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Baroness Robson of Kiddington moved Amendment No. 19:
The noble Baroness said: I shall not take long in moving this amendment. It is a necessary amendment because it deals with two aspects of a pilot scheme. It seeks to provide that no pilot scheme should be implemented for less than 18 months before the evaluation takes place.
The primary health care service is extremely complicated and it is necessary that a scheme should run for at least 18 months before it is evaluated. But it is necessary also that it does not run for ever and ever without being evaluated. That is why the amendment provides a maximum of three years.
We feel that it is necessary to have this amendment in the Bill because of what we consider were the unfortunate circumstances in relation to the pilot scheme for the nursery voucher scheme. We do not want that treatment to face the people who are working with the implementation of the pilot scheme. I hope that the Minister will be able to grant us the approval of this amendment that we seek. I beg to move.
Lord Rea: I support the amendment. By time limiting the pilot schemes, the amendment would stimulate the evaluation team to clarify the criteria on which the evaluation of the scheme would be based. I believe that the evaluation should be in the minds of those who are running the scheme right from the inception of the scheme, even before it starts. To have a set limit for the scheme helps very much to concentrate the minds of those who are to carry out the evaluation. Therefore, I support the amendment.
Lord Harmsworth: Does the Minister agree that when a large number of pilot schemes are set in place, it may well be possible to evaluate some of those which fall into a pattern before the 18 months have expired?
Baroness Cumberlege: We are committed to thorough reviews of pilot schemes because we wish to ensure that we learn from experience and establish what works well and what works less well. However, the variety of schemes that we hope will emerge makes it difficult to prescribe a fixed timescale for the operation and evaluation of all schemes--a point made by my noble friend Lord Harmsworth. We believe that, as we
Some schemes are likely to become established more quickly than others and will therefore be ready for evaluation more quickly. More ambitious schemes may need a longer period to settle down and demonstrate their effectiveness. We must ensure that schemes are given enough time to become established before they are evaluated so that we can get a good idea of how the pilot scheme is performing. The Secretary of State will set a timescale for each pilot that he approves with that in mind. Therefore, there will be flexibility, which is important, but also we shall ensure that each scheme has a regular plan to it.
It is likely that the vast majority of pilot schemes will be evaluated within the timescale specified in this amendment, but there may be exceptional cases where the timescale will be inappropriate. For example, where several of the individual GPs providing services under the pilot change, perhaps because of personal circumstances unrelated to their work, more time may be needed for the pilot to become established and to demonstrate its effectiveness. A three-year review could be premature and perhaps of little value. Conversely, it is possible that some pilots involving very small changes in existing arrangements could be ready for an earlier evaluation.
Therefore, we agree with the timescales set out in the amendment as general rules but we believe that it would restrict unnecessarily our initiative if we were to try to set those timescales on the face of the Bill. Therefore, we do not support the amendment.
Baroness Robson of Kiddington: I thank the Minister for that reply. I am glad that she believes in the principle. I thought that I was providing sufficient flexibility by specifying between 18 months and three years. I want to prevent a pilot scheme running on indefinitely without evaluation. The noble Baroness gave an example which may need a time extension, but that could almost be considered to be a new pilot scheme because the people involved would be different. Therefore, I should like to see a maximum of three years.
I can see also that when a scheme is running--and some pilot schemes are already in existence--there may be similar pilot schemes which are not quite the same thing but would need perhaps a shorter evaluation timescale. However, I am determined that pilot schemes should not run indefinitely. I shall read what the Minister said and perhaps return to this matter at a later stage. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 20 to 23 not moved.]
Clause 10 [Leaving medical lists]:
Baroness Hayman moved Amendment No. 25:
The noble Baroness said: In moving this amendment, I seek clarification in relation to Clause 10, which I must admit I found rather difficult to understand. As I read it, personal medical services are those provided under pilot schemes and schemes that then become permanent schemes under this legislation. General medical services are provided by family practitioners under Part II of the 1977 Act or Part II of the 1978 Act.
Clause 10 appears to separate those two functions and to ensure that a medical practitioner who is undertaking a pilot scheme under this Bill should not be a medical practitioner who is receiving remuneration under Part II of the 1977 Act. I seek clarification as to why someone who is providing GMS under the 1977 Act should be debarred from providing also PMS, which may be different and involve different services, under this Bill.
I should also like to probe a little into the exceptional circumstances, or the "prescribed" circumstances, where there would be exceptions to the rule. There is a reference in Clause 10(1) to there being "prescribed" circumstances and their extent, to the effect that there might be exceptions from the barring of people performing both sorts of medical services, both personal and general. I should be most grateful to receive some clarification from the Minister about what those circumstances might be. I beg to move.
Lord Alderdice: We certainly support the amendment. We have some concern because we want to see some creativity; indeed, we want to see people coming forward with pilot schemes. However, we are worried that this may actually deter general practitioners because it will be asking them to move out from a circumstance to which they are accustomed and with which, in many cases, they are very happy, into a very unknown field. We do not feel that is a particularly helpful approach. We heard the earlier advice from the Minister in that regard, but we are still rather puzzled as to why there is the need to split things in quite this way. As I said, we support the amendment.
Baroness Cumberlege: We believe that the national arrangements which have formed the link between GPs and the NHS have served us well. They date mainly from 1948. But our wide-ranging discussion on primary care has also made it clear that the services these arrangements deliver--for some patient groups and in some areas--are not always of the highest quality. It has also become clear that we need to consider new ways of addressing those problems.
The proposals set out in Choice and Opportunity are not forcing GPs to move into a completely different system. What we are proposing is that where GPs wish to test out a wide range of contractual options to see what benefits they will bring, this legislation will allow that to happen. The overriding aim must be to deliver high quality primary care from well-motivated professionals.
Considerable flexibility is required in this legislation to provide the scope to enable the potentially wide variety of arrangements that are likely to be proposed to take place. Part II of the 1977 Act does not provide the flexibility to allow these broad ranging changes to be put into effect. The Bill will provide a base which will enable a wide and diverse range of arrangements to be brought about.
It is important that it is clear under which arrangements GPs provide services. They should provide them either under the existing Part II arrangements or under the proposed pilot arrangements. It would be a bureaucratic nightmare to have GPs who provided services under both arrangements. It would be difficult for GPs and health authorities and potentially confusing for patients. What we want is a coherent and seamless service from our GPs. This amendment would not further that aim. Because a GP who takes part in the new arrangements will no longer be participating in the Part II arrangements they no longer need to be on the health authorities' medical list, the list being a list of the GPs in each area who are providing Part II services.
We made a commitment in Choice and Opportunity that GPs should not be disadvantaged by taking part in the new arrangements. We have also made a firm and solid undertaking that participation should be voluntary. These pledges are backed up by the provisions in Clause 11 which will allow for a GP to transfer to a medical list where a pilot ends for any reason, and which we shall debate in due course.
The MPC will of course continue to have an important role, particularly in relation to existing arrangements where it will continue to approve vacancies. But one of the reasons for the pilots is to improve the distribution of GPs which remains uneven because the MPC only has powers of negative direction. Both locally and nationally we need to discuss with the professions what a fair distribution of services would be. Then Part II general practice, pilots and permanent schemes will all need to develop in a way which is consistent with fairness. We shall be discussing with the GMSC how best to achieve that aim. I hope that that is a sufficient explanation for the noble Baroness.
Baroness Hayman: I am grateful to the Minister. We are on technical territory here. The Minister talked about the bureaucratic implications as regards the people involved in both sets of services. There are also implications about the funding streams, together with difficulties about the two sets of funding. I listened to the Minister's response, but I have residual concerns that we may in fact be stifling innovation--a point made by the noble Lord, Lord Alderdice. There are potential circumstances in which someone who is delivering most of his services as mainstream services under GMS might still wish to be involved in an innovative project, which was not a full time one, and in providing services that were very specific and more innovatory. However, I shall read with care what the Minister said on that point. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 12 [Liabilities and obligations in relation to deputies]:
Page 4, line 3, at end insert ("not less than eighteen months and not more than three years after the date on which the pilot scheme comes into operation.").
Page 5, line 27, leave out ("not").
6.45 p.m.
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