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Baroness O'Cathain: Perhaps I may remind the noble Lord, Lord Desai, that running a rural practice in particular and a primary care group is not exactly the same as running a department of economics. At the moment the people on the ground who are involved in fundholding practices are being poached to set up primary care groups. Anecdotally, in one practice I know very well the person in charge of fundholding has been appointed chief executive or director--I forget the exact title--of the local primary care group. As a result there has been a problem back at the practice. She spends two days back at the practice and three days trying to set up the primary care group and is at her wits' end knowing that she is running out of time. We know that primary care groups are to be introduced and we accept that--at least I do--but I am sure that none of us in this Chamber wants the process to go off at half-cock so it is in a mess right from the start. Is it not

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better to ensure that the organisation, staffing levels and liaison with practices are correct before the scheme comes into being? For that reason and for many others I support my noble friend's amendment.

Lord Haskel: I ask my noble friend to reject this amendment. I believe that the noble Baroness, Lady O'Cathain, has just given my noble friend a very good reason for rejecting it. Her argument points to getting on with it rather than delaying it. PCGs are a very important part of the Bill. If we delay that, we would be delaying all aspects of the Bill. I advise my noble friend to reject the amendment and to get on with it.

Baroness O'Cathain: Perhaps I have misled the noble Lord. It takes a lot longer than five weeks, or whatever the period is, to do it. I suggest that there should be a longer running-in period. We should not get on with it now when there is still a state of confusion and in effect people are doing two jobs.

Lord Campbell of Alloway: We do not seek to delay. This is an important part of the Bill. Having listened to the argument and knowing a little about this, I believe that as laymen most people deal with the problems that have been spoken to during their lives. The noble Baroness, Lady Hayman, must be perfectly well aware of this, too. The point that has been put in so many ways is that this should not go off half-cocked. Why cannot this be dealt with? The case that has been put is genuine. To say that we seek to delay is a totally meretricious intervention. We do not seek to delay. We do not challenge the principle, but as a matter of common sense we want to try to make it work. The noble Baroness and the Secretary of State can deal with this matter in a perfectly sensible, proper way. Clause 52 states:

    "(1) The preceding provisions of this Act are to come into force on such day as the Secretary of State may by order appoint.

    (2) Different days may be appointed under this section for different purposes".

Cannot the noble Baroness give the Committee an assurance that the Secretary of State will look at this with an open mind and not commit himself in advance to bringing in these provisions before it is right, proper and reasonable to do so? That is all I ask. Amendments to Clause 52 have been tabled but this is not one of them. I have only just thought of it while listening to the debate.

Baroness Berners: I support the amendment. Only a fortnight ago I spoke to my trust which told me of the difficulties that it was experiencing. Yes, it has known of this in advance and is working to try to get it to work, but the mere fact that it must be done in such a short time is causing no end of problems. I can assure the Committee that the pressures and the anxieties are very great.

Lord Peston: As a matter of principle, I am intrigued to hear the case put by noble Lords opposite. This is one of the great breakthroughs as far as concerns the future

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of the health service. My experience is that, when you have made up your mind to do something that is both sensible and will help to solve problems, the best thing to do is to go ahead and do it. I am not quite clear how the running of an economics department comes into this. When I ran such a department I never encountered any problem. I simply decided what needed to be done and it was done. I entirely accept that this is more complicated than that. But the fact remains that many of us regard this as an important step forward. As I understand it, the noble Earl, Lord Howe, is at least willing to consider that this may be an important step forward and does not oppose it. It follows that the best course to take is to go ahead and do it. The notion that somehow one should not do anything until Parliament has passed the relevant Bill into law is an entirely new one to me. I have attended here only a dozen years, but it is the first time I have heard it enunciated that the provisions of a Bill should never start to come into practice until the legislation has become law because it would be an insult to Parliament.

I attended on the Benches opposite for a great many years. I often did not like what I heard. However, on the whole when governments said that they were going to do something, one generally took the view that they would do it and we should prepare for it to happen. I am at a loss to know where the doctrine comes from that it would be unfair and insulting to Parliament to ask people to act before the Bill became law.

I know how reasonable and moderate the Minister is. She will be listening carefully to all the amendments. However, on this occasion, despite her desire to be helpful, I would advise her not to accept the amendment.

4 p.m.

Lord Campbell of Alloway: The noble Lord speaks from another dimension. He is an economics don. He can say, "This is this. Let's get on and do it". Whether or not it works does not really matter. I read economics some time ago. Economists get it wrong anyway. But the one thing about which they do not care is whether it will work in practice. It is theory.

We are concerned here with making the provision work. We are not in the dimensions of erudite economic theory. It is a practical problem. Delay it only to make it work.

Lord Peston: Since we are in Committee, I am allowed to intervene. Logically I do not see how one discovers whether something works in practice until one puts it into practice. The position is the exact reverse of what the noble Lord said. It may well be theory now but it is very good theory.

What I hope the Government wish--it is certainly what I wish--is that we put the provision into practice and make it work. I have a higher opinion of the medical people involved. I am firmly convinced that they will

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make it work. I hope that they will be willing to make it work--without having their mouths stuffed with money--because it is the right thing to do.

Baroness O'Cathain: Surely we need the assurance that we have the people on the ground to make it work. One of my great fears is that we do not have them.

Lord Monkswell: The noble Baroness, Lady O'Cathain, seems to argue for our making the change, and as quickly as possible. She cited a case of a practice manager also being employed as a primary care group manager. Presumably within that primary care group there are other practices with practice managers. When the primary care group is set up, those managers will be redundant. They will no longer need to be paid by the National Health Service to provide that management function at the doctor practice level. The management function will be provided by one person at the primary care group level.

I exaggerate, but the system set in place by previous governments required a superfluity of managers for small groups. It is proposed that a smaller group of managers covers a larger number of people. Effectively, the money that we spend on the National Health Service will go into patient services, not management functions. The sooner we do that, the better for everyone involved.

Lord Skelmersdale: We have now had the second red herring of the afternoon in debate on an amendment which my noble friend Lord Howe wished to be brief.

Yes, the management decision has been made. The Government want to get on with it but they do not want it to end in a mess. My noble friend Lord Campbell of Alloway is absolutely right. I readily understand that the Government will not accept the suggestion of a year's time, or 13 months. We want to know what date it will be introduced. Will it be introduced properly? Will it work? That is the only thing that matters.

Baroness Gardner of Parkes: The noble Lord, Lord Monkswell, does not seem to understand that a practice with, say, five doctors will still require a very active practice manager on the premises. The practice will also have someone running a much larger group of practices. The practice manager on the premises of the five-doctor surgery cannot be paid at the same rate as previously where he or she has had a much bigger role. Many of those practice managers will either want the job of the overall practice manager (there will be only one) or they will become redundant. Very few will wish to see their salary halved or greatly reduced. That is where the redundancy money comes in. I hope that the Minister will reassure us that every effort will be made to ensure that the money required for the changes is available. The story I hear from general practitioners is that they are having great trouble obtaining the necessary funding to bring in the changes.

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