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Baroness Cumberlege: My Lords, I wish to pick up some of the points made by the noble Baroness, Lady Jay. I understand her feelings about the one amendment that has been passed in your Lordships' House. However, I would not want the noble Baroness to think that all her hard work and that of her colleagues on the Benches opposite has not made an impact in another place.
We take the issue of evaluation seriously. However, as the noble Baroness has said on the Floor of the House it is hard to work out the details. Indeed, we felt it was not appropriate to put that on the face of the Bill. As your Lordships will know, we have set a high priority on working with those in the National Health Service who provide the services.
In the intervening period since your Lordships had the Second Reading of this Bill we have set up national consultative groups. They have a wide-ranging membership which guarantees their representative nature. They are looking at local criteria. They are looking to see the principles which need to be established. When the initial pilot schemes are set up, they will set out detailed requirements for evaluation. They will cover the principles of the wider impact that the pilots may have on local services. That is the important point. They will need to ensure that there is improvement in quality; that there is a wide range and accessibility of services; and that value for money is provided by the pilot. Those will be the principles but clearly every scheme will need to have its much more detailed criteria against which it can be measured.
I am aware that I did not reply to the noble Baroness, Lady Hayman, on LMCs. We consider that they also have an important role to play in terms of evaluation and consultation. In the new developments health authorities will need to seek their views on the impact of pilots and on existing arrangements before the piloting and during evaluation stages. We very much value LMCs but we felt that it was time for a change in that there will not be a statutory duty for LMCs to be funded specifically relating to contracts. However, we still think that they will have an important part to play. It will be up to GPs to decide whether they want to use the LMCs or seek an alternative in terms of the full consultation necessary.
On Question, Motion agreed to.
10
Clause 8, page 5, line 11, after second ("by") insert ("regulations made or")
Page 5, line 12, leave out ("Part I of")
Baroness Cumberlege: My Lords, I beg to move that the House do agree with the Commons in their Amendments Nos. 10 and 11 en bloc. I have already spoken to these amendments with Amendment No. 1.
Moved, That the House do agree with the Commons in their Amendments Nos. 10 and 11 en bloc.--(Baroness Cumberlege.)
On Question, Motion agreed to.
11
12
Clause 9, page 5, line 16, at end insert--
Baroness Cumberlege: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 12. I should also like to speak to Amendments Nos. 24, 26, 29, 33, 54, 69 to 73, 81, 101 and 106. At Second Reading in another place cross-party concerns were raised about the limitations in the Medical Act 1983 which prevented pre-registration house officers taking placements in general practice except in health centres. The Government responded to those concerns through Amendments Nos. 54 and 106.
These amendments are designed to enable more young doctors in their final year of basic training--the pre-registration house officer year--to undertake part of that training in general practice. Allowing them to train in general practice fits in well, given that this Bill provides opportunities for more flexible ways of working and providing services. Our proposals are also fully supported by the profession.
Finally, the amendments to Clauses 9 and 20 and to Schedule 2 also extend to the new arrangements the provisions for vocational training which currently exist in the general medical services. They will also enable the Secretary of State to provide for vocational training in the personal dental services.
Moved, That the House do agree with the Commons in their Amendment No. 12.--(Baroness Cumberlege.)
Baroness Hayman: My Lords, I welcome the amendment. We support the concept of giving junior doctors at an early stage in their career the opportunity to participate in general practice. We have all been concerned with the issues of recruitment and retention in general practice. It is wise to allow those pre-registration house officers to have a taster of general practice. It is to be hoped that they will be encouraged to spend at least a part of their career in that branch of the service. The combination of the training opportunities, together with the possibilities of salaried service--we hope that the pilot schemes will give an opportunity for more flexibility at various stages of people's careers than general practice has allowed for in the past--is
Baroness Gardner of Parkes: My Lords, I, too, welcome the amendment. General practice is under threat at present. There is every need for young doctors to become interested in it. They will see everyday conditions in general practice. When the system was limited only to health centres it was not wide enough. It is a splendid amendment.
Baroness Robson of Kiddington: My Lords, we on these Benches welcome the amendments.
Baroness Cumberlege: My Lords, I thank all noble Lords who have spoken in support. I commend the amendment.
On Question, Motion agreed to.
("( ) Subsection (1) does not prevent the performance of personal medical services by--
(a) a person who is acting in the course of acquiring the experience prescribed by regulations made under section 32 of the 1977 Act or section 22 of the 1978 Act;
(b) a person who is provisionally registered under section 15 or 21 of the Medical Act 1983, acting in the course of his employment in a resident medical capacity in an approved medical practice (within the meaning of section 11(4) of that Act); or
(c) such other category of person as may be prescribed.")
13
Clause 14, page 7, line 14, leave out subsection (1) and insert--
Baroness Cumberlege: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 13 and I shall speak also to Amendments Nos. 14 to 16 and 18. These amendments deal with additional points which concern the way in which NHS contracts will work in pilot schemes. They will ensure that the benefits of NHS contracts can play a full part in the new arrangements.
Amendments Nos. 13 to 16 clarify who may apply to become a health service body for the purpose of piloting. The provisions of Clause 14, to which the amendments relate, will of course be available only to members of the NHS family. Individual GPs or dentists can already apply to become health service bodies under the Bill. These amendments will enable applications to be made by various groupings from within the NHS family--for example, partnerships of GPs--and ensure that such groupings can comprise a single health service body. The amendments also ensure that each time the membership of a health service body changes after it has been granted health service body status (for example, where one partner in a partnership retires) it does not have to re-apply for such status. The provision fits in well with the flexibilities which the Bill aims to achieve.
Finally, Amendment No. 18 removes a power which is already provided elsewhere in the Bill. I commend these amendments to the House.
Moved, That the House do agree with the Commons in their Amendment No. 13.--(Baroness Cumberlege.)
Baroness Jay of Paddington: My Lords, perhaps I may ask the Minister a question on the amendments.
I cannot recall the number of the amendment withdrawn at Report stage because concern was expressed by Members on these Benches about the expression "body corporate" as regards the number of people who could be involved in contracts. I wish to be absolutely clear. I come back to the points raised earlier on the group of amendments with Amendment No. 2. Does the expression "body corporate" exclude "bodies corporate"? I believe that we would understand the common sense meaning of that term to include commercial organisations.
Baroness Cumberlege: My Lords, I can reassure the noble Baroness. Those who apply for the pilot schemes have to ensure that all the shares are held by members of the NHS family. The noble Baroness can rest assured that this is not a back-door into privatisation or commercialisation. That is not our intention at all. I commend the Motion.
On Question, Motion agreed to.
("(1) In the case of a pilot scheme entered into, or to be entered into, by a single individual or body corporate, that individual or body may make an application under this section to become a health service body.
(1A) In the case of any other pilot scheme, all of those providing, or proposing to provide, piloted services under the scheme may together make an application under this section to become a single health service body.").
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