§ Mr. Litterickasked the Secretary of State for Social Services what steps she is proposing to reduce the excessive working hours of hospital medical staff.
§ Mrs. CastleI would refer my hon. Friend to my reply to my hon. Friend the Member for Walsall, South (Mr. George) on 4th November—[Vol. 898, c. 1053]—on the junior hospital doctors and dentists in which I included an offer of joint examination by the professions and the Health Departments of the long hours worked by these doctors and dentists. The new contract, upon which a ballot is being held, should tend to a reduction in their excessive hours of duty. More generally, I would draw attention to the figures which I gave in the debate on the National Health Service on 27th October—[Vol. 899, c.91–94]—There has been a steady overall increase in the number of doctors working in the National Health Service, both in hospitals and in general practice. Our policies also aim at a better distribution of doctors, and we are increasing the output of the medical schools, year by year.
§ Mr. Moonmanasked the Secretary of State for Social Services if she will publish in the Official Report the average rates of pay, including extra duties awards, in the various ranges from house officer to senior registrar, for the past 12 months.
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§ Dr. OwenSalary scales and rates of extra duty allowance effective from 1st April this year, and the previous rates, are set out in Appendix B to the Fifth Report of the Doctors' and Dentists' Review Body (Cmnd. 6032) published in April. Since April average annual earnings, including extra duty allowances, of whole-time staff in England and Wales are estimated to be as follows:
House officer £3,500 p.a. Senior house officer £4,500 p.a. Registrar £5,350 p.a. Senior registrar £6,550 p.a. Only a proportion of staff in each grade earn extra duty allowances, and the amounts earned vary widely.
§ Mr. Michael McGuireasked the Secretary of State for Social Services if she is satisfied with the procedure for the removal of a doctor from the medical list of a family practitioners' committee on the grounds of failure to comply with the contractual arrangements as laid down; and if she will make a statement.
§ Dr. OwenA direction by the National Health Service Tribunal disqualifying a doctor for inclusion in any family practitioner committee's medical list, and thereby preventing him from practising as a general practitioner in the National Health Service, is a very serious matter and the conduct of inquiries by the tribunal is governed by long-established provisions of the National Health Service Acts and of regulations. Whilst we are satisfied with the substance of these arrangements, experience has shown that the detailed procedures are not adequate to deal with all the circumstances that may arise, and we are considering in what ways they might be simplified and amended consistent with justice to all parties. Before any amendment of the relevant regulations the Secretary of State is required by Section 10 of the Tribunals and Inquiries Act 1971 to consult the Council on Tribunals, and we would of course consult also the National Health Service Tribunal itself and the professions and health authorities concerned.
§ Mr. Michael McGuireasked the Secretary of State for Social Services if she will describe the procedure which is followed to determine whether or not a doctor has failed and is continuing to fail 529W to comply with the terms of the contractual agreement as laid down by the family practitioners' committee, giving (1) the various stages of the procedure and (2) the approximate time-scale at each stage.
§ Dr. OwenThe procedures are prescribed in Section 42 and the Seventh Schedule to the National Health Service Act as amended and in the National Health Service (Service Committees and Tribunal) Regulations 1974, as amended. Complaints alleging that a general medical practitioner has failed to comply with his terms of service are considered in the first place by the family practitioner committee's medical service committee, who may find it necessary to hold a hearing. The report of the medical service committee is then considered by the family practitioner committee, which sends a copy of the report, and its decision upon it, to the parties to the investigation and to the Secretary of State. Any party to whom the decision is adverse may appeal to the Secretary of State within a month of the date of the receipt of the report. In the event of an appeal, copies of the notice of appeal must usually be sent to the other party and to the family practitioner committee for its comments. In certain circumstances an appeal may be determined without an oral hearing; otherwise the Secretary of State appoints persons to hold an inquiry and report to her. The Secretary of State then determines the appeal. Additionally in any case where the practitioner has been found to have failed to comply with his terms of service and the Secretary of State has it in mind to direct a withholding from his remuneration, she then consults her medical advisory committee. The Secretary of State then notifies the parties of her decision, giving her reasons for it.
Comparatively few cases have to pass through all the stages provided for in the procedure. The time taken for each stage varies widely, depending amongst other things on the complexity of the case and the amount of correspondence involved. No useful estimate of the average time taken could be provided without disproportionate effort.
A further procedure is available whereby representations may be made by a family practitioner committee or any 530W other person to the National Health Service Tribunal, which is independent of the Department, that the continued inclusion of a practitioner in any medical list kept by a family practitioner committee would be prejudicial to the efficiency of the general medical services. If the complainant is a family practitioner committee the tribunal must, and in any other case may, inquire into the case, and does so by oral proceedings. A statement of complaint, setting out the alleged facts and grounds on which the representation is based, must first be sent to the tribunal. The tribunal then sends a copy of the statement to the practitioner; he may, within a time specified by the tribunal, admit or dispute the truth of any or all of the allegations. After the inquiry, the tribunal prepares a statement containing its findings of fact, its conclusions and any direction it makes to the effect that the practitioner's name should be moved from the family practitioner committee's medical list—and removed from, or not Included in, the medical list of any other family practitioner committee. The statement is sent to the complainant, the practitioner and the Secretary of State. If the practitioner has not appealed within 14 days, any such direction takes effect at the end of that period. If the practitioner appeals, the Secretary of State appoints a person to hear the appeal. After considering the report of the person appointed, and any recommendation of the medical advisory committee to whom she must refer the report, the Secretary of State gives her decision on the appeal and notifies the parties.
The operation of the procedure, up to the appeal stage, if any, is a matter for the tribunal itself, and I cannot comment on the detailed time-scale involved at each stage. In general it is clearly right to take care to give a practitioner who is at risk of losing his livelihood a fair chance to prepare and present his case, and this means that the whole procedure will generally take some months.