be re-registered following voluntary removal in certain circumstances. That would allow a

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degree of scrutiny over the return to practice of a doctor who has voluntarily removed his name. It is anticipated that this scrutiny would be exercised only in a small number of cases where there is evidence that a doctor may have voluntarily removed his name to avoid possible fitness to practice proceedings.

However, during the debate in another place there was concern that some doctors might abuse the provisions of Clause 2 to avoid proceedings concerning serious professional misconduct. The Opposition tabled a number of amendments aimed at addressing that but none of them gave the GMC the flexibility it requires. Both the Government and the GMC recognise that there may be some instances where it is justified that the doctor should remain on the register and face a committee hearing, primarily where it is alleged that a doctor has committed serious professional misconduct. In conduct cases it is important for the case to be resolved at the time. If the doctor was allowed to avoid a hearing by voluntary removal and then applied some years later to be restored to the register, it could be very difficult to re-open and prove the case—especially if a considerable time had elapsed. This is not the case with health and performance where the issue is the doctor's fitness to practise at the time he applies for restoration to the register.

The amendments will enable the GMC to make regulations to allow its registrar to refuse applications for voluntary removal in defined circumstances. This will not only give the GMC flexibility, but also send a message to the profession and the public that the GMC takes a grave view on matters of serious professional misconduct.

I know that my noble friend Lord Harmsworth has been concerned that under the previous wording of Clause 2 the GMC might not make regulations covering the application to subsequently return to the register. These amendments bring together the three strands of the GMC's new powers to make regulations about voluntary removal and re-registration. I hope that this will meet my noble friend's concern.

My noble friend's comments on this matter have proved helpful. The amendment we have tabled has tightened up the drafting of new Section 31A. Rather than subsection (2) being separate, it is now a new paragraph of subsection (1), thereby making quite clear the intention to treat these powers as a single package and not as separate matters. I hope that this fact and my earlier comments reassure my noble friend. I beg to move.

12 noon

Lord Walton of Detchant: This amendment corrects an anomaly in the Bill that was not spotted at an earlier stage. I warmly support it.

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