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Baroness Cumberlege: My Lords, I beg to move that the Bill do now pass. In doing so I wish briefly to state that I think this is an important piece of legislation affecting a key part of our health service--primary care. Current arrangements have served us well for almost half a century. But it is clear that they lack flexibility to tackle some of the diverse health needs that arise in different areas.
The Bill aims to provide that flexibility. It seeks to do so in a way which maintains the principles of quality, fairness, accessibility, responsiveness and efficiency which are at the heart of primary care. It proposes a way forward, through piloting, which allows us to learn as we go.
I thank your Lordships for the attention given to the Bill. It has been good to see a consensus on the broad principles behind it--a consensus which also extends to the professions. We have had some lively and informative debates. The amendments moved by your Lordships have contributed greatly to that. I shall resist the temptation of mentioning noble Lords individually as I understand there is great pressure for further Business this evening. However, I am happy to have been able to give several undertakings on matters such as the relationship between patient and GP and consultation. I was especially pleased to accept earlier today the proposal of the noble Baroness, Lady Robson, on a maximum time-span for pilots.
It is with some regret that I was unable to agree with the noble Baroness, Lady McFarlane of Llandaff, on the role of nurses in the context of this Bill, but we are at one in both being vice-presidents of the RCN and in agreeing on the increasingly important role of that profession within the NHS and in primary care in particular.
The Bill does not impose a template for future services. Instead it frees health professionals to work with health authorities to develop local solutions to local needs. The UK primary healthcare system is the envy of the world and the Bill will allow it to develop its potential still further. I look forward to seeing its safe passage through another place and on to the statute book. I commend the Bill to the House.
Moved, That the Bill do now pass.--(Baroness Cumberlege.)
Baroness Jay of Paddington: My Lords, we have had some interesting and illuminating discussions on this innovative Bill. We on these Benches remain supportive--as we were at Second Reading--of the principle of making primary care organisation more liberal. We particularly welcome the idea that long-term changes will only be made once pilot schemes have been allowed to run their course and have been properly evaluated. However, we cannot forbear to remark, even at this late stage of the Bill, that this is certainly a change of direction for the present Government in making changes to the NHS.
As I said in earlier debates, this is essentially an enabling Bill and some of the changes in prospect we are sure will be useful. We particularly welcome the possibility that pilots may include the employment of GPs by hospital trusts in areas of deprivation where places have been difficult to fill under the long-standing arrangements of GP contracts. We are sorry--I gather from the Minister's remarks that perhaps she is sorry too--that the Government resisted amendments which sought to include nurses as lead players in the new role that they may have in new forms of general practice. We hope that this may still be considered.
We are also concerned that the Government resisted the amendments we proposed to broaden the consultation perspective on the Bill so that those outside the professions, as well as those inside them, could take a view on the future prospects for their local services. We were delighted to hear the Minister this afternoon accept the amendments which had earlier been proposed by the noble Baroness, Lady Robson, about the length of pilot schemes, which obviously had a great deal of force behind them. We are also grateful that the Government seem to be in positive negotiation with the Medical Practices Committee about the essential nature of an overall strategic approach to the manpower questions of general practice in the NHS as a whole.
We welcome, of course, positive liberalisation and experimentation, but our greatest concern is that it may become in practice a form of rather chaotic deregulation if commercial organisations are allowed to get a toehold in the general practice system. We tried again today to ensure that there are safeguards in this regard but once more our proposal was defeated. I hope that when the Bill reaches another place the general assurances about agreements that have been reached with the British Medical Association--the Minister spoke of them this afternoon--will be translated into specific amendments which protect general practice pilots from the kind of commercial influence which we still fear may occur.
I am grateful to the Minister and to the noble Baroness, Lady Miller, for their full and courteous replies to our amendments, even if they have not always been, in our view, totally helpful. I also thank the Minister for her detailed briefing on Government amendments which she gave us at the later stages of the Bill. I am particularly grateful to my noble friends Lady Hayman and Lord Rea whose long experience and understanding of the health service has meant that they have spoken with great authority on the amendments that they have proposed.
This is a short Bill but nevertheless an important one, as the Minister said. We have been helped by outside organisations who are concerned about the Bill. I particularly wish to mention the Royal College of Nursing, the Royal College of Midwives, the British Medical Association and the Medical Practices Committee whose concerns have been widely aired in your Lordships' House. We have also received useful advice from the Royal Pharmaceutical Society, local authority associations and the National Consumer Council, as well as the Consumers Association and the Association of Community Health Councils.
That long list of organisations which have aided our understanding of the Bill and which have raised questions on the Bill that we have subsequently asked gives a taste of the level of concern there is on these changes to primary care which the Bill proposes and promotes. We all wish the Bill well in another place. I suspect that there will be some vigorous attempts to amend it particularly in the areas that I have described which remain of concern to us. I look forward to those debates, and indeed to the acceptance of some other amendments by the Government.
Baroness Robson of Kiddington: My Lords, I wish to add a few words on the Bill. We believe that it opens up
great opportunities to improve the primary care service within our communities but that process must be carefully controlled by set criteria so that the service does not end up being good in some parts of the country but not so good in others.We are happy about the voluntary, non-enforcement aspect of the pilot schemes. Previously, the Government and the Department of Health have tended to lay down the rules from the centre. If that process is properly handled, it will grow of its own accord into something which will be of great value to the nation. I like some of the provisions in the Bill to which we have agreed, for example, that a general practitioner can now be employed on a salaried basis. That should be helpful to many practices.
The other provision we welcome with open arms is that health authorities are no longer forced to appoint, in single doctor practices, from among the three finalists in the competition. That was the previous procedure irrespective of whether or not anyone was any good. The new provision was overdue; now it is in the Bill. I am very grateful to the noble Baroness for agreeing to my suggestion that the pilot schemes should last for only three years.
As was evident today, we were worried about the problem of commercial contractors and the removal of overall control of manpower from the Medical Practices Committee. However, we received certain assurances from the Minister which we hope will be even more clearly defined when the Bill goes to another place.
My one regret is that we did not have written into the Bill provision on pension rights for nurses and staff working in the primary healthcare sector. I know that the Government gave an assurance in their White Paper, but I would love to have seen a reference on the face of the Bill. That aside, I join the noble Baroness, Lady Jay, in thanking Ministers, and all the various organisations which sent us so much advice. I wish the Bill great success in the other place.
Lord Colwyn: My Lords, in even fewer words than the noble Baroness, Lady Robson, used, I thank my noble friend for the splendid way in which she piloted this Bill about pilot schemes through the House. Often the Government do not consult dentists. Sometimes I am not sure that they even understand the difference between a general medical practitioner and a general dental practitioner. Dentistry is often forgotten in service planning and is added as an afterthought, far too late. I am delighted that in this Bill we see an assurance that dentistry will continue to play an important part in primary care. I hope that the attitude to my profession will remain the same. I welcome the Bill.
On Question, Bill passed, and sent to the Commons.
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