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Lord Walton of Detchant moved Amendment No. 3:
The noble Lord said: My Lords, the noble Lord, Lord Colwyn, has asked me to move the amendment in his place as he is exercising his professional skills elsewhere. If this had been a purely dental amendment I should not have felt able to move it. My friendly relationship with my dentist has always been based upon the old principle that in my life there is one greatest thrill; what the dentist does when he stops the buzz and puts away the drill.
The amendment relates to an issue of importance to both the medical and dental professions. In the amendment local representative committees embrace local medical committees, as referred to in the NHS Acts; local consultative committees, which are the Scottish equivalent; and committees of GPs, dentists, optometrists and pharmacists. That is why the amendment includes the word "appropriate".
At Second Reading on 17th December the Minister said that the Government,
I have been advised that both the British Medical Association and the British Dental Association believe that the local medical committee and the local dental committee respectively have a unique overview of the provision of services in their locality such as workforce issues and the health needs of their local populations. They represent the voice of their local doctors and dentists as a whole, including those who may put forward proposals for pilot schemes.
The whole purpose of this simple amendment is that the necessity for the Government to consult with these local representative committees should be on the face of the Bill. I beg to move.
Lord Colwyn: My Lords, I apologise for arriving in the House just as the amendment was called. I took the precaution of ensuring that the noble Lord, Lord Walton, had a list of the points that I wished to make. I am sure that he made them perfectly adequately and I commend them to my noble friend the Minister.
Baroness Hayman: My Lords, I support the amendment, limited though it is. At other stages of the Bill we discussed our concerns about the need for wide consultation with members of the professions and the public both when the schemes are initially put forward and when the Secretary of State examines the results of pilot schemes. The amendment fulfils one area of those concerns in that it will ensure professional consultation at the stage when the Secretary of State is evaluating pilot schemes. We welcome that.
We are worried that the amendment does not deal with the wider issues of public consultation which were discussed and widely supported throughout the House. However, I am sure that my honourable friends in another place will return to that issue when debating the Bill. We support this limited amendment.
Baroness Cumberlege: My Lords, I hope that during the different stages of the Bill I have demonstrated that consultation will be a key feature of piloting. However, we are not indifferent to the strength of feeling expressed by many of your Lordships and in the light of this we will consider whether some of the undertakings we have given might be given greater force on the face of the Bill. We will, if appropriate, come back with amendments in another place. I hope that on that basis the noble Lord will not seek to press the amendment.
I should like to return briefly to a related matter--the amendments put forward by the noble Baroness, Lady Robson, in Committee and again at Report stage, about timescales for pilot schemes. We remain concerned that a minimum timespan of, say, 18 months could hold up evaluation and perhaps a wider application of straightforward schemes that quickly prove their worth. However, on further consideration we accept that three years is an appropriate maximum timespan for a pilot. For the vast majority of schemes, three years will be long enough to demonstrate whether they have met their objectives. If any need longer, it may well be appropriate to evaluate them so that interim lessons can be learned. I am grateful to the noble Baroness, Lady Robson, for putting forward that point and I confirm that we shall introduce an amendment in another place to insert a maximum time span of three years into the Bill.
Baroness Robson of Kiddington: My Lords, I am very grateful to the Minister for agreeing to the three years as a maximum length of time for the evaluation.
Lord Walton of Detchant: My Lords, with the assent of the noble Lord, Lord Colwyn, and in the light of the Minister's assurances, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Cumberlege moved Amendment No. 4:
Page 4, line 11, at end insert ("and
(c) the appropriate local representative committee or local consultative committee, as the case may be.").
"are committed to working with representatives of the professions at national level on matters such as detailed operational arrangements and general criteria for evaluation of schemes".
Locally, the Government will expect health authorities, GPs and dentists to work together on proposals. The Minister also said:
"Local representative committees have a role, particularly in considering the implications of the proposed pilot schemes on existing arrangements".--[Official Report, 17/12/96; col. 1426.]
She also referred to powers in the 1977 Act.
After Clause 11, insert the following new clause--
(".--(1) Regulations must be made providing for a medical practitioner who--
(a) has provided or performed personal medical services under a pilot scheme, and
(b) in contemplation of doing so, gave up fund-holding status,
to be allowed to return immediately to fund-holding status on satisfying the Secretary of State that, if he were granted that status, he would be able to fulfil the conditions for the time being in force for continuing to have it.
(2) For the purposes of this section "fund-holding status" has such meaning as may be prescribed.").
The noble Baroness said: My Lords, in moving this amendment, I should like to speak also to Amendments Nos. 9, 10, 15, 24, 25, 26, 37 and 4l. The purpose of these amendments is to enhance choice and opportunity for GPs. Fundholding is at the cutting edge of primary care, leading the way to improved health care on a number of fronts. It will be no surprise if a number of fundholders want to take part in pilots. During the wide-ranging consultation that we carried out last year fundholders were instrumental in pressing for the flexibilities that the Bill provides. There is no doubt that fundholding continues to bring many benefits to patients; one only has to look at the effects that fundholders, who group together to form what are known as multifunds, have had in raising standards of care for patients in the inner city. In Newham this form of collaboration between fundholders, the Newham Multifund, has increased the influence of both doctors and patients and has raised the standards of primary care.
As your Lordships are aware, the principle of involvement by enthusiastic volunteers is central to the Bill. Piloting will be by volunteers and it follows that volunteers should be able to leave the pilot if they so wish. Amendments Nos. 4, 9 and 10 provide for those GP fundholders, who decide to enter into a PMS pilot, or later on into the permanent arrangements, to be able to return to the fundholding scheme. If they can fulfil the relevant conditions, they will be able to return without needing to apply in the same way as a new fundholder. Their previous experience of the scheme will carry with it the appropriate weight and it is right that they should be able to return to fundholding with immediate effect.
Amendments Nos. 15 and 24 make clear which health authority or board will be responsible where members of a fundholding practice also provide personal medical
Amendment No. 37 makes it clear that GPs who provide PMS, other than those who are employed, may apply for recognition as a fundholding practice.
Amendment No. 37 and the Scots equivalents, Amendments Nos. 25 and 26, make various further amendments to Sections 14 and 15 of the 1990 Act and Sections 87A and 87B of the 1978 Act concerning fundholding practices. Some of the amendments ensure that the fundholding provisions in the Act apply not just to doctors who have individual lists of patients but also to doctors who have one practice list. That will not undermine the personal relationship between a GP and his patients. That is clearly prized by both doctors and patients and the current right of a patient to choose his or her GP is restated in Clause 20. It merely recognises that, in the future, some patients may wish to choose to be a patient of a practice rather than an individual GP. I commend these amendments to the House.
On Question, amendment agreed to.
4.45 p.m.
[Amendment No. 5 not moved.]
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