FAMILY PRACTITIONER SERVICES

HC Deb 02 May 1984 vol 59 cc483-8

1. '(1) Subject to subsection (2) below, section 10 of the National Health Service Act 1977 is hereby repealed.
2. (2) The following section shall be substituted for section 15 of the National Health Service Act 1977—

"15. It is the duty of each District Health Authority in accordance with regulations—

1. (a) to make arrangements in pursuance of this Act for the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services for their locality, and
2. (b) to perform such other functions relating to those services as may be prescribed.".

1. (3) All Family Practitioner Committees shall cease to exist on the appointed day.
2. (4) All functions which immediately before the appointed day were functions exercisable by a Family Practitioner Committee shall be conferred upon the District Health Authority or jointly upon those District Health Authorities which established that Family Practitioner Committee.
3. (5) Wherever in the National Health Service Act 1977 as amended by the Health Services Act 1980 and in other enactments, orders and regulations the functions of a Family Practitioner Committee are prescribed, those references shall from the the appointed day be read as references to the functions of a District Health Authority.
4. (6) It shall be the responsibility of the District Health Authority in pursuance of its responsibilities under section 15 of the National Health Authority in pursuance of its responsibilities under section 15 of the National Health Service Act 1977 to establish a Primary Care Committee which shall include persons nominated by the Local Medical Committee for that locality, the Local Dental Committee for that locality, the Local Optical Committee for that locality, the Local Pharmaceutical Committee for that locality and such other persons as the Secretary of State shall prescribe in regulations.
5. (7) Schedule 4 of this Act shall have effect.'. —[Mr. Dobson.]

Brought up, and read the First time.

1.15 am

Mr. Deputy Speaker (Mr. Harold Walker)

With this it will be convenient to discuss the following amendments: Amendment No. 12, in page 4, line 4, leave out Clause 2.

Amendment No. 79, in schedule 2, page 31, line 7, after 'chairman', insert

'and he shall not be the medical practitioner, the dental practitioner, the pharmacist, the ophthalmic optician or the dispensing optician nominated respectively under sub-paragraph (3)(a) (b) (c) (d) and (e) below,'. Amendment No. 80, in schedule 2, in page 31, line 27,after 'persons', insert

'not being members of the contracting profession'. Amendment No. 81, in schedule 2, in page 31, line 30,after 'persons', insert

'not being members of the contracting profession'. Amendment No. 82, in schedule 2, in page 31, line 34, after 'appointed', insert

'not being members of the contracting profession'. Amendment No. 83, in schedule 2, in page 31, line 35, at end insert

'and the Secretary of State shall so arrange these appointments as to ensure that at least one person nominated by each district health authority entitled to make nominations in respect of sub-paragraph (g) above is appointed to the Committee.'. Government amendment No. 84.

Amendment No. 85, in schedule 2, in page 31, line 46, at end insert—

'(5A) If a local pharmaceutical committee so require, they may appoint deputies for those persons nominated under sub-paragraph (3)(c).'. Amendment No. 86, in schedule 2, in page 31, line 46, at end insert—

(5A) If a Local Pharmaceutical Committee so require, the Secretary of State shall appoint from among pharmacists nominated by the Local Pharmaceutical Committee under sub-paragraph (3)(c) above a pharmacist to be the deputy of such a pharmacist appointed from among persons nominated by them under sub-paragraph (3)(c) above. '. Government amendment No. 105.

Mr. Dobson

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

I will take your word, Mr. Deputy Speaker, as to what we are discussing.

The Labour party does not support the Government's proposals to separate family practitioner committees from district health authorities. We accept that the degree of integration to date has not been marked or effective, but we and the Royal Commission on the National Health Service feel that they should be integrated rather than separated. We advocate that the system which has prevailed in Scotland since the reorganisation of the National Health Service, and which has worked well, should be extended to this country.

The report of the joint working group on collaboration to which the Minister referred contains an amazing statement about the Government's intention to separate the FPCs:

The intentions underlying the proposed change are to bring district health authorities and family practitioner committees into a closer working relationship. Anyone who brings things into a closer working relationship by separating them seems to have gone quietly barmy.

The fourth page of that document says:

If the Government's present proposals prevail, in their effort to integrate district health authority services with those of family practitioner committees they will be faced with the fact that 60 of the family practitioner committees relate to one or more district health authorities; 17 family practitioner committees relate to three district health authorities; in the case of seven family practitioner committees they each relate to four district health authorities, and in six cases they relate to five or more district health authorities. In the reverse direction, 22 district health authorities relate to more than one family practitioner committee. That structure does not seem calculated to bring about an integrated approach between district health authorities and FPCs. In other words, we are faced with a structural shambles that will be made worse by the Government's proposals.

It appears that the proposition has been sold to the British Medical Association on the grounds that those free-standing and separate FPCs will be better placed to look after the interests of family practitioners and the services that they provide. We believe that that separation will expose FPCs to more interference from the Secretary of State than in the past. In support of that contention, I shall quote what the Minister said in Committee on 21 February. Doctors and the BMA should note it carefully. He said:

The fact is that these committees have to be accountable for substantial sums of public money. The FPCs are disbursing at the moment for services which cost £2½ billion. It is about one-fifth of the total current expenditure on the National Health Service. For the disbursement of all that money there really has to be a line of responsibility and accountability to the Secretary of State".—[Official Report, Standing Committee A, 21 February 1984; c. 314.] In fact, the FPCs incur small administrative expenses. Those are the only expenses for which they are responsible—the £2.5 billion expenditure is incurred by doctors, dentists and opticians. We believe that in time what we are saying will prove correct — that the Secretary of State intends to intervene in the spending of doctors, dentists, and opticians, to the disadvantage of their patients. The Government's proposals are structurally and managerially unsound, and calculated to give the Secretary of State more powers than he should have over general practitioners, dentists and opticians. That is why we oppose them.

Mr. Meadoweroft

I should like to explain amendment No. 83. There appears to be an anomaly in the Bill as it is drafted in that the paragraph that relates to representations means that there could be four representatives from one DHA. I know that that is not the intention of the Bill, but it could happen.

Also, in several places round the country more than four DHAs are involved. The purpose of amendment No. 83 is to make it possible for all those DHAs to be represented, and says that the Secretary of State will have a duty to ensure that all the DHAs are represented among the seven representatives in subparagraph (h)—no more and no less.

I hope that our amendment tidies up the situation and allows for more consultation. It means that none of the DHAs is left out in the cold in the new state of affairs.

Mr. John Hannam (Exeter)

I declare an interest as an adviser to the Pharmaceutical Society of Great Britain. There are four amendments in my name in this group, three of which relate to the composition of family practitioner committees. The fourth, No. 85, proposes deputies for pharmacists on the FPCs.

Amendments Nos. 80, 81 and 82 relate to the need to achieve a proper balance between lay and contracting members. I welcome very much the Government's proposal in amendment No. 84 to ensure that the members appointed by local authorities, district health authorities and those appointed after consultation by the Secretary of State shall not be members of the contracting professions. That will ensure that no one profession dominates the proceedings of the FPC to the advantage of that profession and consequently to the disadvantage of the public.

If my right hon. and learned Friend had not been able to accept the case for creating that protection in the Bill I would have had to embark on giving a series of examples of the way in which some FPCs have allegedly been guilty of acting against the public interest because of domination by a particular profession. I am pleased that the Government have acted promptly in dealing with this important matter.

Amendment No. 85 tackles another problem that we face in seeking to ensure that the FPCs maintain a proper balance of membership at their meetings. It seeks to allow pharmacists the right to send a deputy if they cannot attend a meeting of contractors. The Bill currently proposes that deputies should only be allowed for contractors represented by a single member — in particular, the ophthalmic opticians. Of course it is desirable that one dispensing and one ophthalmic optician should be present to represent their professions, but it is also accepted in the Bill that two persons nominated by the local pharmaceutical committee should normally be present too. I hope that I can convince my right hon. and learned Friend that because of a legal requirement in the Medicines Act 1968 that pharmacists must be present at their pharmacies whenever they are open, they should also be allowed to send a deputy. The pharmacists are the only contracting profession required by legislation to be present at their place of work, and I believe that they should be a special case.

At the end of March 1984 there were 10,928 pharmacists in Great Britain responsible for dispensing over 300 million prescriptions at a total cost of £1.25 billion. The presence of pharmacists at meetings of contractors is essential in order to ensure that an adequate pharmaceutical service is provided to meet the needs of the public. It is not envisaged that this facility would be utilised on many occasions. It is just as important that continuity of representation should be maintained. However, on the small number of occasions when a pharmacist may be prevented from attending by his legal obligation to be present at his pharmacy, the use of a deputy would facilitate the work of the FPC and protect the public interest.

Pharmacists provide a dedicated community service and play an important role in the administration of health care. I hope that my hon. and learned Friend will be sympathetic towards that amendment.

Mrs. Jill Knight

I support my right hon. Friend the Member for Exeter (Mr. Hannam) in what he says. I also ask my hon. and learned Friend to consider the situation that will arise when dispensing opticians are no longer able to be placed on the FPCs. There will be a vacancy to be filled. I hope that the balance between lay and professional members will be maintained when that vacancy is filled.

The proposed new part II to schedule 5 to the National Health Service Act 1977 states in paragraph 7A(2) that the vacancy be filled by a doctor, a dentist, a pharmacist or an optician. There are eight doctors on the FPC already, three dentists and two pharmacists, but only one ophthalmic optician. There is not a very good balance. I suggest that the vacancy should be filled by the appointment of a second ophthalmic optician, when the dispenser is no longer present. I ask my hon. and learned Friend to take that point on board.

1.30 am

Mr. Kenneth Clarke

On new clause 29, throughout our debates there has been a division between the Opposition and ourselves about our intention to give independence to family practitioner committees.

The report of the working party on collaboration contains many features with which the hon. Member for Holborn and St. Pancras (Mr. Dobson) agrees. In practice, I believe that the further we go the more we shall erode his opposition and weaken his belief that somehow we are dividing the service. We need FPCs performing effectively while developing collaboration with district health authorities, but we do not support the hon. Gentleman's proposal to integrate or subordinate the FPCs within the DHAs.

We believe that the primary services — family doctors, dentists, dispensing pharmacists and opticians — are so important that they should be the special interest of FPCs. All this is part of the task of ensuring the right balance between the hospital service and community-based health care.

It is always important to ensure that the community services, which are the primary services, are not dominated by the hospital service, which inevitably absorbs most of the money spent on the National Health Service. At present the balance within the DHAs, between hospital and community services is very much a one-way matter. In the central London health district with which the hon. Gentleman is concerned, of the £108 million annual budget £100 million goes to the hospital services and only £8 million to the community health services.

I do not believe that we are ready to include primary care services within the DHAs as well. I believe that specialist committees collaborating with the DHAs are the correct way forward. The hon. Gentleman's proposal would also involve considerable expense because a primary care committee for every district to deal with these specialist problems would mean 192 such committees. I believe that the 90 family practitioner committees can do a more cost-effective job.

The hon. Gentleman did not touch on amendment No. 79, which is somewhat too hostile to the professions in seeking to exclude them from the chairmanship of FPCs, although we shall try to achieve the right balance between lay and professional chairmen.

The hon. Member for Leeds, West (Mr. Meadowcroft) seeks with amendment No. 83 to cover the problem that arises when an FPC covers a territory affecting more than four DHAs. I hope that I can meet the point by assuring him that in that situation we intend to ensure that each DHA is represented on the FPC. We dealt with this in Committee, but I appreciate the hon. Gentleman's problem in that he was not fortunate enough to be selected to serve on the Standing Committee.

I resist amendment No. 83 because it would impose a rather narrow solution. We propose to live up to the commitment that I have given in ways that fit each FPC so that we can respond to local circumstances. In some cases we can ensure that an additional DHA obtains a representative through the seven lay appointments made by the Secretary of State. In others, especially the larger FPCs, it would probably be better to make the committee bigger while preserving the lay-professional balance in the resulting membership.

I hope that the hon. Gentleman will accept that commitment from me. I am sure that any successor to my post will adhere to it. We shall then have the flexibility to achieve the aim that he seeks in a way that suits each local FPC.

On the desire of pharmacists to have deputies, my hon. Friend the Member for Exeter has the support of the Opposition as their amendment No. 86 deals with the same issue as my hon. Friend's amendment. We have always maintained that deputies should be allowed on FPCs only for professions which have only one representative. As there is only one dispensing optician and one ophthalmic optician, an entire profession could be left unrepresented if an individual was unable to attend.

If deputies are allowed from the other professions, however, continuity of attendance may be destroyed. I agree that the pharmacists have the most attractive case in this respect as there are only two of them and, as my hon. Friend pointed out, there is the problem that the pharmacist must be in the pharmacy if it is to be open for dispensing. Nevertheless, some of the eight doctors and three dentists could also make out a case for having deputies. We want working committees, not floating public meetings with a different attendance on each occasion. Therefore, we prefer to keep continuity. We must persist in that for fear of changing the nature of their work. On the other hand, we have, in amendment No. 84, met at least one of the concerns of the Pharmaceutical Society of Great Britain. It pointed out to us—and the case was underlined by my hon. Friend the Member for Exeter that on some FPCs the principle of achieving a balance between lay and professional members is being damaged because some of the lay places are being taken by professionals, and not in a way that is of great assistance to pharmacists.

We accept that case, and amendment No. 84, with the obvious assistance of the parliamentary draftsman, is the right way of handling the matter. It will ensure that we maintain the present balance, and that no one can use lay places for extra professionals. Having met the Pharmaceutical Society of Great Britain to that extent, I hope that my hon. Friend will accept that although he has a fairly compelling point on deputies, if we conceded that we would concede to the others, and the very nature of the work of FPCs would be changed.

Mr. Dobson

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.