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Baroness Jay of Paddington moved Amendment No. 44:
The noble Baroness said: My Lords, the purpose of the amendment is similar to that moved by my noble friend Lady Hayman regarding complaints. It reflects our concerns about whether the right to choose a general practitioner is the same within the meaning of this legislation as the right to be registered with the general practitioner.
Two aspects need to be more specific on the face of the Bill than at present. The first is the patient's right to know, for example, the type of general practice with which he or she is registered. Secondly, will the GP practising under Part I pilot arrangements have a personal list, or will there be a practice list? There are obvious reasons why it is important for patients to know what type of contractual arrangement the GP has. For example, it would affect the hours of availability. A salaried GP might have an agreement under his pilot scheme to work for certain hours. That would be of obvious relevance to a patient who was concerned to make contact with him or her. It affects the nature of the services offered. After all, a GP may also be an independent contractor or employed by a trust.
Originally we and the professional bodies who look after these issues on behalf of the medical profession had understood that patients would continue to register in a pilot scheme with an individual general practitioner regardless of the type of contractual arrangement which was being undertaken by him in that pilot scheme. We understand from the Minister that there would be practice lists. We need to clarify the implications of a practice list before we move to another stage of the Bill.
The questions that arise come under various headings. For the purposes of this debate I merely list them in this order. Is, for example, the right of a patient to choose a GP the same as the right to be registered with an individual GP; or is it a right to be registered with a practice and to choose a GP in that practice without registering with that GP? If it is with a practice, what happens to patients if the GP in a Part I pilot, or indeed a permanent arrangement that may come out of a pilot, wishes to leave the partnership and return to Part II arrangements in the same area? Earlier government amendments were designed to facilitate that on behalf of the general practitioner. But will there be equal safeguards to allow the patient the right to choose whether to remain with the Part I practice in the pilot scheme or to move with his or her original GP who may be leaving the partnership?
When general practitioners in Part II arrangements move to Part I, do they have a right to continue to have their own practice list, or will there be a mechanism that
Those are all significant questions. Earlier we examined government amendments designed to facilitate the rights of GPs to move in and out of pilot schemes. It is extremely important that we have equal clarity in respect of the rights of patients.
There are all kinds of practical arguments and questions. For example, if practice lists are to be created, who would be responsible for patient cover out of surgery hours; and how would patients be made aware of those arrangements? Additional questions were raised in another context by my noble friend Lady Hayman about the responsibility for complaints. In a practice list, who will take the ultimate responsibility for any complaint that is made, however it is administered? These are very important issues on which we need to have clarity. This amendment seeks to put them on the face of the Bill unless the Minister can help us by providing that clarity in her explanation of what lies behind the Government's intentions. I beg to move.
Baroness Cumberlege: My Lords, the problem is principally one of language. I believe our intentions are absolutely at one. We believe that the direct relationship between a doctor and a patient on his list is one of the cornerstones of general practice. We certainly do not seek to change that in any way in the Bill.
Clause 19 secures a patient's right to choose a GP and extends the effects of the existing law to cover personal medical services. We believe that the present wording of the clause in the Bill is the best way to confirm a patient's right, subject to GP consent and any limitation on list size, to that personal relationship.
I shall try to answer some of the questions put by the noble Baroness. I believe she asked: is the right of a patient to choose a GP the same as the right to be registered with an individual GP, or is it a right to be registered with a practice and to choose a GP in that practice without registering with that GP? The patient will continue to have the right to choose to be on an individual GP's list and be registered with that GP, subject to the existing provisions about GP consent and list size. The practice could also choose to run a practice list system. The patient may also choose not be registered with an individual GP but with the practice as a whole. It would therefore be possible to have each doctor in a practice with an individual list of patients and a separate list of patients shared between the practice as a whole depending on the choices that patients made.
The noble Baroness also asked what happens if a practice list is in operation and a partner chooses to move out of the practice. What happens then to the patients--do they stay with the practice or do they move with the GP? Where that is a difficulty, a practice may operate a practice list system. When one or more of the partners decides to leave, both the patients on any individual list of the leaving doctors and those on the
The noble Baroness asked a whole range of other questions. I am very happy to answer them now; however, I am aware that time is going on and there is other business. Especially in the light of the views expressed by the noble Lord, Lord Harris, I am extremely anxious to be conciliatory. Perhaps the noble Lord was not in the Chamber when I withdrew one of the government amendments in just the spirit that he indicated. In addition, I succeeded in speaking with the noble Baroness, Lady Robson, last night, when I gave her an explanation of some of the amendments that we were putting forward, as I did with the noble Baroness, Lady Jay.
Lord Harris of Greenwich: My Lords, I was indeed here when the noble Baroness withdrew that amendment and rejoiced at the time that she had done so. I very much hope that, so far as the remaining stages of the Bill are concerned, the Government will adopt the same position. Without being, as she terms it, conciliatory, the prospect of this legislation getting on to the statute book in this Parliament would be seriously jeopardised.
Baroness Jay of Paddington: My Lords, I am grateful to the Minister for her reply. As she says, this may be a question of language. However, it is obviously not as clear as many people, including professional organisations, are concerned to have it.
I take the Minister's point about not replying in detail to the questions I raised. However, they were put to me by those with a professional concern about this matter, both from the point of view of the patient and that of the profession. This may be another amendment which it would be sensible for her to discuss further with the department and perhaps even with the British Medical Association, as she intends to do with Amendment No. 18, simply in order not to prolong discussion this evening but to be sure that those understandings about language, if it is simply a question of language, are appreciated and agreed upon by all sides.
Baroness Cumberlege: My Lords, I would be very happy to do that.
Baroness Jay of Paddington: My Lords, I thank the Minister and beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Cumberlege moved Amendments Nos. 45 and 46:
The noble Baroness said: My Lords, I have already spoken to Amendments Nos. 45 and 46. I beg to move.
On Question, amendments agreed to.
Lord Walton of Detchant moved Amendment No. 47:
Page 13, line 39, leave out ("choose") and insert ("be registered with").
6.15 p.m.
Page 14, line 13, leave out ("provides") and insert ("performs").
Page 14, line 45, leave out ("provides") and insert ("performs").
Before Clause 27, insert the following new clause--
(" . In the 1977 Act, at the end of section 29(2) insert--
"(h) for the circumstances in which a medical practitioner who is not suitably experienced within the meaning of section 31 or who does not have an acquired right prescribed or otherwise provided for by regulations may provide general medical services.".").
The noble Lord said: My Lords, in speaking to this amendment I must express the hope that my voice will last out. I suspect that I may shortly be seeking primary care. The objective of the amendment is perfectly straightforward, but the practical implications are a little more complex. The 1977 Act to which the amendment refers is the one that required a statutory period of vocational training for all individuals wishing to enter general practice before they could become principals in general practice in the National Health Service.
The amendment would permit the Secretary of State to introduce regulations enabling doctors from outside the European Economic Area--that is not just the European Union, but also doctors from Iceland, Norway and Liechtenstein--who are fully qualified in their own countries, to be involved in international exchanges, visiting the UK for short periods to learn from the experiences of working in general practice and possibly contributing to the education of UK undergraduates.
Many doctors from across the world have come to this country; some junior, seeking postgraduate training and experience, but some of them senior--professors and distinguished consultants--spending periods of sabbatical leave learning about medical practice in the United Kingdom and becoming involved in teaching the programmes. Since vocational training was introduced here in 1977 the quality of general practice and the nature of that training have become greatly admired overseas, not least in the United States, which is far behind us in the development of training programmes in primary care.
The General Medical Services Committee has been talking to the Department of Health on this topic. Many of us had thought that the department would be anxious to resolve the issue to enable doctors from overseas to obtain experience in general practice in this country. We believe that this amendment will provide a useful opportunity to give the Secretary of State power to introduce regulations to facilitate international exchange.
The purpose is that doctors from outside the EEA could be issued with time-limited certificates to enable them to work as supervised deputies in a named practice, assisting with the provision of general medical services. Overseas doctors, including professors of primary care and long-established general practitioners from other countries, should be able to visit the UK for that purpose.
Educational visits to general practices in the UK by GPs from abroad had proved of value but ceased in January 1995 following the implementation of Title IV of EC Directive 93/16, which facilitates the free
The Joint Committee on Postgraduate Training for General Practice in this country does not issue UK certificates to non-EEA doctors unless the individual concerned has completed a period of training in the UK, but my understanding is that that provision applies to individuals who might wish to become principals in general practice. I am subject to correction by the Minister but I do not believe that that should, or indeed could, preclude the issue of time-limited certificates to doctors from overseas wishing to work in a supervised capacity in a named practice.
One hopes that the passage of this amendment will enable regulations to be introduced requiring that a visiting doctor would work under the supervision of a principal on a medical list who had been approved as a supervisor; secondly, that the GP supervising the visitor would be responsible for any breach of terms of service occasioned by the visiting doctor; and, thirdly, that a time-limited visiting certificate could be issued which would not carry with it any right to make application for inclusion on a health authority's medical list and which would require that the doctor could only practice in a named practice or practices. My understanding is that recent draft proposals relating to immigration and employment would allow such doctors to be attached to practices in the UK.
I believe that the problems of registration with the General Medical Council could be overcome. After all, for many years temporary full registration has been offered to visiting professors coming to this country from abroad. There was even a situation some years ago when Japanese doctors coming to look after Japanese nationals working in the UK were allowed to have temporary full registration to enable them to work in that capacity.
The amendment covers only England and Wales. If, as I hope, it is acceptable to the Government, a similar amendment would be necessary to amend the 1978 National Health Service (Scotland) Act. I beg to move.
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