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Page 14, line 4, at end insert--
Page 14, line 4, at end insert--
Page 14, line 11, after ("arrangements") insert ("or corresponding services under section 17C of the National Health Service (Scotland) Act 1978").
Page 14, line 36, leave out from beginning to end of line 38.
Page 15, line 3, leave out from beginning to end of line 5 and insert--
Page 15, leave out lines 14 to 16 and insert--
Page 15, line 34, leave out from ("enforceable") to end of line 37 and insert ("in like manner as extract registered decrees arbitral bearing warrant for execution issued by the sheriff court of any sheriffdom in Scotland.").
Page 16, line 12, at end insert--
Page 16, line 12, at end insert--
Page 16, line 19, after ("arrangements") insert ("or corresponding services under section 28C of the National Health Service Act 1977").
Clause 21, page 17, line 9, at beginning insert ("In particular,").
Page 17, line 10, leave out (", in particular,").
Page 17, line 27, at end insert--
Page 17, line 41, at beginning insert ("In particular,").
Page 17, line 42, leave out (", in particular,").
Page 18, line 12, at end insert--
Clause 22, page 18, line 24, at end insert--
Page 18, line 36, at end insert--
Clause 23, page 19, line 31, leave out ("medical") and insert ("Part II").
Baroness Cumberlege: My Lords, I spoke to Amendments Nos. 20 to 43 when I spoke to Amendments Nos. 1 to 7, 12 and 19. I beg to move.
Moved, That the House do agree with the Commons in their Amendments Nos. 20 to 43.--(Baroness Cumberlege.)
On Question, Motion agreed to.
("medical practitioners performing personal medical services, and dental practitioners performing personal dental services, in accordance with section 28C arrangements.
In paragraph (b) "practitioner" does not include a practitioner who is undergoing training of a prescribed description.").
25
("( ) The Secretary of State must--
(a) consider whether section 28C arrangements are likely to have an adverse effect on the distribution of medical practitioners providing general medical services or performing personal medical services in England or in Wales;
(b) if he thinks that the arrangements are likely to have that effect, consider whether it is necessary to include in the regulations provisions designed to secure that, so far as is possible, the arrangements do not have that effect; and
(c) if he thinks that it is necessary, include such provisions in the regulations.").
26
("( ) Regulations which impose conditions on persons performing personal medical services or persons performing personal dental services (whether made by virtue of subsection (2)(b) or otherwise) may, in particular, include provision of a kind that may be made by regulations under section 32.").
27
28
29
("medical practitioners performing personal medical services, and dental practitioners performing personal dental services, in accordance with section 17C arrangements.
In paragraph (b) "practitioner" does not include a practitioner who is undergoing training of a prescribed description.").
30
("(d) require details of section 17C arrangements to be published.").
31
32
("( ) The Secretary of State must--
(a) consider whether section 17C arrangements are likely to have an adverse effect on the distribution of medical practitioners providing general medical services or performing personal medical services in Scotland;
(b) if he thinks that the arrangements are likely to have that effect, consider whether it is necessary to include in the regulations provisions designed to secure that, so far as is possible, the arrangements do not have that effect; and
(c) if he thinks that it is necessary, include such provisions in the regulations.").
33
("( ) Regulations which impose conditions on persons performing personal medical services or persons performing personal dental services (whether made by virtue of subsection (2)(b) or otherwise) may, in particular, include provision of a kind that may be made by regulations under section 22.").
34
35
36
37
("( ) Regulations under this section may also provide that the right to choose a medical practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.").
38
39
40
("( ) Regulations under this section may also provide that the right to choose a medical practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.").
41
("( ) The regulations may, in particular, provide that the right to choose a dental practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.").
42
("( ) The regulations may, in particular, provide that the right to choose a dental practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.").
43
44
Clause 26, page 23, line 38, leave out ("63(2)(a)") and insert ("63(2A)(a)").
Baroness Cumberlege: My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 44. I shall also speak to Amendments Nos. 45, 47 and 49. These amendments are drafting amendments which ensure that the correct article reference from the Health and Personal Social Services (Northern Ireland) Order 1972 is used when referring to pharmaceutical lists in Northern Ireland.
Moved, That the House do agree with the Commons in their Amendment No. 44.--(Baroness Cumberlege.)
On Question, Motion agreed to.
45
Clause 26, page 24, line 27, leave out ("63(2)(a)") and insert ("63(2A)(a)").
Baroness Cumberlege: My Lords, I have already spoken to Amendment No. 45. I beg to move.
Moved, That the House do agree with the Commons in their Amendment No. 45.--(Baroness Cumberlege.)
On Question, Motion agreed to.
46
Insert the following new clause:
.--(1) Section 31 of the Opticians Act 1989 (matters with respect to which the General Optical Council may make rules) is amended as follows.
(2) In subsection (5) (power to make rules requiring registered optician to refer persons to registered medical practitioners except in certain circumstances), for the words from "except" to "take the prescribed steps" substitute "except--
(a) in an emergency,
(b) where that person is consulting him for the purpose of being given treatment in accordance with rules under subsection (l)(d) above, or
(c) in such other cases as may be prescribed,
take the prescribed steps".
(3) After subsection (5), insert--
"(5A) Rules made by virtue of subsection (5)(c) may impose conditions which must be satisfied if the exception for which those rules provide is to apply." ").
Baroness Cumberlege: My Lords, I beg to move that the House do agree with the Commons in the new clause inserted by Amendment No. 46. This takes account of development in the role of ophthalmic opticians, who I know prefer to be known as optometrists. Thirty years ago they were primarily concerned with the testing of sight and correction of refraction errors through the prescription of glasses. Now, in addition, they undertake a clinical examination of the eye for signs of common eye diseases.
The General Optical Council's present rule requires that, otherwise than in an emergency, the optometrist should refer the patient to a registered medical practitioner. In practice, by local agreement with GPs and hospital ophthalmologists, they use discretion. For example, most elderly people acquire opacities in their lenses, but only a few progress to cataracts. Hence, an optometrist might advise a patient to attend annually for a sight test in the knowledge that he could still refer the patient in time for successful treatment if the opacity started to thicken.
That is accepted good practice but, under the present rules, could leave the optometrist exposed to sanction under the investigative and disciplinary procedures which the GOC is obliged to follow. That would clearly be unreasonable.
The new clause inserted by this amendment would enable the General Optical Council to submit a new rule for consideration by the Privy Council which would give the GOC virtually full discretion in prescribing when an optometrist should refer a patient with a disease or injury of the eye to a registered medical practitioner. I commend the new clause to the House.
Moved, That the House do agree with the Commons in their Amendment No. 46.--(Baroness Cumberlege.)
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