HC Deb 12 June 1973 vol 857 cc1405-12
Mr. Alison

I beg to move Amendment No. 9, in page 6, line 30, leave out from beginning to 'it' in line 38 and insert: `in accordance with regulations:— (a) to administer, on behalf of the Area Health Authority by which the Committee was established, the arrangements made in pursuance of the Health Service Acts for the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services for the area of the Authority; and (b) to perform such other functions relating to those services as may be prescibed; and if'.

Mr. Deputy Speaker (Sir Robert Grant-Ferris)

With this we can take Amendment No. 8, in Clause 5, page 5, line 1, after 'Act', insert: 'and as a sub-committee of such Area Health Authority.'. and Government Amendments Nos. 10 and 12.

Mr. Alison

The purpose of the amendment is to give some express indication on the face of the Bill of the functions which are to be conferred on family practitioner committees by regulations under Clause 7 (3).

As I explained in Committee at the Eleventh Sitting in columns 602–604, the functions of family practitioner committees which are to be prescribed under Clause 7(3) will consist mainly of entering into individual contracts with the family practitioners, administering their terms of service, including nationally-settled remuneration schemes, and the statutory disciplinary arrangements, which will remain as before. On matters which involve other parts of the health service, primary responsibility will rest with the area health authority, by virtue of the amendment made to the earlier National Health Service Acts by Schedule 4, so that those aspects of the family practitioner service can be suitably integrated within the reorganised and unified health service.

This amendment is not intended in any way to alter the division of functions between the area health authority and the family practitioner committee which I have just outlined. Nor, on the other hand, does it mean that the precise division of functions that we decide upon now is one to which we shall be permanently committed. The clause will provide, as now, the necessary measure of flexibility for changes to be made by amending regulations in the light of experience. The effect of the amendment is simply that, whatever detailed changes may be made by subsequent regulations in the functions of family practitioner committees, they will at least retain the basic functions set out in paragraph (a) of the amendment. Any proposal to take those functions from them would require an Act of Parliament.

The Government have put down the amendment in response to representations from the General Medical Services Committee and bodies which represent the other professions providing the family practitioner services—representations to which the hon. Member for Liverpool, West Derby (Mr. Ogden) briefly referred in Committee. These professional bodies have understandably been very concerned lest the Bill, in providing the flexibility needed for integration and development of the reorganised service, might—even though unintentionally—have weakend the legislative safeguards of their status as independent contractors, which is of course a cardinal feature of our NHS, and one to which the professions attach great importance—I notice the smile on the face of the tiger—the hon. Member for Willesden, West (Mr. Pavitt). They particularly had in mind that some future amendment of the regulations to be made under Clause 7(3) might leave family practitioner committees nominally in existence but without any effective functions to carry out.

As my right hon. Friend has explained to the professional bodies, the independent contractor status of their members in providing family practitioner services is enshrined in the earlier NHS Acts, and is not affected by any provision of the Bill nor would it be necessarily diminished even if the functions of family practitioner committees were to be eroded in the way the professions feared. Nevertheless, as I made clear in the debate on Amendment No. 8, we regard the family practitioner committee, with its special constitution and its direct access to the Department, as an essential part of the integrated service, and one which successive Governments have undertaken to establish. I accordingly commend the amendment to the House as one which ensures a continuing role for the family practitioner committees without in any way reducing the scope for integration and development of the service which is secured by the other provisions of the Bill.

Amendment agreed to.

1.30 a.m.

Mr. Deputy Speaker

Amendment No. 10 can be dealt with formally.

Amendment proposed: No. 10, in page 6, line 39, after 'preceding', insert 'provisions of this '.—[Mr. Alison.]

Mr. John Silkin

On a point of order, Mr. Deputy Speaker. I think some confusion has arisen because of the fact that in the selection list Amendment No. 9 precedes Amendment No. 8, and I think that my hon. Friend the Member for Halifax (Dr. Summerskill) intended to speak to Amendment No. 8. The speed with which we are proceeding temporarily caught her unaware.

Mr. Deputy Speaker

I am in a difficulty. I put the Question on Amendment No. 9 and I have taken that decision. Amendment No. 8, which preceded it, was grouped with it by Mr. Speaker for discussion but not for division. Therefore, if any hon. Members had wanted to speak on Amendment No. 8, I was expecting them to rise to their feet while we were discussing Amendment No. 9. I think I detected a misunderstanding on the part of the Under-Secretary of State, who thought that he would be answering the hon. Lady the Member for Halifax (Dr. Summerskill). However, the situation cannot be changed now and I am afraid the opportunity has been missed. It is normal procedure to group matters for discussion, and, having collected the voices and disposed of the Question, I cannot go back on that. I am willing to hear another point of order on the matter.

Mr. John Silkin

On a further point of order, Mr. Deputy Speaker. Would it be possible for Amendment No. 10, which would otherwise be taken formally, to be taken separately and for there to be a little latitude in the rules of order to accommodate my hon. Friend the Member for Halifax?

Mr. Deputy Speaker

I accede to the right hon. Gentleman's request.

Dr. Summerskill

I am grateful to you Mr. Deputy Speaker, for your latitude. I shall attempt to speak to Amendment No. 10, which deals with the family practitioner committee. I cannot refer specifically to my amendment by which we should like to set up a family practitioner committee as a sub-committee of the area health authority, but I wish to express our general dissatisfaction with the Government's justification of the family practitioner committees as they appear in the Bill.

The explanation given in Committee by the Under-Secretary of State was far from satisfactory and remains so. He has seen fit to respond to an amendment from the General Medical Services Committee and we regret that he could not see fit to respond to criticism we made in Committee. We still feel that this is, as he once said himself, a titular desecration Bill, or rather, that many aspects of it are titular desecration. The executive councils, although they have been deprived of some of their functions, remain much as before under another name.

We are left with the retention, if not of a tripartite system, of a bipartite system where we have family practitioners separated from hospital practitioners, hospital doctors and hospital pharmacists in these committees.

The basic philosophy behind this is a belief that family practitioners are independent contractors, but on this side we question for how long they will remain so. They are not as independent as they used to be from the point of view of the way in which they receive their salary.

Among many doctors there exists a view that the future of the family practitioner is as a salaried officer in a health centre. There is excessive emphasis on appointment within the family practitioner committees, in that 11 will be appointed by the area health authority and the rest will also be appointed. It is questionable how much these committees will be acceptable to the public, known to the public and accountable to the public. They will not be at all. They will not even be accountable to the area health authorities. They will deal directly with the Minister.

Other functions of the area health authorities, such as setting up health centres, family practitioner premises and helping family practitioners will not be under the family practitioner committees, so there is this division of powers, some being with the area health authorities and some with the family practitioner committees, and yet the accountability of the family practitioner committees will be totally to the Minister, so the arrangement under the Bill is rather anomalous and certainly undemocratic.

It will require co-operation from doctors to play this new and positive rôle which is the pride of the Government in presenting this Bill, but I wonder whether doctors will have the time or the wish to co-operate as the Bill will require.

There is no doubt that strong reservations have been expressed by the Secretary of the British Medical Association in the British Medical Journal and at the recent Folkestone conference.

We were left, at the end of the Committee, in some confusion as to the exact role which the various teams will play. We were told that there will be health care planning teams below districts which will review primary services and these will float up ideas to district management teams, and they in turn will float up ideas to the area health authority.

This sounds reasonable. I shall not say that the committee sounds any more reasonable but I wonder whether in practice it will operate efficiently or whether these bodies will have the power we should like them to have. We are told that they will be more powerful than family practitioner committees, but that remains to be seen.

We are also told that the Bill makes provision for an area health authority to interchange its functions with family practitioner committees and vice-versa. Certainly that gives scope for a great deal of alteration in the future, and it is difficult to comment on that until we know exactly what will be entailed. Much will depend on the Government of the day and how they use that scope.

It seems that these family practitioner committees do not provide a patient-oriented service. We had hoped for some Government amendments on this aspect. The Under-Secretary told us that the family practitioner committee is an extension into the new organisational set-up of a philosophy which was considered right back in 1946 by the late Aneurin Bevan to be a reasonable one in the context of the professions. But the Opposition are not living in 1946 any more. We are living in 1980, 1990 and even 2000 when planning this Bill. It is no justification to say that because it was all right in 1946 it is all right for this Bill.

The Bill continues to be a regressive measure. Opportunities have been missed, and the amendment was a simple and workable alternative.

Mr. Alison

The hon. Member for Halifax (Dr. Summerskill) has again expressed the fear which she and her right hon. and hon. Friends have and which runs wider than the amendment upon which she was precluded from speaking, that the arrangements in the Bill would isolate family practitioners from other parts of the integrated health service and would limit their impact upon developments and plans which affected them.

I understand and respect those fears about the future integration of the family practitioner committees. It is a novel attempt to weave into a single fabric elements which in the past have been quite separate and disparate. But I have no reason to believe that a family practitioner committee will not work closely with its area health authority which, after all, will have appointed more than a third of the members of the committee.

Unlike executive councils, family practioner committees will not be fully distinct organisations. They will use staff and premises provided by the area health authorities. I believe that they will be effectively integrated, if only by these means.

I explained that the functions of the family practitioner committees which are to be prescribed under Clause 7(3) are simply the traditional and recognised functions connected with the individual contracts of these independent contractors. But on matters involving other parts of the health service, primary responsibility will rest with the area health authorities, so that those aspects of the family practitioner committee services can be suitably integrated with the reorganised and unified health service.

I am confident that, given the special disposition of staff, premises, the powers of the area health authorities to give directions, and so on, and given this narrow limitation on matters affecting the contract, we shall secure to an unprecedented degree and in tune with the needs of the 1970s and 1980s a real integration of the old executive council functions in the reorganised service and the hon. Lady's fears will, I hope and believe, prove to be groundless.

Mr. Pavitt

I do not share the hon. Gentleman's optimism. As I said in Committee, I believe that this is one of the major mistakes in the Bill, simply by not having it as an integral part of the rest of the machinery.

The Under-Secretary has made it clear that however persuasive our arguments in Committee about the fact that this should be incorporated as a sub-committee of an area health authority, they have not had the slightest effect. However, when the General Medical Services Committee presses the hon. Gentleman, he immediately accedes to that pressure and finds an amendment to meet the point.

I am in some difficulty because of the procedural trouble that we have had. I was looking forward to surveying the House from the Dispatch Box tonight. I have almost succeeded on nearly two occasions. However, before dawn it may be that I shall have an opportunity to do so. Circumstances have not permitted me to do it on this occasion, but I should dearly have loved to.

Amendment agreed to.

1.45 a.m.

Mr. Alison

I beg to move Amendment No. 11, in page 7, line 26, after 'section', insert 'or by an Area Health Authority by virtue of Part IV of the principal Act;'. The purpose of the amendment is technical. It is to fill an unintentional gap left in the Secretary of State's powers of direction.

Amendment agreed to.

Amendment made: No. 12, in page 8, line 17, leave out 'or (4)'.—[Mr. Alison.]

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