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Lord Clement-Jones: I rise to break my vow of silence and to support the amendment of the noble Lord, Lord Rea. The Minister in the Commons Committee stage said that the reason there could not be the same kind of consultation with the GPC over PMS was that, because of the voluntary nature of the contract,

It has been put to me--I am sure that the noble Lord, Lord Rea, knows the position--that this is a rather misleading portrayal of the situation. The national

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framework of PMS contracts is set by nationally determined implementation directions and a core contractual framework. Therefore, there is a strong national context. It would be perfectly right and feasible for the General Practitioners Committee to be consulted. So the questionmarks remain despite the Commons Committee stage. I look forward to hearing what the Minister has to say on the matter.

4.45 p.m.

Lord Hunt of Kings Heath: I found my right honourable friend's arguments wholly persuasive. I recognise the issue. I know that the GPC is exercised about the matter.

It is important to remember that the key element of PMS and PDS schemes are their scope and flexibility to negotiate individual local contracts tailored specifically to meet local needs. On a local level the appropriate way for that to be done is through the relevant medical or dental committees. Indeed, government amendments to the Health Act 1999 ensured that LMCs and LDCs could be recognised as representing doctors in PMS and dentists in PDS who so wished. I cite that as a movement to a local level of representation in line with many of the provisions of the Bill, which sees a devolution of power from the centre to the locality. The PMS or PDS contract is therefore individually tailored between the commissioner and the PMS or PDS provider.

Furthermore, there is the standard national contract between the Secretary of State with all GMS GPs and general dental practitioners. That is concerned with the remuneration and provision of general medical services and general dental services. It is an inherently different concept from PMS and PDS contracts. That is why the emphasis must be on local development and negotiation. The consultation process for those matters needs to be more flexible and wider. For example, key stakeholders in PMS arrangements are not exclusively general practitioners. They can include a range of primary care professionals and organisations such as primary care trusts, NHS trusts and nurses.

We have established an implementation group for personal medical services to replace the present national consultative group. That group will be the key forum for consulting and advising on arrangements for PMS. The knowledge and experience of its members will be drawn on to provide advice and better inform PMS developments. The GPC has membership of the group.

That is the most appropriate approach to consulting on the overall development of PMS. It is not through a duty on the Secretary of State to consult a single stakeholder group over a particular aspect of PMS. The BMA is an organisation with influence and the ability to make its views known. We have very well established consultation procedures with the medical and dental professions. There is no intention to weaken those arrangements in any way.

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It is not right to go down the route of the GPC for this particular development of LMS and PDS in relation to dentists.

Lord Clement-Jones: Perhaps I may ask the Minister a question. Many of the new developments will be taking place through PMS. Is that not really just a rather crude attempt to marginalise the GPC in the process?

Lord Hunt of Kings Heath: I cannot see any reason why we should want to marginalise the GPC. It is an important body which represents a large number of general practitioners. It is worth making the point that its core responsibility is to cover pay and terms and conditions. PMS goes much wider than that and covers the quality of service and so on. A PMS core contract, which the noble Lord mentioned, sets out the minimum requirements as to quality. I believe that our approach is the right one. There is certainly no slight intended towards the GPC.

Lord Rea: I do not think that the British Medical Association will be terribly pleased with my noble friend's answer. Although the type of contract that PMS doctors have throughout the country will differ, there is a basic level of remuneration and terms and conditions of service which cover them all. As circumstances will differ, there can be local variations. But it is very important for a national body to continue to be able to negotiate with the Government for PMS practitioners as a whole.

Lord Hunt of Kings Heath: I am sorry if I have to disappoint the BMA, which I hold in the highest respect. However, just occasionally it is one's duty to disappoint it. All I can do is to reiterate my previous remarks. We need to reflect on the fact that we are considering here a very much more flexible approach at the local level. For that reason, the arrangements for discussions at the national level need to reflect the differences encompassed within PMS. Furthermore, it should be recognised that, through this approach, the role of the local medical committee will assume more importance because it will have the capacity to discuss PMS schemes locally with the local health authority. Surely that is the right approach; namely, to push those discussions down to the local level.

Lord Rea: I do not think that we shall reach agreement on this. However, my noble friend's words will prove extremely useful when carrying this discussion further, either once the Bill has been passed or, possibly, at a later stage in our deliberations. However, in order to speed matters along, I shall withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 208 not moved.]

Lord Hunt of Kings Heath moved Amendments Nos. 209 and 210:

    Page 38, line 38, at end insert--

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"( ) 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 of the 1977 Act." Page 38, line 49, 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
(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.

[Amendments Nos. 211 to 213 not moved.]

Clause 33, as amended, agreed to.

Clause 34 [The Family Health Services Appeal Authority]:

Lord Hunt of Kings Heath moved Amendment No. 214:

    Page 39, line 37, leave out "facilities and persons" and insert "the services of persons employed by a Special Health Authority and"

The noble Lord said: This important clause provides contractors with an independent body to whom they can appeal against health authority decisions. We have encountered it before in earlier amendments. It reconstitutes the Family Health Service Appeals Authority, which is currently a special health authority, into an independent appeals body. The members of this reconstituted authority will be appointed by the Lord Chancellor. Membership will include people with a lay background, those with legal expertise, and members with relevant professional expertise. As well as performing its existing functions, the reconstituted authority will have adjudicative powers to hear appeals from contractors removed by health authorities. The FHSAA will come under the supervision of the Council on Tribunals.

Amendments Nos. 214, 215 and 216 deal with the provision of administrative staff and premises to the authority. Amendment No. 216 allows the Secretary of State to make the staff and facilities of a special health authority or NHS trust available to the FHSAA, even though he does not employ them. Amendments Nos. 214 and 215 make technical corrections to Section 49S(7), which imposes a duty on the Secretary of State to consult the staff affected.

In order to protect the existing staff of the authority, they will be transferred to an SHA or NHS trust and arrangements will be made for that body to make them available to the reconstituted FHSAA. Not only will this allow them to retain their Whitley terms of service and entitlement to participate in the NHS pension scheme, but also to retain their expertise in handling appeals. That will be invaluable to the newly appointed president and members.

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Amendment No. 217 provides for the Lord Chancellor to be responsible for also determining the terms of their appointment. Amendment No. 218 is consequential and deletes the reference which allows the Lord Chancellor to set the terms of appointment for the members only. Amendment No. 219 is also consequential. It provides for the Lord Chancellor to determine the qualifications which members, other than the president and any deputy president, must have in order to be eligible for membership of the FHSAA.

Amendment No. 223 is a technical amendment which allows time limits on appeals to the existing FHSAA to continue to apply when the determination of those appeals is transferred to the reconstituted authority. Amendment No. 224 provides for regulations to be made providing for a minimum period to elapse before an application or further application can be made for a condition to be varied, replaced or revoked. I beg to move.

On Question, amendment agreed to.

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