Moved, That the order of the House of 9th September appointing a Select Committee to join with a committee of the Commons to consider and report on any clauses of a draft Gambling Bill presented to both Houses by a Minister of the Crown be amended by leaving out the words "within the United Kingdom".(The Chairman of Committees.)
The noble Lord said: In moving Amendment No. 456, I shall also speak to Amendment No. 457. Subsection (4)(b) of proposed new Section 28U provides for regulations to be made that would suspend or terminate a requirement in the GMS contract to provide services of a specified type. I have no difficulty with what I interpret to be the purpose of this provision; my only difficulty is with the drafting. It will surely not be possible for regulations on their own to achieve the intended purpose because, in reality, if a PCT or LHB wished to suspend or terminate an additional service, I should have thought that it would almost always be practice-specific. Surely, regulations would not want to provide for a blanket suspension or termination of a service, nor legally could they provide for a suspension or termination of that service by particular doctors. Will the Minister shed some light on that matter and reassure the Committee that the drafting is robust? I beg to move.
Proposed new Section 28U(4)(b) allows for regulations to make provision about the suspension or termination of a duty under the new GMS contract to provide services of the prescribed nature. It allows for GMS practices to be able to opt out of providing out-of-hours services and those services designated as additional services in the agreement between the BMA and NHS Confederation. The regulations will define those particular services and detail the procedures through which the option to opt out can be affected.
We believe that the wording does deal with the practice issue. Certainly, the agreement on the new GMS contract allows practices to be able to opt out of providing out-of-hours and additional services with or without the agreement of the PCT, provided that they follow the procedures that will be set out in the regulations. Only in exceptional circumstancesand provided that the PCC has been able to demonstrate to an appeal body that it is essential for the practice to continue to provide a particular service in order to guarantee patients' rightswill the PCT be able to prevent such opt-outs.
Maternity, family planning, child health surveillance and minor surgery have always been optional services for practices. Under the current arrangements, individual GPs can opt out in full or part when they do not have the necessary professional expertise or facilities, or, in the case of family planning, they cannot provide the services for reasons of conscience. Not all individual GPs currently provide those services. The new agreement provides for vaccinations, immunisations and cervical screening to be added to the list. However, those services are also voluntary because practices and GPs could currently opt out of providing them. Again, it is up to the practices. If they opt out of providing services, their income will be reduced.
I could develop those arguments further but I have sought to explain the purpose behind the clause and the effect that the amendment would have on it. We do not think that the drafting is deficient, but I am happy to arrange for the noble Earl, if he wishes, to talk to the lawyers about that outside the Committee.
Earl Howe: I am grateful to the Minister. He will realise that I was, essentially, asking a simple question through a probing amendment: how can regulations operate at the level of individual practices? I think that I understand what the Minister told me about opt-outs. I will read carefully what he said. For now, I beg leave to withdraw the amendment.
(iii) under section 19 or 25 of the 1978 Act or Article 56 or 61 of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No. 1256 (N.I.14));" Page 92, line 24, leave out "an individual" and insert "a person"
Page 92, leave out lines 27 to 37 and insert
"( ) an individual who is providing services as specified in subsection (1)(bc)(iii) above" . Page 92, line 38, leave out from ""section 28C employee"" to end of line 39 and insert "for "an individual providing" substitute "a person providing or performing""