HL Deb 17 June 1999 vol 602 cc433-6

15 After Clause 9, insert the following new clause—

LOCAL REPRESENTATIVE COMMITTEES

(".—(1) Section 44 of the 1977 Act (recognition of local representative committees) is amended as provided in subsections (2) to (4).

(2) Before subsection (1) there is inserted— (A1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of—

  1. (a) the medical practitioners providing general medical services or general ophthalmic services in that area;
  2. (b) those medical practitioners and the deputy medical practitioners for that area; or
  3. (c) the medical practitioners mentioned in—
    1. (i) paragraph (a) above; or
    2. (ii) paragraph (b) above,
and the section 28C medical practitioners for that area, and any committee so recognised shall be called the Local Medical Committee for the area.

(B1) A Health Authority may recognise a committee formed for their area which they are satisfied is representative of—

  1. (a) the dental practitioners providing general dental services in that area;
  2. (b) those dental practitioners and the deputy dental practitioners for that area; or
  3. (c) the dental practitioners mentioned in—
    1. (i) paragraph (a) above; or
    2. (ii) paragraph (b) above,
    3. and the section 28C dental practitioners for that area,
and any committee so recognised shall be called the Local Dental Committee for the area."

(3) In subsection (1), paragraphs (a) and (b) and "the Local Medical Committee, the Local Dental Committee," are omitted.

(4) After subsection (2) there is inserted—

"(3) For the purposes of this section and section 45 below, a person who meets the condition in subsection (4) below—

  1. (a) is a deputy medical practitioner for the area of a Health Authority if he is a medical practitioner who assists a medical practitioner providing general medical services in that area in the provision of those services but is not himself on a list;
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  2. (b) is a section 28C medical practitioner for the area of a Health Authority if he is a medical practitioner who provides or performs personal medical services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another);
  3. (c) is a deputy dental practitioner for the area of a Health Authority if he is a dental practitioner who assists a dental practitioner providing general dental services in that area in the provision of those services but is not himself on a list;
  4. (d) is a section 28C dental practitioner for the area of a Health Authority if he is a dental practitioner who provides or performs personal dental services in accordance with arrangements made under section 28C above by the Health Authority (whether with himself or another).

  1. (4) The condition referred to in subsection (3) above is that the person concerned has notified the Health Authority that he wishes to be represented under this section by the appropriate committee for their area (and has not notified them that he wishes to cease to be so represented).
  2. (5) For the purposes of subsection (3) above—
    1. (a) a person is to be treated as assisting a medical practitioner or dental practitioner in the provision of services if he is employed by that practitioner for that purpose or if he acts as his deputy in providing those services; and
    2. (b) "list" has the same meaning as in section 46 below."

  1. (5) Section 45 of that Act is amended as provided in subsections (6) to (8).
  2. (6) For subsection (1) there is substituted—
  3. "(1) Regulations may require Health Authorities—
    1. (a) in the exercise of their functions under this Part of this Act to consult committees recognised by them under section 44 above,
    2. (b) in the exercise of any of their functions which relate to arrangements under section 28C above to consult committees recognised by them under section 44(A1)(c) or (B1)(c) above,
on such occasions and to such extent as may he prescribed.

  1. (1A) The power conferred by subsection (1) above is without prejudice to any other power to require a Health Authority to consult any committee recognised under section 44 above.
  2. (1B) Committees recognised under section 44 above shall exercise such other functions as may be prescribed.
  3. (1C) A committee recognised for an area under subsection (A 1)(b) or (c) or (B1)(b) or (c) of section 44 above shall, in respect of each year, determine the amount of its administrative expenses for that year attributable—
    1. (a) in the case of a committee recognised under subsection (A1)(b) or (c)(ii) of that section, to the deputy medical practitioners for the area;
    2. (b) in the case of a committee recognised under subsection (Al)(c) of that section, to the section 28C medical practitioners for the area;
    3. (c) in the case of a committee recognised under subsection (B 1)(b) or (c)(ii) of that section, to the deputy dental practitioners for the area;
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    4. (d) in the case of a committee recognised under subsection (B 1)(c) of that section, to the section 28C dental practitioners for the area."

  1. (7) In subsection (2), "(including travelling and subsistence allowances payable to its Members)" is omitted.
  2. (8) After subsection (3) there is inserted—
  3. "(4) Where a committee has made a determination under subsection (1C) above, it shall apportion the amount so determined among the deputy medical practitioners, section 28C medical practitioners, deputy dental practitioners or section 28C dental practitioners, as the case may be, for the area and each such practitioner shall pay in accordance with the committee's directions the amount so apportioned to him.
  4. (5) References in this section to administrative expenses of a committee include references to travelling and subsistence allowances payable to its Members; but the reference in subsection (2) above to a committee's administrative expenses does not include so much of the committee's administrative expenses as are determined under subsection (1C) above to be attributable to any practitioners mentioned in that subsection.''").

Baroness Hayman

My Lords, I beg to move that the House do agree with the Commons in their Amendment No. 15. In moving this amendment I should like to speak also to Amendments Nos. 19 and 125. These provisions amend Sections 44 and 45 of the 1977 Act which provide for recognition of, and consultation with, local representative committees in respect of their statutory functions. The primary care Act made possible personal medical and personal dental services, and arrangements to pilot such services, but left untouched the provisions in the 1977 Act for doctors' and dentists' statutory consultation arrangements by which a committee is recognised by a health authority as being representative of medical or dental practitioners in its area.

My right honourable friend the Member for Darlington undertook to put right this obvious defect to ensure that any doctors who had opted to provide services under the primary care Act could be reintegrated into the local medical committee arrangements if they wished, and that undertaking is honoured by these government amendments. In the light of discussions during the Committee stage in another place my honourable friend the Member for Southampton Itchen had extensive discussions with the chairman of the General Practitioners Committee of the BMA. The chairman asked us to go further than the original undertaking in order to strengthen the role of local medical committees so that they can represent not only doctors working as principals in general medical services and doctors in primary care Act pilots but also the many other doctors who contribute to our high-quality family doctor services as assistants and deputies.

Having listened carefully to the arguments, my honourable friend brought forward government amendments to the clause to give effect to the more broadly based representative machinery; and after further discussions with the GDSC the Government took the opportunity to broaden the representative base of local dental committees in the same way. The details of the amendments were discussed with the national representative bodies of both doctors and dentists, and we understand that they have their support. A tidying-up amendment was also tabled to ensure that the statute is in line with long-established practice and with what successive Health Secretaries and the professions' representative bodies have understood the position to be for many years.

Section 45 currently requires local representative committees to be consulted but only where that requirement to consult is made in regulations. The requirement to make regulations to make or vary consultation requirements involves a very inflexible framework for developing a service which can, as now, evolve rapidly. In practice, successive Health Secretaries have made provisions for a health authority to consult locally on specific issues over and above any consultation requirements specified in regulations. These are mainly in connection with the questions of entitlement to certain fees and allowances and other matters to do with the remuneration of individual practitioners. Consequential Amendment No. 19 updates a cross-reference in Section 17A of the Act; and Amendment No. 125 details repeals consequential on Amendment No. 15.

Moved, That the House do agree with the Commons in their Amendment No. 15.—(Baroness Hayman.)

Earl Howe

My Lords, I welcome these amendments, in particular Amendment No. 15. I welcome especially the scope of that amendment. I understand that a government amendment on this issue was tabled in Committee in another place almost at the last moment. The clause as then framed was deficient, at least in the eyes of the Opposition, in that it did not cover, as the noble Baroness rightly said, the 7,000-plus non-principal GPs who have the right to expect their views to be represented in their local representative committees, if those committees are to perform their very important statutory functions in an effective manner. I am delighted that the Government tabled further amendments in Standing Committee to meet the concerns expressed. The very satisfactory result is what we now see on the Marshalled List as Amendment No. 15. I thank the Minister for her comments.

Lord Clement-Jones

My Lords, in very similar terms I add my thanks to the Minister for the amendment. I know that the amendment is very broadly welcomed by the medical profession.

On Question, Motion agreed to.