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The noble Lord said: My Lords, this amendment seeks to ensure that pilot schemes involve general practitioners who are in active general practice. We believe that the Bill should clarify that only general practitioners currently on medical lists and who are active in the National Health Service should be involved in pilot schemes. The concern of the Royal College of General Practitioners, and of many others, is that doctors who are eligible to work in general practice, but who are not currently involved actively in it, may become involved in pilot schemes; for example, in a trust, or even a private company setting up some kind of pilot scheme which will deliver only parts of the full range of primary care. As the Bill stands, it seems that pilot schemes could be set up without reference to general practitioners. We are concerned that the present system,
One of the key roles of general practitioners is to be the advocate of patients and their interests. It is particularly important to ensure that patients have appropriate, necessary and timely access to secondary care services. As an independent contractor within the NHS, a GP has a unique role through the referral system in obtaining access to secondary care for patients. We believe that that may be undermined by general practitioners who may be recruited from outside the present system. They may be salaried and they may have a conflict of interest between the commercial interests of their employers who are setting up the pilot scheme and those of their patients.
These are the anxieties that I have and which have been expressed to me by other general practitioners. I shall be very grateful if the noble Baroness can either accept this amendment or give me some reassurance that the Government will follow at least the principles which it implies. I shall be very interested to hear her reply. Perhaps it will not be necessary to press this amendment if she can give us something to go on. I beg to move.
Baroness Cumberlege: My Lords, I shall do my best to reassure the noble Lord. This amendment aims to reinforce the emphasis on a team-based approach in primary care. That is an objective that the Government very strongly share. The White Paper Delivering the Future puts forward specific proposals to this end. We shall expect proposals for pilot schemes to reflect that approach. But putting conditions on GPs who have an automatic right to have their pilot proposals put forward will not necessarily help. On the contrary, it might even hamper desirable proposals from those who wish to use piloting to develop more collaborative ways of working, perhaps through a practice-based contract.
We would also see difficulties emerging over how,
We believe that the principle of encouraging team-based family health care service teams is better served through the assessment of the quality and suitability of proposals in the approval process. I hope that that gives the noble Lord enough to go on, as he put it, and that he will not press this amendment.
Lord Rea: My Lords, I thank the noble Baroness for those words, which we shall read in detail. She certainly reassures me that it is her intention at least that these pilot schemes will improve primary care in this country. I am sure that she means what she says. But we have to look at what the Bill will allow. After we have scrutinised her words and had another look at the Bill, I give notice that we may yet return to this matter at Third Reading. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 3 [Approval of pilot schemes]:
Baroness Jay of Paddington moved Amendment No. 9:
The noble Baroness said: My Lords, I spoke to this amendment with Amendment No. 4. I beg to move.
On Question, Whether the said amendment (No. 9) shall be agreed to?
Page 3, line 15, after ("lists)") insert ("and who is actively working in general practice as part of a primary health care team").
"actively working in general practice as part of a primary health care team",
would be defined in practice. It would be unhelpful if a relatively simple application process were made more complex and subject to argument simply over status.
Page 3, line 24, at end insert--
("( ) The Secretary of State may not approve proposals for a pilot scheme unless he is satisfied that the scheme will satisfy standards and criteria for the quality of services provided to patients determined by a national representative group established by the Secretary of State for this purpose.").
4.58 p.m.
Acton, L.
Addington, L.
Archer of Sandwell, L.
Ashley of Stoke, L.
Berkeley, L.
Borrie, L.
Broadbridge, L.
Bruce of Donington, L.
Calverley, L.
Chapple, L.
Clancarty, E.
Cledwyn of Penrhos, L.
Clinton-Davis, L.
Cocks of Hartcliffe, L.
Darcy (de Knayth), B.
David, B.
Donoughue, L.
Dormand of Easington, L.
Dubs, L.
Eatwell, L.
Gallacher, L.
Geraint, L.
Gould of Potternewton, B.
Graham of Edmonton, L.
Grenfell, L.
Grey, E.
Hanworth, V.
Harris of Greenwich, L.
Haskel, L. [Teller.]
Hayman, B.
Hilton of Eggardon, B.
Hughes, L.
Jay of Paddington, B.
Jeger, B.
Jenkins of Hillhead, L.
Jenkins of Putney, L.
Judd, L.
Lester of Herne Hill, L.
Lockwood, B.
Longford, E.
McFarlane of Llandaff, B.
McIntosh of Haringey, L.
McNair, L.
McNally, L.
Masham of Ilton, B.
Mason of Barnsley, L.
Merlyn-Rees, L.
Morris of Castle Morris, L. [Teller.]
Murray of Epping Forest, L.
Nicol, B.
Ogmore, L.
Paul, L.
Peston, L.
Plant of Highfield, L.
Prys-Davies, L.
Ramsay of Cartvale, B.
Rea, L.
Richard, L.
Robson of Kiddington, B.
Rodgers of Quarry Bank, L.
Serota, B.
Stoddart of Swindon, L.
Strabolgi, L.
Symons of Vernham Dean, B.
Thurlow, L.
Tordoff, L.
Turner of Camden, B.
Wallace of Coslany, L.
White, B.
Whitty, L.
Williams of Crosby, B.
Williams of Elvel, L.
Williams of Mostyn, L.
Winston, L.
Aberdare, L.
Addison, V.
Ailsa, M.
Alexander of Tunis, E.
Anelay of St. Johns, B.
Astor of Hever, L.
Balfour, E.
Barber of Tewkesbury, L.
Beloff, L.
Bethell, L.
Blake, L.
Blaker, L.
Blatch, B.
Bowness, L.
Brabazon of Tara, L.
Brookes, L.
Butterfield, L.
Byford, B.
Cadman, L.
Campbell of Alloway, L.
Campbell of Croy, L.
Carnegy of Lour, B.
Chesham, L. [Teller.]
Clark of Kempston, L.
Coleridge, L.
Courtown, E.
Craigavon, V.
Cranborne, V. [Lord Privy Seal.] Cumberlege, B.
Dean of Harptree, L.
Denbigh, E.
Denham, L.
Denton of Wakefield, B.
Dixon-Smith, L.
Downshire, M.
Eccles of Moulton, B.
Eden of Winton, L.
Elibank, L.
Elles, B.
Elliott of Morpeth, L.
Elton, L.
Flather, B.
Fraser of Carmyllie, L.
Goschen, V.
Hacking, L.
Hailsham of Saint Marylebone, L.
Harding of Petherton, L.
Harmsworth, L.
Hayhoe, L.
Hemphill, L.
Henley, L.
Holderness, L.
HolmPatrick, L.
Howe, E.
Inglewood, L.
Jenkin of Roding, L.
King of Wartnaby, L.
Lauderdale, E.
Lindsay, E.
Liverpool, E.
Long, V.
Lucas, L.
Lucas of Chilworth, L.
Lyell, L.
McColl of Dulwich, L. Mackay of Ardbrecknish, L.
Mackay of Clashfern, L. [Lord Chancellor.] Mackay of Drumadoon, L.
Macleod of Borve, B.
Marlesford, L.
Massereene and Ferrard, V.
Merrivale, L.
Mersey, V.
Miller of Hendon, B.
Milverton, L.
Monteagle of Brandon, L.
Mottistone, L.
Mountevans, L.
Mowbray and Stourton, L.
Munster, E.
Murton of Lindisfarne, L.
Nelson, E.
Norfolk, D.
Northesk, E.
O'Cathain, B.
Orr-Ewing, L.
Oxfuird, V.
Park of Monmouth, B.
Pender, L.
Pike, B.
Pilkington of Oxenford, L.
Platt of Writtle, B.
Plummer of St. Marylebone, L.
Quinton, L.
Rankeillour, L.
Reay, L.
Renton, L.
Renwick, L.
Romney, E.
Rotherwick, L.
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Seccombe, B.
Selsdon, L.
Shaw of Northstead, L.
Skelmersdale, L.
Strange, B.
Strathcarron, L.
Strathclyde, L. [Teller.]
Strathcona and Mount Royal, L.
Sudeley, L.
Swansea, L.
Swinfen, L.
Taylor of Warwick, L.
Tebbit, L.
Terrington, L.
Teviot, L.
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Trumpington, B.
Vivian, L.
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Young, B.
Resolved in the negative, and amendment disagreed to accordingly.
5.7 p.m.
Baroness Cumberlege moved Amendment No. 10:
The noble Baroness said: My Lords, in moving Amendment No. 10, I should like to speak also to Amendments Nos. 11, 23, 30, 32, 36, 39, 43, 45, 46, 65, 67, 76 and 78 to 84. These amendments tidy up the drafting of the Bill and aid interpretation by clarifying some of the provisions. Examples include Amendments Nos. 10, 11, 30 and 36 which ensure that, while providers of services such as GPs and dentists will be able to withdraw from taking part in the schemes if they
Amendment No. 65 provides that where references are made in any legislation to Section 28C or Section 17C arrangements, that should be read as referring to both pilot and permanent schemes. That means that the clauses in the Bill such as those securing the right of patients to choose their doctor and dentist, and the consequential amendments to other legislation contained in Schedule 2, apply to all PMS and PDS schemes. In addition, we shall need to bring forward a number of consequential amendments at Third Reading to ensure that various relevant Acts of Parliament apply to the new system, as they do to the existing one.
We worked hard to table as many government amendments as possible at the end of last week and at the beginning of this week to give noble Lords the maximum time to consider them. We accept, however, that your Lordships may not have had adequate time to consider some of the amendments that were tabled later. We have therefore withdrawn many of those amendments and propose to return to the matters that they cover at Third Reading. Those matters are fundholding, principally providing a return ticket to those fundholders involved in the new arrangements, ensuring that NHS trusts can play their full role in the new arrangements, making a number of minor and consequential changes to the provisions in connection with the sale of medical practices, and making further minor or consequential amendments, including changes to other legislation. I hope that your Lordships will be content to consider those matters at Third Reading. The amendments in this group are technical but important and I commend them to the House. I beg to move.
Page 3, line 26, leave out ("participants") and insert ("any participant other than the authority").
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