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Lord Rea moved Amendment No. 26:


Page 6, line 17, leave out ("perform") and insert ("provide").

The noble Lord said: In moving the amendment, I shall, with the leave of the Committee, speak also to Amendment No. 27. The amendment seeks simply to improve the Bill by inserting rather more appropriate language. I feel that the use of the word "perform" is wrong because of its double meaning. We are more inclined to think of a performance as involving someone who is executing some tricks in front of an audience or, indeed, putting on a musical recital. I believe that the word "provide" is better; in fact, the Shorter Oxford English Dictionary defines it as to "supply or furnish" whereas the word "perform" refers to something coming into effect or being "the agent of" something. While speaking to the two amendments, I should point out that there is another part of the Bill--namely, Clause 11(4)--where the word "performing" appears. I also believe that that word should be altered to "providing". With those short remarks, I beg to move.

Baroness Cumberlege: GMS services are delivered through the personal relationship of the GP with the patients on his list. It is the GP who must see to it that GMS are delivered and he remains responsible for this delivery. However, when a GMS (or Part II GP) engages a deputy and, for example, that deputy is on the health authority's medical list, then that deputy, through the existing regulations, will be responsible for his own acts and omissions under the terms of service for doctors. That is because as a professional in his own right of the same standing as the GP he deputises for, it is right and reasonable for him to take responsibility for his acts and omissions while he provides services under a deputising arrangement.

Under the proposed pilot arrangements, the word "provide" has a very specific meaning. A pilot GP might enter into an agreement with a health authority to "provide" services. This means that while the GP may enter into an agreement to "provide" services, he may then actually arrange for the performance of these services by someone else. That is likely to happen when, for example, the GP has agreed to provide chiropody services or the services that are provided by an NHS trust. It then becomes another person's duty to provide those services.

If the word "perform" were replaced by "provide" it would suggest that the regulations would be about more than merely deputising for a pilot scheme GP. It would suggest that the Part II GP would be taking on all of the pilot scheme GP's obligations to provide services under his contract with the health authority (including, for example, arranging for subcontracting of the services to be provided by the pilot scheme GP), whereas the clause

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as currently drafted is only about deputising for the actual performance of medical duties. It is therefore right to talk about "perform" rather than "provide".

Lord Rea: I thank the noble Baroness for her explanation. I do not like the word "perform". I would almost prefer the word "undertake". However, that does not appear in the amendment before us. I undertake to read the noble Baroness's remarks and beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 27 and 28 not moved.]

Clause 12 agreed to.

Clause 21 agreed to.

Clause 13 [NHS contracts]:

[Amendment No. 29 not moved.]

Lord Rea moved Amendment No. 30:


Page 7, line 21, after ("circumstances") insert ("including cessation at that person's request").

The noble Lord said: The amendment seeks clarification. We note that all the pilot schemes are to be conducted on a voluntary basis. However, having agreed to participate it is not clear whether the person concerned has to carry on to the conclusion of the pilot scheme, or whether for personal or other reasons he can leave the scheme before it is finished. In the prescribed circumstances when a person ceases to be such a body, the amendment includes the personal decision of such a person. I beg to move.

Baroness Cumberlege: The effect of Clause 13 is to give providers of personal medical and dental services a choice of whether the contracts they make with health authorities and boards should be ordinary contracts, or NHS contracts. The advantage of the latter is that they provide for dispute resolution by the Secretary of State, thus avoiding time-consuming and expensive recourse to the courts.

Under existing law only so-called "health service bodies" are eligible to make NHS contracts for certain purposes. Clause 13 enables providers to apply to the Secretary of State to become health service bodies. They will then be able to make NHS contracts. The whole arrangement is purely voluntary. We believe that NHS contracts are a sensible, cost-effective arrangement and will encourage GPs, dentists and NHS trusts to opt for them. But there will be no compulsion.

If achieving health service body status is entirely voluntary, then leaving it should also be at the discretion of the person concerned. There would be no point in allowing choice in one respect but not in the other. The purpose of Clause 13(8), to which this amendment relates, is to enable the Secretary of State to make regulations setting out arrangements by which someone can stop being a health service body in certain circumstances. It stands to reason that a request by a volunteer health service body to stop being one is a circumstance that will be covered. The regulations will simply set out the arrangements for this to happen, including dealing with any obligations under existing NHS contracts. Just as a

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GP will need to approach the Secretary of State to become a health service body, so he will need to approach him again to stop being one.

The freedom for GPs and dentists to stop being health service bodies is inherent in the logic of this clause. We will certainly provide for it. But we see no need to spell it out on the face of the Bill. I hope that the noble Lord will withdraw the amendment.

Baroness Gardner of Parkes: My noble friend stated that there would be provision to meet any obligations. If someone seeks to withdraw, is there any cover to ensure that others are not left with heavy obligations afterwards?

Baroness Cumberlege: That is an issue which would have to be explored when the pilot scheme was being proposed.

Lord Rea: I thank the noble Baroness for her detailed answer to a small amendment. I believe that the answer justified the moving of the amendment. We now have something to go on. We shall read Hansard in order fully to understand the answer and its implications. In the meantime, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 13 agreed to.

Clauses 14 to 16 agreed to.

Clause 22 agreed to.

[Amendments Nos. 31 and 32 not moved.]

Baroness Hayman moved Amendment No. 33:


Page 11, line 35, at end insert ("and unless the order has been approved by a resolution of each House of Parliament.").

The noble Baroness said: In moving Amendment No. 33, I speak also to Amendment No. 56, which is consequential upon it.

At Second Reading of the Bill, the noble Baroness, Lady Robson, flagged up the issue of the procedures to be used when certain provisions of the Bill came into force. She argued that it would be necessary to have positive rather than negative procedures in order to ensure parliamentary debate. The amendment seeks to ensure that there has to be positive agreement to provisions under Clause 17 of the Bill.

Clause 17 provides for permanent schemes to be set up. Bringing that provision into force will change permanently the way in which primary health care is delivered.

We believe that the change is important enough to merit another parliamentary debate before schemes are made permanent. It would provide an opportunity for full parliamentary scrutiny of whether the pilot schemes so far evaluated had worked well--that is a question to which the Secretary of State must have regard--and, if so, whether it would be,


    "in the interests of any part of the health service to bring this [new] section into force".
I beg to move.

Baroness Robson of Kiddington: The Minister will know that I support the amendment because I mentioned

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the issue at Second Reading. Before a scheme becomes a permanent part of the National Health Service, in the sense that the schemes can be implemented in other parts of the country, it is important that Parliament should debate the matter. It should not go through on a negative instrument. I prefer it to be an affirmative instrument. I support the amendment.

Baroness Cumberlege: The aim of these amendments is to introduce a more rigorous parliamentary test for the commencement order triggering the provisions on permanent arrangements which may follow piloting.

I understand the thinking behind this--the wish to ensure that permanent arrangements are not introduced until pilot schemes have been properly tested and found to be successful. However, I believe firmly that the safeguards necessary to secure this are already in place in the Bill.

First, there is the voluntary nature of both piloting and permanent arrangements, set out explicitly on the face of the Bill in several places. If pilots fail to deliver, nobody will be able to force GPs and dentists to enter either further pilots of the same kind, or permanent arrangements based on them. They will continue to provide services under existing arrangements. Nor will trusts or other providers be able to take over from them. The skills and experience to provide primary care services rest with GPs and dentists who provide those services at the moment.

Secondly, there is our commitment to a thorough review of pilot schemes, involving the relevant health authorities or boards and providers of services. This will not be an attempt to gloss over difficulties but a frank analysis. We will learn from them. If they show that certain schemes are ineffective, we will not repeat them. We will certainly not attempt to give them the status of permanent arrangements.

Finally, there are the conditions attached to the commencement of permanent arrangements which already appear in the Bill. The two tests that are set are crucial: no permanent arrangements without taking account of the views of pilot schemes--which is why thorough and honest evaluation is so important--and no such arrangements unless the Secretary of State is satisfied that these would be in the interests of the NHS. That surely must be the acid test of any scheme. No scheme that does not work well, and work for patients, could be interpreted as being in the interests of the health service. In today's climate it would be a foolhardy Secretary of State who attempted to introduce permanent arrangements which did not demonstrably meet those strict criteria.

So we are not trying to mask some masterplan with a thin layer of piloting. If schemes work, we will allow them to develop to the point where the Secretary of State's direct approval is not necessary and permanent arrangements can be introduced. If they do not work, we will not hesitate to drop them. I hope that I have demonstrated that the Bill backs that approach with the force of law. The further hurdle proposed by

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these amendments--affirmative resolution--would be without parallel in current NHS legislation. It would also be unnecessary. I hope that the noble Baroness will agree to withdraw the amendment.

7 p.m.

Baroness Hayman: I am grateful for the Minister's comments. I understand that the Secretary of State has to take into account what is in the interests of any part of the health service. However, after the experience of the past seven years at least, we have to conclude that what is in the interests of the health service can be a matter of both dispute and honest disagreement. I am rather saddened that on the issue of the annual report and on this amendment there seems to be a reluctance to have parliamentary scrutiny of what are quite far-ranging changes to the structure of primary care. However, I will read the Minister's remarks. For the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 17 agreed to.

Clauses 18 to 20 agreed to.

Clause 23 [Provision of additional pharmaceutical services]:

[Amendments Nos. 34 and 35 not moved.]


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