HC Deb 28 February 1984 vol 55 cc125-7
6. Mr. Hal Miller

asked the Secretary of State for Social Services what representations he has received from general practitioners in response to his draft circular on deputising services; and if he will make a statement.

9. Mr. Fisher

asked the Secretary of State for Social Services what responses he has received from family practitioner committees in relation to his consultative proposals on controls over, and standards of, medical deputising services.

The Minister for Health (Mr. Kenneth Clarke)

Forty six committees and 704 general medical practitioners have so far responded with a variety of detailed comments on the draft circular. Their responses will be considered carefully with all the others received when decisions are made on the final form of the circular.

Mr. Miller

Will my right hon. and learned Friend accept that some of the provisions in the draft circular may have been misunderstood by the profession and that its members would welcome his assurance that the consultations are proceeding? To set doctors' fears at rest, will he confirm that the use of a deputising service is justifiable, that it may be necessary when doctors are undertaking public duties or specialist training, and that his chief concern is to see that a satisfactory service for patients is maintained?

Mr. Clarke

The bulk of the proposals, paticularly those relating to the standards of the deputising services and the increased lay control over them, were well received. Many members of the medical profession seem to have misunderstood the basis of the proposals on frequency of use. We are now discussing the profession's own proposals on frequency of use, and I am sure that we shall reach a conclusion which will ensure that good quality deputising services continue to provide an essential part of primary care.

Mr. Fisher

Will the Minister set up a committee of inquiry to establish the facts — which it is perfectly apparent he and his Department do not know — about frequency of use, hours worked by deputising doctors and the experience — in particular the gynaecological experience — of doctors supplying deputising services? The public will be assured about the quality of the service only if the Minister establishes the facts by means of a committee of inquiry.

Mr. Clarke

Knowledge of the services and control over them can best be established at local level, which is why we propose to give the family practitioner committees more guidance on how to exercise their responsibilities. We propose for the first time to involve laymen in the exercise of those responsibilities, and we are also laying down the standards that should be achieved by the co-operatives, especially their qualifications or experience of general practice, before they are employed in deputising services. We are going in the direction that the hon. Gentleman would wish, although I realise that he has been worried by recent unfortunate cases involving deputising services in his constituency.

Mr. Colvin

Will my right hon. and learned Friend confirm that the object of this exercise is to ensure high quality services for patients 24 hours a day while being fair to doctors, who cannot possibly be expected to be on duty 24 hours a day? Will he also confirm that he has not the slightest intention of ending good existing deputising services?

Mr. Clarke

I cannot improve on the way that my hon. Friend put it. The main interest of Ministers has to be to keep up the standard of service provided for patients. It is the interests of patients that we must protect, first and foremost. That can be done by maintaining the best of deputising standards, which are already extremely satisfactory in most parts of the country, but unfortunately not in all.

Mr. Kilroy-Silk

Will the Minister confirm, as he has already suggested in answer to questions, that an unacceptably large number of doctors in my constituency use deputising services excessively? Will he tell them that if they wish to work from nine to five as, in practice, they are doing, they should have a proper salaried service?

Mr. Clarke

One of the duties of the family practitioner committee should be to determine a reasonable level of use in its area. We decided that family practitioner committees clearly required more guidance on how they should discharge that responsibility. I believe that we can agree a reasonable code of guidance and issue a circular to help them.

Mr. McCrindle

Is it not just as unacceptable that we should be contemplating moving towards what I might describe as a nine-to-five GP service as it is that we should be trying to deprive doctors of a reasonable break in their working day? Is it not a fact that where deputising services are operating well they are a source of admiration? Is it not the case that GPs have somewhat exaggerated the impact of my right hon. and learned Friend's statement?

Mr. Clarke

It is a fact that 55 per cent. of GPs never use commercial deputising services. The vast bulk of the remainder would agree with my hon. Friend that we do not want a nine-to-five GP service in Britain. That would be inconsistent with the traditions of general practice. I agree with my hon. Friend that we should now get together guidelines which retain the best of present practice and ensure that the best is available to patients everywhere.

Mr. Kennedy

Will the Minister accept that there is genuine anxiety about deputising and that, although his intitiative is welcomed in many respects, there is concern among the profession, for example about the possibility of spot checks by telephone? Does he agree that that method would not determine whether deputising was not being used merely for answering telephone calls?

Mr. Clarke

There has been a strong reaction from parts of the profession on two points. The first is the limitations in use that have been described. I hope that we have satisfied them that there is no intention of closing down deputising services. The second concerns how we monitor the use of deputising services. Some system of monitoring is required, but I am prepared to accept that random telephoning is probably not the best. We are now looking for a more suitable one.