RETENTION FEES

HC Deb 20 April 1978 vol 948 cc820-7

"There shall be no increase in the General Medical Council retention fees within two years following the passing of this Act "—[Mr. Beith.]

Brought up, and read the First time.

Mr. A. J. Beith (Berwick-upon-Tweed)

I beg to move, That the clause be read a Second time.

We have heard from the two Front Benches the tone of sweet reasonableness, and it has prevailed because, if there is one thing that has virtually never been discussed from the start of the Bill's passage through the House, it is what it will cost and who will have to pay. These elementary questions should be dealt with tonight.

We should not forget how much resentment was caused when retention fees were first introduced. The fees, by and large, pay for the expenses of the GMC. Many doctors took up practice thinking that there was a once-and-for-all payment to be made on registration. They were resentful when an annual retention fee was introduced. The Merrison Committee referred to that deep resentment. However, the fees have become accepted practice and we know that they will continue, but we do not know what will be the impact of the Bill and the additional work to be undertaken by the GMC.

The Merrison Committee, on whose work the Bill is based, did not shirk the issue. It set out clearly that, in its view, quite a lot of expense would arise from these reforms. In paragraph 433 of its report, it says: In any event there can be no doubt that the new functions which we recommend for the GMC would add considerably to the cost of its operation. A number of areas can be identified where there would be extra expense. First, fitness to practise proceedings have traditionally been an expensive part of the GMC's responsibilities and their cost would no doubt be substantially increased by our recommendation for a new role in relation to the sick doctor and for a unit to investigate complaints. Secondly, we have argued the need for a much wider scope in relation to the supervision of education. The Committee thought that this would be expensive and thirdly, it believed that the assessment of overseas doctors would be expensive. The Committee also thought that its recommendations that have led in the Bill to provisions for giving advice and guidance to doctors would give rise to expense. The report said that this would put a further strain on the GMC's finances, and would hasten the increase of retention fees. The Committee argues strongly that it is worth doing and that better value for money will result for doctors at the end of the day, though it is difficult to convince many doctors with this argument, because so many of the functions with which the GMC is concerned are designed for the protection of the public rather than the protection of the doctor.

Much of what is in the Bill is designed to give the public the knowledge and satisfaction that the medical profession is well regulated from their point of view, so that the patient will know that he is well safeguarded. However, so much of what is in the Bill is bound to create further expense. If the GMC is enlarged substantially, as it can be under the Bill, there will be many more people trotting up and down the country to meetings and many more doctors' train fares and air fares to pay as they attend meetings. The additional branch councils must also necessarily give rise to expense. These are matters upon which all the parties, with the exception of the branch councils, are agreed. The need for the work has not been denied, but we must make clear what it will cost and who will have to pay for it.

The Merrison Committee talked in terms of a possible partnership between doctors and the Government, with the Government chipping in a certain amount. So far the Government have held their reserve on this matter, because they see it as something to be discussed when the new GMC is set up. However, they have thrown out some interesting possibilities. In another place Lord Wells-Pestell said that the retention fees could be increased or the GMC could hold fund-raising activities. That conjures up delightful possibilities—"Come to the GMC's fund-raising bazaar". Doctors and their families will gather round running wheels of fortune in order to raise the day-to-day expenses of the GMC.

I do not think that events will take that course. There is only one likely consequence and that is an increase in the retention fee. That will be resented by doctors, who are not convinced that the ability to set the payments against income tax makes it possible to ignore the cost altogether.

We are drawing a blank cheque on the bank accounts of the doctors. We owe it to them to give them a clearer indication of what is involved, and to know ourselves before we give the Bill a Third Reading. We should know what it will cost and the way in which the burden of the cost will fall. It is with that in mind that I bring this matter before the House.

Dr. Vaughan

The hon. Member for Berwick-upon-Tweed (Mr. Beith) has raised an important point. There is no doubt that the costs of the new General Medical Council will be considerably higher than the present costs. There will be an argument whether the professions should pay the whole of the cost or whether the Government should pay part of it as the new General Medical Council will be carrying out various additional functions for the Government.

That is a matter that the Merrison Committee considered. The Committee recommended that the new General Medical Council should be a totally independent body. However, can it be independent if the Government are paying part of its costs? I ask the Minister to tell us whether the Government have in mind to pay a proportion of the new costs. If so, what effect do they think that that will have on the independence of the new body?

Mr. Moyle

The new clause, moved by the hon. Member for Berwick-upon-Tweed (Mr. Beith), would have the effect that the General Medical Council would be deprived of an increase in its income for two years to enable it to cope with rising costs. We hope that there will be no return to hyper-inflation, but there must be protection against all eventualities. It would be possible for the Council to meet rising costs only by increasing initial registration fees.

I am sure that the hon. Gentleman does not wish the clause to have that effect. I understand that he is probing the Government as regards the future financing of the Council. He is doing so against the background of the original dispute which led to the setting up of the Morrison Committee and which was based on an increase in the retention fees.

There will be an important distinction to be drawn between the General Medical Council as it is now and was when the dispute occurred and the Council in future under the Bill. The majority of the Council in future will be elected representatives of the profession. They will have the predominant voice, therefore, in fixing the retention fee. That is a substantial change from the time of the dispute.

Much of the work of the General Medical Council relates to the protection of the public, but by a paradox and interrelationship, what is done to protect the public leads to the protection of the profession. That process leads to public confidence in the profession and, in the end, protects it.

I cannot give a precise indication to the House of the terms of the Council when it is formed under this measure. Clearly, it will have to make up its mind whether it wants to receive a financial contribution from the Government. It is only the new reconstituted Council that will be in a position to take that decision. It will have to take it against the background of the pertinent point made by the hon. Member for Reading, South (Dr. Vaughan)—namely, that if it receives some money from the Government it is conceivable that not the present Government, perhaps not even a Government in which the hon. Member for Reading, South is a member or a Government in which the hon. Member for Berwick-upon-Tweed serves, but some other Government in future might use that provision to reduce the independence of the profession.

The profession will have to make up its mind about that. It will have to weigh inflation, the commitment that it wants to make to administration and the burdens of so doing against its desire for independence. All the other professions that I have been able to study have wanted to retain their independence and have not sought Government assistance.

I hope that the House will join me in opposing the clause.

10.30 p.m.

Mr. David Crouch (Canterbury)

I am glad to hear the Minister of State say that, because I cannot in any way support what was said by the hon. Member for Berwick-upon-Tweed (Mr. Beith).

Mr. Beith

I did not say that. I said that the Merrison Committee said that.

Mr. Crouch

I do not support what the Merrison Committee recommended.

The General Medical Council is a very powerful body in our society. In Committee I said that it was one of the most powerful statutory bodies of which we know. There is no such powerful body in the legal profession as exists in the medical profession. If the medical profession wants such a powerful body, it must pay for it. I should not accept so much as one penny or one farthing of that money going to support the medical profession in that sense. It must support itself if it wants this power.

If it wants this power, it must have it 100 per cent. on its own. I should not support any contribution whatsoever from Parliament towards this body. I am not against it, but it must be paid for by the medical profession. It has this powerful body, and it must pay for it. No one else should be asked to make any contribution towards it. I feel extremely strongly about this matter.

Dr. Alan Glyn (Windsor and Maidenhead)

The point made by my hon. Friend the Member for Canterbury (Mr. Crouch) is that the General Medical Council wants to be independent. What worries me—the House should know about this facet—is how much it will cost. No one has calculated what fees will have to be levied for either initial registration or continuation. My recollection is that those who registered originally were given a once-and-for-all fee, but Parliament changed it.

I am concerned about what the Minister said. Rightly, he said that some of the functions now being taken on are not entirely GMC matters, although they may be in the interests of patients. I do not know. I want to see an entirely independent GMC which is not in receipt of Government money. On the other hand, I have no idea to what extent the fees would have to be raised to achieve that object. There is no estimate in the Bill.

Mr. Beith

It is nice to have generated some excitement over the Bill. I share with the hon. Member for Canterbury (Mr. Crouch) the belief that any professional self-regulating body which wants to retain its independence should look warily at the prospect of finance from the Government, but, as I pointed out, that was one of the possibilities canvassed by the Merrison Committee when it looked at ways of financing it.

I think that the hon. Gentleman misleads the House slightly if he supposes that doctors from end to end of the country are bursting to see the GMC engage in numerous activities and levy fees in order to do so. There is considerable support among doctors for the kind of constitution and independence that the GMC will get under the Bill. But the idea that there will be rejoicing in every surgery and consulting room from end to end of the country and a ready acceptance "Here is something for which we have been waiting for years; just send us the bills and we shall foot them straight away" is far from reality.

Most doctors going about their ordinary work in general practice or in hospital, having little or no occasion to have dealings with the GMC, will wonder what restraints there will be upon any body of this kind from embarking on a programme of expansion of its activities. What will there be to prevent it from unwise commitment of expenditure? What will there be to discourage it from setting up larger and plusher offices, organising more planning meetings, committees, sub-committees and working parties? All these matters will mean many people spending a lot of other doctors' money travelling round the country from one meeting to another. Doctors getting on with the job will want to know that their money will not be used to excess on activities of that kind.

The Government have been extremely cautious. They have rightly not tried to pre-empt the GMC's decision on where it wants its money to come from, but they have not said what kind of response there would be if the GMC asked them for money, and they have not offered any indication to the House of what they think the whole thing will cost at the end of the day.

We cannot be happy about that state of affairs. If the Minister is not prepared to counsel the GMC to watch its funding carefully and to take a cautious view about what expenditure it should undertake, I so counsel it. I am sure that I carry with me many hon. Members who speak on behalf of the doctors who do not want the GMC to rush into extravagant expenditure now that it is embarking on a new range of functions.

I do not think that it would be reasonable so much to restrict the GMC that it could not cope with the minimal inflation, which we hope to assist the Government in ensuring is all that happens over the next few months and, indeed, over the next two years. But we must make it clear that this House, in providing opportunities for a more representative GMC with wider powers, does not want to see that made the occasion for spending a great deal of doctors' money.

Mr. Crouch

Does not the hon. Member agree that the Law Society, which is a powerful body in regulating the behaviour and practice of solicitors, does not ask the Government for any money? It has wide powers and has the capacity to cause a solicitor to lose his business by striking him off so that he can no longer practice. The GMC has similar—I would maintain even stronger—powers. It would be wrong, no matter what the cost to the GMC, for the GMC to think of the Government—the taxpayer—picking up the tab for these powers. I agree that it is a worry for GPs to consider what the GMC may be taking on on their behalf, but we cannot pass the matter to the taxpayer.

Mr. Beith

The hon. Gentleman is giving wise advice to the future GMC, which will now have to consider the matter. However, on behalf of the doctors we represent we are entitled to give further advice to the GMC—namely, that it should be very careful not to embark on expenditure that could lead to a considerable increase in retention fees when those fees are not viewed with any enthusiasm.

With that advice, and knowing that the restriction imposed by the clause will be too great to be placed on the GMC, I beg to ask leave to withdraw the motion.

Motion and clause, by leave withdrawn.