COMMONS AMENDMENT (Hansard, 20 March 1997)

Baroness Cumberledge
My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 7. In moving this amendment, I should like to speak also to Commons Amendments Nos. 8, 25 and 32.
Your Lordships will recall that the issue of the distribution of GPs and the role of the Medical Practices Committee was subject to continuing discussions with the profession. We have reached an agreement on the new arrangements. In brief, these involve greater scope for local people, who know about local needs, to decide on the distribution of doctors within an authority's area. We shall also ensure that a robust national overview of the GP workforce is drawn together so that we can achieve an equitable distribution of GPs between health authorities. That will draw on the expertise of the MPC and the NHS Executive's national resource allocation group and involve representatives of the profession and of health authorities.
The amendments before the House reflect the agreement that we have struck. Amendments Nos. 7 and 8 ensure that the Secretary of State pays due regard to the effect that pilot schemes will have on the distribution of GPs. To enable him to do this, he will be required to consult the Medical Practices Committee when proposals for pilot schemes are put to him which increase or reduce the number of GPs in the area of the authority concerned. In short, the amendments acknowledge the important role of the Medical Practices Committee and ensure that its knowledge and expertise inform decisions on pilots made by the Secretary of State.
I can also assure your Lordships that, before we take forward any regulations on the issue, we will discuss the relevant issues with the MPC. That will provide a further opportunity for us to consider any outstanding concerns that it may have. Amendments Nos. 25 and 32 give legislative effect to proposals that recognise that national distribution of the GP workforce must be kept in view by the Secretary of State in considering permanent schemes. They ensure that any regulations governing the introduction of permanent arrangements are framed with this in mind. I commend the amendment to the House.
Moved, That the House do agree with the Commons in their Amendment No. 7.—(Baroness Cumberledge.)

§ Baroness Hayman
My Lords, I should like briefly to welcome what the Minister said when introducing the amendments. As she will be aware, the crucial role of the MPC—the work that it has carried out thus far in terms of ensuring a proper distribution of GP services—was an area that we discussed at length during the Committee and later stages of the Bill in this House and in another place. While we welcome what has been done so far, there remain concerns about the role of the MPC and whether we are in fact striking the right balance between a national overview and a local input into those areas.
1070 I heard what the Minister said about her feeling that it was the correct balance. However, I know that the MPC, and many others, are concerned that we have pitched the balance too far in putting the responsibility on health authorities in some of those areas. I therefore welcome what the noble Baroness said about looking very carefully into the matter before regulations are introduced to assess whether the balance is right and whether we should perhaps be strengthening the provisions of the Bill through regulations in regard to the role of the MPC. That is something which has been built up over the years and which we should not let go lightly. Certainly the area of the regulations, as regards what the input of the MPC would be when permanent versions of the pilot schemes come into force, is something that we would want to consider very closely in government. However, given the procedural situation that we are in, I believe that we have to say that, thus far, we welcome what has been done. However, we would welcome the opportunity to look more closely at the areas where we believe there is still scope for further action when it comes to regulation.
As regards the issue of local consultation, we would also have to consider an area where the BMA has signified that it is still unhappy; namely, on consultation with local medical committees; indeed, I believe that the BDA has the same anxiety regarding local dental organisations. Some of us feel that the actual nature of the involvement of those working in pilot schemes and on local representative committees is not as strong as it ought to be and that it does not necessarily provide enough robust structures for ensuring that local professional views are fully taken into account at all stages.
Perhaps the Minister could tell the House how she foresees involving those GPs who are working in pilot schemes in the statutory and non-statutory consultation process with local representative committees, which I know the department has said that it is anxious to continue. That is another area where I believe that the Bill has been improved during the course of its passage but where concerns still remain. While we do not have the procedural opportunities at this stage further to improve the Bill, I believe that we should put down markers that these are areas where, had we perhaps had more time and opportunity, we would have wished to go further.

Lord Campbell of Croy
My Lords, my noble friend the Minister will not be surprised to know that I am pleased to see both this amendment and those associated with it. More than once during the earlier stages of the Bill I raised the concern of the BMA that the MPCs were apparently being ignored. Clearly that has been sorted out and now I welcome the wording which will be inserted in the Bill.
Of course, I drew attention to the fact that the MPC does not extend to Scotland and therefore the Scottish Medical Practices Committee is also to be included in the new section to be inserted in the Bill. I believe that 1071 meets the main objectives which were raised and that it should help to get an optimum distribution of medical practitioners over the country.

§ Baroness Robson of Kiddington
My Lords, I too welcome the improvement that have been made to the Bill, although in my view it is not quite enough. Together with the noble Baroness, I look forward to seeing the regulations that are due to be introduced whereupon we may be able to make alternative arrangements. There is an enormous difference between the MPC having the right of approval of pilot schemes and, under the new amendment, the right only to consultation. It is not the same thing. Consultation sometimes can be a negative process. For instance, one can ask someone, "You are going to be killed; which way would you like us to do it"? That is sometimes what consultation means. I want to be certain that this Bill will ensure that the MPC has a real input into the distribution of general practitioners over the country. It has done a good job in the past and I believe that the regulations must enable it to continue to do so.

§ Baroness Cumberlege
My Lords, my noble friend Lord Campbell of Croy is right to say that we now have a different approach with these pilot schemes. There is much more flexibility. We believe that the flexibility which the Bill provides will allow different ways of delivering services to be tested.
During various debates your Lordships have referred to the salaried employment of doctors or, in some cases, different roles for different healthcare professionals. That is an important point with regard to the MPC and the powers that it has had. It cannot consider in great depth schemes that involve other health professionals. We know that primary care is about team work. Therefore it is important that the whole team is taken into consideration. We believe there is a call for a different approach to workforce planning. That is why the Secretary of State intends to use a range of expertise which will of course include the MPC but also the resource allocation group because we believe that will ensure an equitable distribution of human and financial resources. We have listened to the concerns of the MPC and of your Lordships. As the noble Baroness, Lady Hayman, has said, we believe that the balance is about right.