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Lord Hunt of Kings Heath moved Amendments 189 and 190:

    Page 32, line 26, after "FHSAA" insert ", or a suspension imposed under section 49J above"

On Question, amendments agreed to.

4.30 p.m.

Lord Hunt of Kings Heath moved Amendment No. 191:

    Page 33, line 5, after "49G(3)" insert "or under subsection (5)(b) of this section"

The noble Lord said: In moving this amendment I shall speak also to Amendments Nos. 192 and 193. A practitioner has a right of appeal to the FHSAA against a health authority decision to remove or contingently move them from a health authority list. In determining such an appeal the authority may uphold the health authority decision, impose different conditions or overturn the decision.

These amendments deal with minor and technical amendments to the appeals procedure under the suspension and removal regime. Section 49M of the 1977 Act in Clause 32 of the Bill provides that the FHSAA may decide to remove a person contingently following an appeal against a health authority decision. The clause does not currently provide for the removal of that person if they fail to comply with the contingent removal conditions imposed by the FHSAA.

Amendments Nos. 192 and 193 therefore provide for a health authority to remove that person from a list if they breach the conditions of their contingent removal. Amendment No. 191 provides an appeal to the authority against that health authority action. I beg to move.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendments Nos. 192 and 193:

    Page 33, line 17, after "contingently," insert--

"(a)" Page 33, line 20, at end insert "and

(b) the Health Authority may remove him from their list if they determine that he has failed to comply with a condition."

On Question, amendments agreed to.

Lord Hunt of Kings Heath moved Amendment No. 194:

    Page 33, line 36, leave out from "lists" to "prepared" in line 37.

The noble Lord said: Clause 32 includes provision for the FHSAA to remove a practitioner from all health authority lists. That is known as national

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disqualification. That could be principal lists, supplementary lists, services lists or any combination of the three. That will include any practitioner--and in the case of dental lists, corporate bodies--with whom the health authority has arranged to provide general or personal medical or dental services or general ophthalmic or pharmaceutical services in their area.

Amendments Nos. 194 and 195 deal with minor technical amendments which are necessary to remove references to individual practitioners within health authority lists. Clause 29 enables health authorities to make arrangements with dental corporate bodies to provide general dental services as well, with individual dental practitioners. In doing so a dental corporate body may be included in a health authority list. But it is inaccurate to refer to lists of individuals. Amendments Nos. 201 and 202 substitute the reference to "practitioners" in Section 49(3) of the Act with "persons". The use of that term ensures that non- practitioners such as corporate bodies are also covered by the provisions in the section. I beg to move.

On Question, amendment agreed to.

Lord Hunt of Kings Heath moved Amendments Nos. 195 to 202:

    Page 33, line 39, leave out "of individuals of the practitioner's description"

    Page 34, line 11, after "(1)" insert "(a) to (c)"

    Page 34, line 18, leave out "referred to in subsection (1)" and insert "from which he has been disqualified from inclusion"

    Page 34, line 24, leave out "Except in prescribed circumstances" and insert "Subject to subsection (9)"

    Page 34, line 29, at end insert--

"(9) The Secretary of State may provide in regulations for subsection (8) to have effect in prescribed circumstances as if the reference there to "two years" or "one year" were a reference to a different period specified in the regulations." Page 34, line 42, after "49F" insert "or 49G,"

    Page 35, line 20, leave out "corresponding to a practitioner"

    Page 35, line 21, leave out "practitioner" and insert "person"

On Question, amendments agreed to.

Clause 32, as amended, agreed to.

Clause 33 [PMS and PDS lists]:

Lord Hunt of Kings Heath moved Amendments Nos. 203 and 204:

    Page 36, line 49, at end insert--

"( ) The imposition of such conditions must be with a view to--
(a) preventing any prejudice to the efficiency of the services to which the services list relates; or
(b) preventing any acts or omissions of the type described in section 49F(3)(a) below." Page 37, line 11, at end insert--

"( ) If the regulations provide under subsection (3)(e) or (4) that a Health Authority may suspend or remove a person from a services list, they must include provision--
(a) requiring him to be given notice of any allegation against him;
(b) giving him the opportunity of putting his case at a hearing before the Health Authority make any decision as to his suspension or removal; and

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(c) requiring him to be given notice of the Health Authority's decision and the reasons for it and of any right of appeal under subsection (7) or (8)."

On Question, amendments agreed to.

[Amendment No. 205 not moved.]

Earl Howe moved Amendment No. 206:

    Page 37, line 23, at end insert--

"( ) In this section "perform" includes "provide"."

The noble Earl said: Clause 33 refers to health authorities preparing lists of medical practitioners who perform personal medical services (PMS). However, my suggestion to the Committee is that the term "perform" is too narrow. That is a point raised by the BMA, which believes that there is a genuine distinction between providing personal medical services and performing them. The amendment ensures that both providers and performers are covered in this section of the Act. The National Health Service (Primary Care) Act 1997 makes that distinction. The use of the word "provide" is consistent throughout Part I of the Act where reference is made to a person with whom a pilot scheme agreement may be made.

The distinction between a provider and a performer can be seen clearly in Section 11(1). Under the 1997 Act a provider is defined as a PMS contract holder and a performer is a medical practitioner who performs PMS work and who may or may not be the contract holder. I hope that the Minister will accept the amendment or at the very least agree to reflect carefully on it. I beg to move.

Lord Hunt of Kings Heath : I have given consideration to what I agree is a well-intentioned amendment to extend the services list to include also providers of PMS and PDS as well as performers. The provisions of the current clause prevent that because subsection (1) of Section 28DA limits the persons to be included in the services list to medical and dental practitioners. Providers of PMS and PDS might be included by being on a medical or a supplementary list. However, it is inappropriate for providers, which include organisations such as NHS trusts and primary care trusts, to be included in such lists. For that reason I consider the amendment unnecessary.

There are adequate mechanisms in place to regulate the performance of the providers. I believe that I went through them previously. The Secretary of State has to approve a pilot scheme and significant variations of the PMS contract. Similarly, the Secretary of State has the ability to vary a term of a contract and the commissioner has a role in the overall contract negotiations and performance management functions. In the final resort the Secretary of State has the right to terminate a pilot scheme.

Earl Howe: I am grateful for that answer. It is a fairly technical point and I would not want to press it. No doubt the BMA will find the Minister's comments helpful. I shall take its advice and, if necessary, return to the matter at a later stage. In the meantime, I beg leave to withdraw the amendment.

22 Mar 2001 : Column 1561

Amendment, by leave, withdrawn.

Lord Rea moved Amendment No. 207:

    Page 37, line 23, at end insert--

"( ) After section 6(1) of the National Health Service (Primary Care) Act 1997 (making of pilot schemes) there shall be inserted--
"(1A) The Secretary of State shall, in making directions applicable throughout England regarding the implementation of proposals for pilot schemes, consult such organisations as he may recognise as representing persons with whom arrangements for the provision of personal medical or dental services may be made.""

The noble Lord said: Amendment No. 207 concerns the terms and conditions of service of doctors providing personal medical services, rather than those contracted to provide general medical services. Clause 33 concerns those doctors who provide PMS--personal medical services. Practitioners providing PMS are classified under a different category from GPs who provide general medical services, although they do the same work; some individuals may work part-time in both categories.

The British Medical Association therefore feels that matters relating to conditions of employment with the health service--remuneration and so on--should be negotiated with the same body as GMS practitioners. That is the General Practitioners Committee of the British Medical Association. By an agreed terminology, the Secretary of State should consult,

    "such organisations as he may recognise as representing persons with whom arrangements for the provision of personal medical or dental services may be made".

That means the BMA's General Practitioners Committee. It is a formula that is understood between the BMA and the Government.

The negotiations to achieve this uniform status for both categories of doctors providing general practitioner services are in progress between the department and the British Medical Association. So far these negotiations have been inconclusive.

Perhaps my noble friend can outline the reasons why the BMA General Practitioners Committee cannot negotiate a settlement with Ministers so that its members who have chosen the PMS option have their conditions negotiated by the same body as other GPs. Even if my noble friend cannot accept the amendment, his words will be extremely helpful in taking the negotiations forward. I beg to move.

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