NATIONAL HEALTH SERVICE (VOCATIONAL TRAINING) BILL [H.L.] (Hansard, 17 June 1976)

§ Lord WELLS-PESTELL

My Lords, the Bill which I commend today to your Lordships' House is a simple but significant measure aimed at improving the standards of primary care. Its purpose, which is strongly backed by the academic and professional bodies (including the British Medical Association), is to tighten the entry requirements for becoming a general practitioner principal in the National Health Service by introducing a period of compulsory post-registration " vocational training ". The Bill marks a development not only in the National Health Service but in the recognition of general practice as a speciality in its own right.

There is no need for me to remind the House that this Bill comes before you at a time of severe restraint in public expenditure. However, as the Government's recent Consultative Document on Priorities for Health and Social Services in England pointed out, while it is essential at any time to work out our priorities carefully, at such times of severe restraint it is all the more imperative that we should choose the right priorities. The same document stressed the role of primary care in helping to relieve pressure on hospital and residential services, and described as a " key element " in the strategy, to maintain and where necessary increase the level of training and to improve the ways in which skilled manpower is used. This Bill reflects both these priorities: the importance of primary care and the increased emphasis on training.

Vocational training for general practitioners has existed for some years now on a voluntary basis and its development has been encouraged by successive Governments. Many doctors already embark upon organised schemes, comprising two years in appropriate hospital posts and one year as a trainee in general practice. Others, after a period in hospital, decide that they wish to take up general practice as a career, and also take a trainee year in general practice. In 1970 there were 211 such trainees in England, and in 1975, 660. Wales and Scotland have a similar development. The Government, strongly backed by the medical profession and 1386 other interested bodies, believe that the time has now come to increase the momentum already generated by making vocational training for new general practitioner principals compulsory from a future date to be agreed with the profession. Perhaps your Lordships will allow me to return to that matter in a moment.

I should perhaps make clear now those to whom it is proposed that the new compulsory arrangements will not apply. They will not apply to general practitioners already providing a full range of general medical services when the new arrangements start. They will not apply to doctors employed in general practice as locums or assistants. Nor are they expected to apply to doctors who have in the past been general practitioners within the National Health Service, although the Government will be consulting with the medical profession on whether there ought to be some condition attached to this, such as that the previous practice should not have been too far in the past or should have been of a minimum length of time.

Details such as these are a matter for regulations and need not concern a debate on the general principles of the Bill now before your Lordships. There will he other groups as well who for some reason should not come under these arrangements, but these will not be the general run of family doctors providing the normal range of services. The regulations will also need to take account of the wider European scene and the agreement on the free movement of doctors. With this in mind we have already told our colleagues in the EEC, via the Committee of Senior Officials in Public Health, of our plans. We hope to have the opportunity to discuss these in more detail in the very near future.

I turn now to the mechanics of the legislation, and to explain these I should first remind your Lordships of the current procedure by which a doctor—who must already be a fully registered medical practitioner—sets up as a general practitioner principal in the National Health Service. First he must apply to a Family Practitioner Committee, administering these arrangements on behalf of the Area Health Authority, for inclusion in their list of doctors undertaking to provide general medical services in their area. The Family Practitioner Committee refers 1387 the application to the Medical Practices Committee for a decision. The Medical Practices Committee may refuse the application, but only on the grounds that there is already an adequate number of medical practitioners undertaking to provide general medical services in the area or part of the area concerned. Thus the Family Practitioner Committees, which receive the applications and make subsequent arrangements with those doctors whose applications have been accepted, have no power to accept or refuse applications, and the powers of refusal of the Medical Practices Committee are confined by law to the grounds of adequate provision in the area.

What this Bill does is to extend the powers of the Medical Practices Committee to refuse applications so that after the appointed day they can, and indeed they must, refuse applications from doctors who have not been vocationally trained and who are not entitled to exemption. The exemptions will, of course, cover doctors providing general medical services on the appointed day and subsequently moving to another Family Practitioner Committee area. Because the Bill extends to Scotland, I should mention here that arrangements there are similar except that they are operated by the Health Boards, not Family Practitioner Committees, and that there is a separate Scottish Medical Practices Committee; the Bill makes suitable corresponding provision.

My Lords, I come now to the very important question of timing. The Bill provides for the new powers of the Medical Practices Committee to operate after an appointed day, that is, a day appointed in regulations, to which I made reference earlier, and there are a number of factors to he taken into account before a decision is made on what that day shall be. We cannot commence these new arrangements tomorrow. The full period of training will be three years, and clearly in regulations we must give doctors at least three years' warning so that they can plan their careers to comply with the statutory requirements. The medical profession have proposed 1980 as the target date for the full three years' training requirement, and this will be in our minds when consulting on the regulations.

1388 I will describe the clauses very briefly because, as I have indicated, this is a simple measure and requires only a very short Bill. In fact there are only five clauses. Clause 1 is the basic provision of the Bill; it contains the new powers of the Medical Practices Committee and the Scottish Medical Practices Committee to which I have already referred. Clause 2 contains a number of regulation-making powers, including powers to prescribe details of the training to he required. We have already had preliminary discussions with the profession and the details to be prescribed here will of course be subject to full consultation and discussion with the medical profession and educational bodies. There are also powers for medical experience judged to be equivalent to that prescribed to be accepted as meeting the requirement, to prescribe exemptions from the requirement and to make what administrative arrangements may be necessary. The remaining three clauses consist of minor amendments to other legislation arising out of this Bill, definitions of terms, authority for expenditure incurred by the proposals and the usual formal provisions for citation and extent. This Bill does not extend to Northern Ireland, but I understand that there is a proposal to introduce a similar requirement there by means of an Order in Council.

I therefore commend this Bill to your Lordships' House as an important step, the result of which will be a significant and on-going improvement in the standards of primary care in this country. My Lords, I beg to move that the Bill be now read a second time.