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Baroness Robson of Kiddington: My Lords, on behalf of these Benches, I too welcome these amendments. This is much too late a stage to start even trying to play around because it is not possible to achieve anything. We may not have 100 per cent. of what we were asking for but it is a tremendous improvement on the Bill as it was drafted and we welcome that.
Baroness Cumberlege: My Lords, I thank noble Lords for their support for the principle of the Bill. I understand the point made by the noble Baroness, Lady Jay, as to how we managed to clarify, throughout the course of the Bill, some of the fears and misunderstandings which were originally apparent.
At one point during the course of the passage of the Bill, the noble Baroness was concerned about my use of the word "chatter"; that there was a good deal of chatter going on as regards commercialisation. I should like to assure your Lordships that no organisation has approached us to explain how it thinks it might be able to provide services under the new provisions in the Bill. Therefore, I am very happy to put clearly on the record exactly what the provisions mean. We have taken great care to rule in members of the NHS family and to define that and to rule out others. Now the only companies whose proposals may come forward to the Secretary of State and which may make contracts with health authorities to provide services under the Bill are those which fall within the definition of a qualifying body. We have defined a "qualifying body" very carefully; that is,
- "a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (c) or (e) of subsection (2)".
I believe that the situation is now crystal clear. As my noble friend Lord Campbell of Croy said, we believe that we have the support of all the health professionals, including the BMA, and they can rest happily that their initial fears have been resolved.
Moved, That the House do agree with the Commons in their Amendment No. 2.--(Baroness Cumberledge.)
On Question, Motion agreed to.
3
After Clause 1, insert the following new clause--
(" .--(1) This section applies to any pilot scheme under which personal medical services are provided.
(2) An agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may be made by an authority only with one or more of the following--
(a) an NHS trust;
(b) a suitably experienced medical practitioner;
(c) an NHS employee or a pilot scheme employee;
(d) a qualifying body;
(e) an individual who is providing personal medical services under that or another pilot scheme.
(3) In this section--
"NHS employee" means an individual who, in connection with the provision of services in the health service, is employed by--
(a) an NHS trust;
(b) a medical practitioner whose name is included in a medical list; or
(c) a medical practitioner who is providing personal medical services in accordance with a pilot scheme;
"pilot scheme employee" means an individual who, in connection with the provision of personal medical services in accordance with a pilot scheme, is employed by an individual providing those services;
"qualifying body" means a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (c) or (e) of subsection (2).
(4) For the purposes of this section, a medical practitioner is suitably experienced if he is suitably experienced for the purposes of section 9 of this Act, section 31 of the 1977 Act or section 21 of the 1978 Act.
(5) In this Part, "medical list" means--
(a) in relation to England and Wales, a list prepared in accordance with regulations made under section 29(2)(a) of the 1977 Act;
(b) in relation to Scotland, a list prepared in accordance with regulations made under section 19(2)(a) of the 1978 Act.").
4
Insert the following new clause--
(" .--(1) This section applies to any pilot scheme under which personal dental services are provided.
(2) An agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may be made by an authority only with one or more of the following--
(a) an NHS trust;
(b) a dental practitioner whose name is included in a dental list;
(c) an NHS employee or a pilot scheme employee;
(d) a qualifying body;
(e) an individual who is providing personal dental services under that or another pilot scheme.
(3) In this section--
"dental list" means--
(a) in relation to England and Wales, a list prepared in accordance with regulations made under section 36(1)(a) of the 1977 Act;
(b) in relation to Scotland, a list prepared in accordance with regulations made under section 25(2)(a) of the 1978 Act;
"NHS employee" means an individual who, in connection with the provision of services in the health service, is employed by--
(a) an NHS trust;
(b) a dental practitioner whose name is included in a dental list; or
(c) a dental practitioner who is providing personal dental services in accordance with a pilot scheme;
"pilot scheme employee" means an individual who, in connection with the provision of personal dental services in accordance with a pilot scheme, is employed by an individual providing those services;
"qualifying body" means--
(a) a body corporate which, in accordance with the provisions of Part IV of the Dentists Act 1984, is entitled to carry on the business of dentistry; or
(b) a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (c) or (e) of subsection (2).").
5
Clause 2, page 2, line 35, leave out from beginning to end of line 40 and insert--
Page 3, line 11, leave out subsection (7).
Baroness Cumberledge: My Lords, I beg to move that the House do agree with the Commons in the Amendments Nos. 3 to 6 en bloc. I spoke to these amendments when dealing with Amendment No. 2.
Moved, That the House do agree with the Commons in their Amendments Nos. 3 to 6.--(Baroness Cumberledge).
On Question, Motion agreed to.
("(2) An authority must prepare and submit such proposals if they are asked to do so by a person--
(a) who wishes to provide piloted services, and
(b) with whom an agreement which constitutes, or is part of, a pilot scheme may be made;
but otherwise they may not do so.").
6
7
Clause 3, page 3, line 28, at end insert--
Baroness Cumberledge: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 7. In moving this amendment, I should like to speak also to Commons Amendments Nos. 8, 25 and 32.
Your Lordships will recall that the issue of the distribution of GPs and the role of the Medical Practices Committee was subject to continuing discussions with the profession. We have reached an agreement on the new arrangements. In brief, these involve greater scope for local people, who know about local needs, to decide on the distribution of doctors within an authority's area. We shall also ensure that a robust national overview of the GP workforce is drawn together so that we can achieve an equitable distribution of GPs between health authorities. That will draw on the expertise of the MPC and the NHS Executive's national resource allocation group and involve representatives of the profession and of health authorities.
The amendments before the House reflect the agreement that we have struck. Amendments Nos. 7 and 8 ensure that the Secretary of State pays due regard to the effect that pilot schemes will have on the distribution of GPs. To enable him to do this, he will be required to consult the Medical Practices Committee when proposals for pilot schemes are put to him which increase or reduce the number of GPs in the area of the authority concerned. In short, the amendments acknowledge the important role of the Medical Practices Committee and ensure that its knowledge and expertise inform decisions on pilots made by the Secretary of State.
I can also assure your Lordships that, before we take forward any regulations on the issue, we will discuss the relevant issues with the MPC. That will provide a further opportunity for us to consider any outstanding concerns that it may have. Amendments Nos. 25 and 32 give legislative effect to proposals that recognise that national distribution of the GP workforce must be kept in view by the Secretary of State in considering permanent schemes. They ensure that any regulations governing the introduction of permanent arrangements are framed with this in mind. I commend the amendment to the House.
Moved, That the House do agree with the Commons in their Amendment No. 7.--(Baroness Cumberledge.)
("(2A) Subsection (2B) applies if--
(a) the Secretary of State intends to approve proposals for a pilot scheme; and
(b) it appears to him that the effect of implementing the proposals would be to increase or reduce the number of general practitioners in the area of the authority concerned.
(2B) The Secretary of State must have regard to the effect that the proposals, as he intends to approve them, are likely to have on--
(a) the distribution of general practitioners in England, in the case of proposals submitted by an authority in England;
(b) the distribution of general practitioners in Scotland, in the case of proposals submitted by an authority in Scotland;
(c) the distribution of general practitioners in Wales, in the case of proposals submitted by an authority in Wales.
(2C) In carrying out his functions under subsection (2B), the Secretary of State must consult the Medical Practices Committee or (as appropriate) the Scottish Medical Practices Committee.").
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