§ 3.55 p.m.
§ Debate continued on Second Reading.
§ Baroness YOUNGMy Lords, I should like to begin by thanking the noble Lord, Lord Wells-Pestell, for introducing this 1393 Bill this afternoon and for explaining its provisions so clearly. As he has said, it is a very short Bill but it is nevertheless an important one. I believe this is a case where we are all agreed on the principle; it is in no sense a Party politically controversial Bill, and my understanding is that both the medical profession and those in the academic medical profession are agreed on its main provisions. It is not, therefore, my wish to detain the House for more than a very few minutes in making my comments on the Bill.
It seems to me that the core of the Bill will in fact lie in the regulations which follow from it. It is very necessary that we should know that there will be complete consultation with the medical profession, with the universities and others involved in this matter, so that they may be satisfied that the powers under the Bill are workable and are indeed what everybody wants to see. Secondly, as I understand it, the effect of the Bill will be to add another three years to the training of a doctor, a general practitioner; that is to say, a boy or girl going into the medical profession will train at a university or hospital for five or six years. When they have passed the exam they will have then to have a further year of prescribed medical experience before they are fully qualified as general medical practitioners. This means that it will become a very long training indeed, lasting nine years. I wondered whether the Government and others concerned had considered the effect of this very long training on those entering into the profession, and in particular the effect on women doctors. One of the, I thought, most important provisions of the Sex Discrimination Act, as it now is, is that the discrimination which had been widely exercised by medical schools against girls becoming doctors has become illegal. In fact this Bill will make it almost as difficult, because it means that people will have to train for nine years before they are fully qualified, and this is a very long time indeed. I do not know whether this matter has been adequately considered. I think it is a serious point, and I should like to ask the noble Lord what he thinks about it.
Lastly, I was interested to hear what the noble Lord had to say about the European Economic Community and their regulations. I understand that in the medical world British doctors command 1394 very much the top place in the international market. I hope this will not make it more difficult for British doctors to move around the world. I assume that as a result of the Bill they will be better qualified, and other countries will be even more likely to employ them rather than less likely, which seems to be to me a very important point. As I said, I do not believe that this is a contentious Bill, but I believe it to be a very important one. I welcome it, and I hope that it has a speedy passage through your Lordships' House.
§ 3.59 p.m.
§ Lord AMULREEMy Lords, my noble friend Lord Winstanley was going to welcome the Bill on behalf of noble Lords on these Benches. Unfortunately, he is sick and cannot be present, so I have volunteered to say a word of welcome in his place. This is a Bill to which nobody, I think, can object. It really goes back to the days, quite a long time ago, when to qualify it was not necessary for young doctors to take one year preregistration work in hospitals. In my young days the moment you were qualified you could go and put up your plate and the patients would come. That is a change for the better now, and I think it will be of great advantage to the profession, and general practice in particular, if people going in for general practice have a longer and better training, because it is a very difficult profession. That being so, I welcome this Bill very warmly.
The only thing I am not quite sure about—and I rather share this with what the noble Baroness said—is that it means that it is a very long time from the moment when the boy or girl wishes to be a doctor to the moment they are let loose entirely by themselves. I do not grumble about this, but it means a very long period of training, and I wonder whether the noble Lord in charge of the Bill can possibly tell me how that compares with our colleagues in the Common Market countries who want to go into general practice. How long a training do they do before they start their practice? Apart from that one question, all I want to do is to welcome the Bill. I am pleased that under Clause 2 it is possible for the rather firm length of time to be reduced if the Committee thinks that the doctor in question 1395 has had sufficient experience to qualify him to treat patients.
§ 4.2 p.m.
§ Lord PLATTMy Lords, as one who has been concerned with medical education for a long time and as a member of the Royal Commission, I too welcome this Bill in its intentions and am grateful to the noble Lord who so clearly explained it to us. I rise only to ask one or two questions for clarification. The noble Lord, Lord Wells-Pestell, was concerned to tell us of the exceptions, which I think are important. I do not think that this has got to apply to everyone. It is not quite clear to me from the Bill—although this may be my bad reading of it—what happens if a person is already in general practice today and has not undergone this particular training but has been in practice for a long time and he then wants to change from his practice in Brixton to a practice in the Lake District, or something of that kind. I take it that he is exempt from the provisions of this Bill, and he would be acceptable as a principal.
Secondly, I am surely right in thinking, because it comes in the first paragraph of the explanatory notes, that this applies only to principals in general practice and not assistants, and presumably not partners of principals. I think a little clarification is needed here, and this may help to clarify the points raised by the noble Baroness, Lady Young. I suspect that most of the women with whom she is so rightly concerned, who have been perhaps bringing up a family for a good many years and want to go back into practice, would not seek to go back straight away as principals in general practice; and if they join a group practice I hope they could do so without difficulty. But this is where I want clarification. Having done so and joined it, and had experience in that practice for several years, I take it they would then be eligible for principals in general practice at the end of that time. While looking forward to some further clarification on these points, I continue to welcome the Bill which I think is a very good measure.
§ 4.5 p.m.
§ Lord WELLS-PESTELLMy Lords, I am very grateful to the noble Baroness, 1396 Lady Young, and to the noble Lords, qualify Lord Amulree and Lord Platt, for the welcome which they have given this Bill. May I try to deal with them in some form of order. The noble Baroness, Lady Young, raised the question of consultation. I could let the noble Baroness and your Lordships know what consultations have taken place so far, but it really is a very long list. Perhaps the House will be good enough to take it from me that detailed consultations have taken place, and in fact will continue to take place so that we can get the regulations set out in a way that is going to be acceptable to everybody concerned.
It is perfectly true that this vocational training is going to add a considerable period to the training of doctors, but there is, I imagine, some compensation. As I understand the situation, a doctor who has been a doctor for 13 years and during the 13 years has had five years as a general practitioner does qualify for a seniority payment. It means that every doctor who completes the compulsory—and I use the word advisedly—vocational training will get an additional allowance of £580 each year from the end of that period. Therefore he will get, I should have thought, an appreciable financial advantage.
The noble Baroness raised the question of women. This of course is a difficult point. I think that this is recognised. I know that there are discussions going on about it. But the regulations will provide, so I am informed, for the part-time training which many women undertake. This will indeed make for a lengthy training, but women are already participating, as the noble Baroness knows, voluntarily in vocational training schemes, and we think that the benefit to general practice warrants this. But special consideration is in fact being given to the position of women.
With regard to the EEC medical Directives, I said to your Lordships not so many weeks ago, when this matter came up in connection with another medical matter, that our lawyers advise that the medical Directives, when read with the Treaty of Rome, may be interpreted as meaning that doctors from other EEC countries cannot be subject to mandatory vocational training. Against 1397 that, the lawyers of the British Medical Association do not share this view, but agree that the issue is not clear. This is where we are at the present moment. We see mandatory vocational training as a necessary consequence of the emergence of general practice as a specialty in its own right, as I said earlier on. We know that there is considerable interest in some other countries in the development of specialist training for general practice. Indeed, this matter is under discussion by the committee of senior officials in public health this very day and we are awaiting the outcome of it. So far as the EEC is concerned, legally the position is not clear, and this is one of the matters we have to clarify in the immediate future. I think that I have already covered some of the points which the noble Lord, Lord Amulree, raised.
§ Lord ROBBINSMy Lords, might I ask the noble Lord to clarify one general question to which perhaps the answer is absolutely obvious, but is not clear to me? What will be the effect of the passing of this legislation on the numbers actively engaged in the practice of medicine after a period? Prima facie it would seem that if the period of training is prolonged by a number of years, then, other things being equal, the numbers actively engaged would be fewer than if the prolongation had not taken place. Am I mistaken in that respect?
§ Lord WELLS-PESTELLMy Lords, I do not know whether I can give the noble Lord a satisfactory answer. My understanding is that more and more people are coming into the medical profession for training; the number has increased appreciably in recent years. The result is that in consequence, there are more coming out of training. I do not know whether that really satisfies the noble Lord.
§ Lord ROBBINSMy Lords, what I am asking is really the intellectual question, not whether in future the numbers will be absolutely greater than they were in the past, but how they will compare with what they would have been if this prolongation had not taken place.
§ Lord WELLS-PESTELLI am in some difficulty, my Lords. I do not think I 1398 can give the noble Lord a satisfactory answer.
§ Lord ZUCKERMANMy Lords, may I ask the noble Lord to clarify one point? What will happen to those medical graduates who have no intention of joining the National Health Service? Will it be obligatory on them to do these three additional years in vocational training or will they have a head start on those who join the national scheme?
§ Lord WELLS-PESTELLThe answer is perfectly clear, my Lords, and I thought that I had made it clear those who want to remain in the NHS as principals will have to take the compulsory training. It is as simple as that. I come to the question of doctors changing areas. A doctor who was a principal providing the full range of general medical services on the appointed day and who subsequently changes areas will be exempt from the training requirement. I think that was the point which the noble Lord, Lord Platt, was making. As for doctors returning to general practice, some doctors on returning will be exempt from the requirements while others may more appropriately apply for a certificate of equivalent experience. We will want to consult with the medical profession on how to apply these two possibilities. As I say, these are matters which are already under discussion and matters which will have to be resolved before the regulations can he laid before your Lordships' House.
I think I have dealt with the whole matter, except the question of exemptions. Doctors contracting to provide only maternity medical services will, I understand, be exempt; doctors contracting to provide only family planning services will be exempt; and those who have already been in general practice at some time in the past though they are not actually practising on the appointed day will, subject to any conditions which may be thought to be appropriate as to how recent or for how long the practice should have been, also be exempt.
§ Lord DRUMALBYNMy Lords, may I ask the noble Lord to say how this will affect doctors in the Defence Services?
§ Lord WELLS-PESTELLMy Lords, doctors in the Defence Services will be 1399 treated in the same way as those in the NHS.
§ On Question, Bill read 2a, and committed to a Committee of the Whole House.