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Lord Astor of Hever: I am grateful to the Minister for explaining the amendment. To speed things along, I shall ask him three quick questions. I also want to make it clear that we agree with his comments on transparency, as long as that system is not too bureaucratic--that is very important. What are the Government's intentions in relation to the recording procedure and the level of gift that has to be declared? Is it £125? What are their intentions in relation to the level of bequests that have to be declared? Does the

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Minister intend that the identity of the donor should be revealed to the health authority? If so, what steps does the Minister intend should be taken in order to seek the consent of patients before disclosure takes place? Some patients may not wish such information to be conveyed to third parties.

Lord Hunt of Kings Heath: I accept the spirit of the noble Lord's amendment. Our legal advice is that the amendment is ambiguous about whether the financial interests mentioned in Clause 30 are also, as well as being gifts, to be subject to the phrase,

    "above a specified value".

In order to give effect to the noble Lord's amendment, we have tabled four amendments--Amendments Nos. 171, 177, 179 and 180--to achieve what he intended and to extend the provision to the other three practitioner professions.

Opposition Amendment No. 176 repeats the question that was raised by the noble Lord about the figure that will be agreed. The suggestion is that it should be £140, in order to be consistent with the ministerial code. We are not going to go down that route because we believe that it is better for doctors to be treated in a manner that is consistent with that which applies to other NHS employees.

The guidance to which I referred in relation to commercial sponsorship provides that all gifts over £25 must be declared and that below that level, if gifts from a similar source aggregate to a value of more than £100 in a year, they should be declared. We are also looking at existing NHS guidance in relation to patient gifts. It is well known that in that context the figure of £25 has been mentioned in discussions with the BMA in recent months. However, the figure has not been finalised so I cannot give a definitive response to the noble Lord.

I understand the noble Lord's point on reporting and bureaucracy. We want the system to be as unbureaucratic as possible. It is not my understanding that that information would be published in the public domain, but a report would be submitted to the health authority. A balance is needed in that context. I understand that no one wants to inhibit the giving of small gifts as a token of appreciation. Equally, we have to ensure that the proper procedures are in place and that they are consistent.

I understand that the question of bequests has been raised. The Bill's provisions are currently wide enough to allow the regulations to deal with that issue. We assume that the level of bequests should be the same as that for gifts.

On Question, amendment agreed to.

[Amendments Nos. 172 and 173 not moved.]

Earl Howe moved Amendment No. 174:

    Page 26, line 3, at end insert "or personal medical services"

The noble Earl said: This is a small, probing amendment. Proposed new subsection (5B) requires the Secretary of State to consult the profession before

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finalising the regulations, but it omits to mention personal medical services doctors. I do not understand that, given that the purpose of the clause is to require all doctors working in general practice to declare financial interests and gifts. My amendment merely seeks to probe that point. I beg to move.

4 p.m.

Lord Hunt of Kings Heath: The part of the 1977 Act to which the amendment relates deals specifically and only with the declaration of financial interests and gifts by general medical services practitioners. That is why clause 30 provides for General Practice Committee consultation rights with respect to declarations about financial interests and gifts. We have every intention of mirroring for personal medical services and personal dental services the regulations on financial interests and gifts, as they apply to general medical services.

A PMS implementation group has recently been established, which represents all the professions involved in PMS. The GPC has membership of this group.

Earl Howe: I am most grateful to the noble Lord. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendments Nos. 175 and 176 not moved.]

Lord Hunt of Kings Heath moved Amendment No. 177:

    Page 26, line 7, leave out from "about" to end of line and insert--

"(a) financial interests;
(b) gifts above a prescribed value; and
(c) other benefits received."

On Question, amendment agreed to.

[Amendment No. 178 not moved.]

Lord Hunt of Kings Heath moved Amendments Nos. 179 and 180:

    Page 26, line 15, leave out from "about" to end of line and insert--

"(a) financial interests;
(b) gifts above a prescribed value; and
(c) other benefits received." Page 26, line 22, leave out from "about" to ", and" in line 23 and insert--

"(i) financial interests;
(ii) gifts above a prescribed value; and
(iii) other benefits received.""

On Question, amendments agreed to.

Clause 30, as amended, agreed to.

Clause 31 [Supplementary lists]:

Earl Howe moved Amendment No. 181:

    Page 26, line 35, after "services," insert "personal medical services,"

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The noble Earl said: Clause 31 seeks to make regulations for the publication of lists of professionals who can assist in the provision of various aspects of community health services. Subsection (1) lists the services concerned. This point is related to the point I made about gifts.

My amendment would clarify that "personal medical services" are either general medical services or personal medical services, as the medical skills and experience of the practitioners is the same. Patients should be assured of exactly the same protection, whatever administrative arrangement their doctor has signed up to. I beg to move.

Lord Hunt of Kings Heath: I am grateful to the noble Earl, Lord Howe. His amendment is well-intentioned, but unnecessary. We have made it clear that supplementary lists are needed to ensure that all practitioners in the family health service professions are included on lists, so that they can be properly regulated. This is important because existing health authority lists apply only to those principal practitioners approved to provide and perform their respective services--general medical services, in other words. Practitioners who assist these GP principals are therefore included in the supplementary list.

The approach in personal medical services is different. All doctors who work in PMS are regarded as PMS performers, so, consequently, one list is sufficient for all practitioners who work in and perform PMS.

In the context of other health care professionals, such as nurses, who assist in the provision of PMS, we believe that there are adequate mechanisms in place to regulate the performance of such persons, in addition to their own regulatory arrangements. The Secretary of State has to approve a PMS scheme and significant variations to the PMS contract. In addition, the commissioner, whether dealing with a health authority or a primary care trust, has a role in overseeing performance in the overall contract negotiation and performance management of a PMS scheme.

In the last resort, the Secretary of State has the right to terminate a PMS scheme. We intend to put in place similar approval and contractual arrangements and provisions for permanent schemes.

Earl Howe: I thank the Minister for his answer and beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Earl Howe moved Amendment No. 182:

    Page 27, line 31, at end insert--

"( ) Where a person employs a relevant practitioner who is included in the relevant supplementary list, that person may be confident of the suitability of the practitioner without making further enquiry.
( ) Exclusion from one Health Authority supplementary list does not automatically imply exclusion from all Health Authorities' supplementary lists.
( ) Under exceptional circumstances a practitioner may be allowed to practise whilst his application is being processed."

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The noble Earl said: I shall speak to Amendment No. 182 as briefly as I can. This part of proposed new Clause 43D sets out provisions that may be included in the regulations on supplementary lists.

I shall speak to each subsection of my amendment in turn. The first is best illustrated by way of an example. Let us suppose that a GP needs to employ a locum so that he can attend court or have a holiday. At present, locums may be recommended by colleagues or perhaps found through a locum agency. It is then the practitioner's responsibility to satisfy himself that the locum is suitably registered, qualified, indemnified and experienced. If the locum is subject to a complaint while he is employed by the GP, the practitioner will be liable if the locum is found to be unsuitable.

The purpose of a supplementary list system is to ensure that practitioners assisting in general medical services are assessed as suitable to provide patient care. The responsibility of assessing and maintaining that suitability is transferred from the practitioner to the health authority. The amendment would clarify that the person employing a practitioner who is included in the supplementary list can be confident of the employee's suitability without making further inquiries. If the locum proves to be unsuitable, responsibility for mistakes would rest with the health authority.

The second paragraph of my amendment refers to supplementary lists, which are to be held and published by health authorities. Each health authority will rightly have local discretion when deciding who to include, or exclude from the list. They will doubtless share their information about applicants--indeed, that would seem to be one of the main purposes of such lists. It is easy to imagine that exclusion from one health authority's supplementary list would lead to national exclusion. The amendment would provide health authorities with discretion, in perhaps rare circumstances, to consider an applicant who may not be suitable elsewhere.

I turn now to the third part of my amendment. The supplementary list system will protect patients from unsuitable practitioners. Nevertheless, one can imagine exceptional circumstances when it may deny patients adequate care because there is no one available on the list. In some parts of the country, it is difficult to recruit healthcare staff. There are simply not enough people with the right qualifications available. The checks required to assess a practitioner's suitability must be rigorous, and they therefore take time to complete. During a major flu epidemic, for example, more practitioners may be needed to cover sickness and to cope with the extra workload. Why prevent perfectly capable practitioners from working in a time of need, simply because they are not on the relevant list? I beg to move.

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