Deputising Services (Hansard, 15 March 1984)

§ Mr. Kenneth Clarke

The consultation period has now ended on the proposals which I published on 19 December, and I am considering in detail the comments received. There has been widespread support for the great majority of my proposals, the object of which is to improve standards of service to the public.

The major change in the existing arrangements is the replacement of the professional advisory committees, which at present monitor standards of deputising services, by sub-committees of family practitioner committees. These sub-committees will contain lay representation in the form of lay members of FPCs. This reform has been widely welcomed by those who have commented on my proposals. If the legislation now before Parliament is passed, FPCs will be directly accountable to the Secretary of State for the discharge of their function. This means that in future they will be accountable to Ministers for the maintenance of standards of deputising services.

There has been general agreement also to our plans for annual reviews of consents to use services and for regular reporting to FPCs by the new sub-committees on standards of service. There has been wide support for the changes which I propose to the code of practice designed to ensure that deputising services are adequately staffed, efficiently run with sound operational policies, and subject to satisfactory and continuing local control. An important 263W point here is that minimum qualifications and experience in general practice will be laid down more firmly for doctors newly employed by deputising services.

The general medical services committee of the British Medical Association has from the outset made it clear that it shares the aim of improving the standard of deputising services. It is among the bodies which have agreed with and offered constructive comment on the majority of my proposals which are concerned with standards. They raised basic objections only to my proposals for limiting the use made of deputising services, and for monitoring that use by random telephone checks.

The response to these two particular proposals has varied. Few respondents, except for some parts of the medical profession and the proprietors of the deputising services themselves, favoured unlimited use of deputising services. The two proposals, as drafted, received support from some groups representing patients' interests, but others considered that they were too severe. Many respondents, including the Royal College of General Practitioners, were anxious that there should be sufficient flexibility to cater for the differing needs of patients and doctors in, for example, the disadvantaged parts of inner cities and in country areas. Most FPCs and the two FPC societies considered that the proposed limitations on use were too severe and opposed random telephone checks.

In the light of these comments, I propose some changes to the two parts of the proposals that have caused controversy. There will be no change in the basic position that a doctor wishing to use a deputising service must obtain the consent of his FPC, and that that consent may be subject to conditions, including conditions on the extent of use. We will try to make clearer what was always my intention—that it would be for the FPC to determine the conditions in the light of local and individual circumstances, subject to the long-standing proviso that it should not normally consent to any standing arrangements involving use of deputising services every night and weekend. FPCs will be asked, in consultation with local medical committees, to formulate and set out a general policy taking into account local variables, such as environmental and social factors and the level of out-of-hours demand from patients. The policy could vary for different parts of an FPC's area and it would be applied practice by practice, depending on the nature and circumstances of the practice.

The original draft circular sought to guide FPCs by giving a model form of consent, specifying the number of nights and weekends on which deputising services might be used. Although the draft said the model was to be "modified as necessary to take account of particular local circumstances and the problems of individual doctors and practices", it was interpreted by many people as too rigid and inflexible. I will therefore expand on this and give wider guidance on the kinds of control which FPCs might consider. These will include limiting the periods during which deputising services may be used, or setting different limits for different times of the day or week, or setting a maximum number of visits per month which the doctor could pass to a deputising service.

I have decided that, in view of the substantial variations in out-of-hours demand from patients, it would be better not to suggest to FPCs the levels at which their consents should be set, or to suggest rigid distinctions between practices of different sizes. The circular will, however, indicate, on the basis of information which we have 264W assembled, the number of out-of-hours visits per month which might be needed in an average practice. This will serve as a starting point for FPCs, which would have to consider what local variations were to be expected and what proportion of calls and what demands could reasonably be met without calling on a deputising service in the circumstances of each individual practice. They would then decide what a reasonable level of usage would be for each individual practice.

I am withdrawing the proposals for random telephone checks. We would achieve monitoring of use by obtaining information from the deputising service, with the doctor's agreement, or by signed information from the doctor himself.

I therefore believe that we are well on the way to achieving all that we set out to do to improve control over the quality of deputising services and to enable FPCs to secure a fair balance between the interests of doctor and patient in the matter of use.

We are still considering the detailed responses from all those who gave their views. I am awaiting the GMSC's response to the new proposals that I have put to it. A good deal of further work and discussion will be needed to revise the detail of the draft in the light of all the comments which we have received. I do not expect the final circular to be ready for issue for several weeks.