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Baroness Cumberlege moved Amendment No. 6:
The noble Baroness said: My Lords, I should like to move Amendment No. 6 and in speaking to this amendment, I should like to speak also to Amendments Nos. 7, 11, 12, 13, 14, 16, 34, 35, 36, 38, 39 and 40. These amendments all make minor, technical and consequential changes. They ensure that amendments to other Acts of Parliament extend to the same territories as those covered in the original Act, and also that the current range of rules and provisions that apply to family health services also apply to pilot schemes and permanent arrangements.
Amendments Nos. 6 and 7 reverse two changes to the provisions about applications for health service body status made on Report. Those changes were consequential on the amendment to Clause 13(1) which I withdrew on Report. We want to consider those provisions further and hold further discussions with the professions. In the meantime, we need to ensure that the whole clause is consistent and these amendments will achieve that.
Amendment No. 40 makes consequential changes to ensure that complaints to the health service commissioner against self-employed doctors and dentists who choose to work in the new system are treated in the same way as if they were working under existing arrangements.
Finally, Amendment No. 16 is a consequential amendment which simply ensures consistency of language between Sections 97 and 97A of the 1977 Act. These amendments tidy up and help to complete the Bill. I hope that your Lordships will support them.
On Question, amendment agreed to.
Baroness Cumberlege moved Amendment No. 7:
On Question, amendment agreed to.
Baroness Jay of Paddington moved Amendment No. 8:
Page 7, leave out lines 16 to 19 and insert ("the applicant is").
Page 7, line 27, leave out subsection (6).
Before Clause 17, insert the following new clause--
(". All agreements made under this Act for the provision of personal medical services shall be submitted by the Health Authority concerned to the Medical Practices Committee, and shall be subject to the approval of the Committee, as if they were applications to provide general medical services under sections 29 and 30 of the 1977 Act.").
The noble Baroness said: My Lords, the purpose of this amendment is to make one final attempt before the Bill leaves your Lordships' House to ensure that the Medical Practices Committee plays an appropriate role in any new arrangements for primary care which may develop if the Bill becomes law.
The House will remember that concerns about that issue were expressed on all sides during the Second Reading debate, in Committee and on Report last week. Until now, we have not pressed the amendment dealing with the Medical Practices Committee because at every stage we were assured by the Government that the Department of Health was in continuing discussion with the MPC.
We hoped that those discussions would be fruitful and that the Government would bring forward amendments to substantiate the MPC's position. I understand that the most recent meeting between the MPC and the department was on Tuesday of this week, but unfortunately that did not produce any positive outcome and as your Lordships will have observed, there are no government amendments to that effect on the Marshalled List today.
Therefore, we believe that it is very important to reintroduce Amendment No. 8 this afternoon. Perhaps I may briefly--and at the risk of wearying your Lordships who have heard the arguments before--remind the House that the MPC has the statutory responsibility for overall manpower distribution in general practice. The committee does that in the interests of trying to achieve equitable primary care services in the NHS, a goal which we on these Benches feel is an essential aim of the health service.
The MPC carries out that task through the negative power of refusing a GP the opportunity to practice in an area which, from its national perspective, is already adequately covered. On Report, the noble Baroness, Lady Miller, who replied to the amendment, was
As I reported to the House last week, in the current issue of the Health Service Journal the chairman of the MPC points out that the percentage of patients in so-called "under-doctored areas" has gone down from 26 per cent. to 1 per cent. in the past 17 years. That is a very good record and shown by any international standards to be an extremely good performance.
Amendment No. 8 simply seeks to maintain and extend that good record to the new systems of personal medical services which will be created by the pilot schemes allowed under the Bill. Until this legislation proposed almost total deregulation of primary care, no government since 1948 had sought to undermine the strategic function of the MPC. Judging by their responses both in Committee and on Report, the Government seem to be content to pass all those decisions to local health authorities which really have no capacity for a national overview; in other words, the MPC is sidelined. We on these Benches see that as further evidence of the fragmentation of the NHS. We are convinced that the diminution of the MPC's role will produce greater inequities in services which we do not want to see as a result of the Bill. I beg to move.
Baroness Robson of Kiddington: My Lords, I support the amendment, as I have supported the proposal at earlier stages of the Bill. We have benefited enormously from the overview of the MPC over the distribution of GPs throughout the country. Without that we would have found it even more difficult to cover GP places in those parts of the country where it is difficult to find people willing to practise.
It has often been said that the MPC is bureaucratic. But if noble Lords look at the way it functions, I am sure that they will agree with me that it is not. The MPC currently grants applications from between 50 and 100 doctors a week to be included in the medical lists of health authorities. It does so at its weekly meeting, with a staff equivalent to two-and-a-half people who process the papers. If its functions were devolved to health authorities, each of the 105 health authorities in England and Wales would have to undertake such procedures, the object of which is to ensure that only properly qualified doctors practise where they have been given permission. Without doubt the MPC has given an
Baroness Miller of Hendon: My Lords, noble Lords will recall that this amendment was moved on Report. I informed the House then that officials planned to meet the chairman of the Medical Practices Committee and the chairman of the GMSC to discuss how an equitable distribution of GPs can be safeguarded in the light of the provisions in the Bill. I am pleased to say that we believe that good progress has been made.
Agreement has been reached that, subject to some "light touch" national safeguards, there should be greater scope for local people to decide on the distribution of doctors within an authority's area to enable service inequalities to be addressed by those who know best the needs and circumstances of patients and that we should issue further guidance shortly.
Agreement was also reached on the need for a robust national overview of the general practitioner workforce so that a fair distribution between health authorities can be achieved. The MPC has an important contribution to make to this as does the NHS Executive's national resource allocation group which has representatives from the professions and health authorities and input from the academic community. The group advises the Secretary of State on resource distribution to health authorities and has an expertise in assessing the need for different services in different areas. We shall be looking to both the group and the MPC to work together to formulate a national view of GP distribution which can be applied both to the existing arrangements and to the new ones provided for in the Bill.
We are now considering urgently the implications of this agreed approach. In considering both pilots and permanent schemes, health authorities will need to take proper account of local workforce plans and the national overview of the GP workforce in a way which will ensure coherence and consistency with the existing Part II arrangements and produce greater fairness. The Government will be considering amendments which they will need to bring forward in another place to help secure this in the Bill. In view of that response, I hope that the noble Baroness will not find it necessary to pursue her amendment today.
"We find it difficult to see how the Medical Practices Committee--a small committee of some nine people in central London--could effectively second guess judgments taken locally by health authorities about such service issues and effectively have the power of veto over such decisions".--[Official Report, 23/1/97; col. 839.]
But as the noble Lord, Lord Butterfield, pointed out in his contribution to that debate on Report, the MPC has been doing that work since the beginning of the NHS. The noble Lord, Lord Butterfield, said:
"It has done a wonderful job. We should try to retain its guidance to ensure we maintain a good distribution of general practitioners".--[Official Report, 23/1/97; col. 838.]
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