Mr Desmond Swayne (New Forest West, Conservative)

I beg to move amendment No. 182, in page 26, line 9, at end insert—

`(7) Before making regulations by virtue of this section, the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services or dental practitioners providing general dental services, as the case may be.'.

Mr John Maxton (Glasgow, Cathcart, Labour)

With this it will be convenient to take amendment No. 183, in page 27, line 37, at end insert—

`(7) Before making regulations by virtue of this section, the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services or dental practitioners providing general dental services, as the case may be.'.

Mr Desmond Swayne (New Forest West, Conservative)

The purpose of clause 27 is to extend the health authority lists to personal medical services to mirror the provisions in clause 24 with respect to general medical services. There is, however, a key difference between the two clauses in that under clause 24, the Secretary of State is required to

consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services.

In effect, that means the general practitioners committee of the BMA. He has to make that consultation before he makes the regulations.

In clause 27, there is an omission with respect to the regulations being made for personal medical services, in that there is no requirement to consult in the same way. What is sauce for the goose should be sauce for the gander. We have lifted the wording of our amendments directly from the provision in clause 24. Members of the Committee may have spotted that, so eager were we to use the exact words of the Bill, we left a small inconsistency in the wording of the amendment—a drafting error—in that it refers to ``general medical services'', when, to be pertinent to the clause, it should refer to ``personal medical services. However, the principle is sound.

If PMS general practitioners are to have confidence in the system, it is essential for them to have the same rights and protection nationally as their general medical services colleagues. That principle should also extend to other medical practitioners, such as dentists, who provide personal medical services.

The BMA's general practitioner committee must apply itself equally to GMS and PMS issues. The BMA states:

This is a matter of fundamental importance to the BMA.

It is happy for the Government to consult others, either informally or through the Department of Health's personal medical services implementation group, but not as a substitute for negotiation with the BMA's GP committee, which is the sole recognised body for negotiating on the rights of general practitioners. That recognition predates the arrival of personal medical services.

A lack of national consultation and similar rights to those enjoyed by general medical services practitioners will cause alarm and may influence general practitioners in their stance on personal medical services. At a time when constructive co-operation is at a premium and co-operative dialogue is in everyone's interests, it is essential to minimise suspicion about personal medical services and the introduction of the clause.

Personal medical services seem increasingly to have a national dimension. The third wave and all future waves of personal medical services contracts will operate within a nationally specified core contractual framework. Paragraph 8.9 of the NHS plan states:

By 2004 both local Personal Medical Services and national arrangements are set to operate within a single contractual framework that will meet the key principles and requirements of a modern NHS.

We believe that the same negotiating framework and requirement for the Secretary of State to consult before making regulations should apply equally to PMS and GMS. Does it? A suspicion will remain if the Government do not reassure us in that respect. Is the intention to use the roll-out of PMS as a vehicle to weaken existing consultation methods with the medical profession?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

One of the delicious ironies of serving on the Committee at this moment in history is that the casual visitor from Mars might have difficulty in identifying which Front-Bench spokesman was the product of the party of closed shops, trade union power and overbearing centralisation, and which was the representative of the radical, libertarian, free-market right.

We have taken the unusual step of referring in the Bill to consultation with the BMA for the purposes of the clause. I can tell the hon. Member for Runnymede and Weybridge that that is not without precedent, because there is a similar measure in the 1999 Act, although it is unusual. The issue is one of great sensitivity among members of the profession, so we want to consult them, and that is recognised in the Bill. We intend to mirror, for PMS, the regulations across the different lists. It would not be satisfactory for GPs to have a different set of criteria on which to be judged unsuitable or for a different process to be in place.

There is a wider issue. A distinction must be drawn between the common or garden use of the term ``to consult'', which means seek the views of or hear the opinions of, and the formal definition for negotiating purposes, which is what the amendments would bestow.

Our view is that PMS is a voluntary, local contract, entered into by GPs at local level. It is perfectly appropriate for GPs who are considering doing that to be represented by the BMA through the local medical committee. Indeed, during the passage of the previous Act, we changed the legislation to enable PMS GPs to be members of the local medical committee and to be represented by them. Because of the voluntary nature of that contract, it would not be right for us to agree a framework in which the general practitioners committee nationally could determine the contract that someone could enter into at local level through his formal negotiating rights.

That said, we are anxious to work with the BMA and a range of other organisations for the successful development of PMS. We have set up a PMS implementation group.

Dr Doug Naysmith (Bristol North West, Labour/Co-operative)

I share the Minister's delight in hearing the hon. Member for New Forest, West arguing for what amounts to trade union negotiating rights. That is almost unprecedented in the House. I take everything that the Minister has said. It is important that people do not get the message that PMS is in any way second-rate compared with GMS. The Minister is sending the message that PMS is important to the 10-year plan for the NHS.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The fact that 22 per cent. of GPs have opted to work on PMS pilots suggests that the more flexible way of working, under which remuneration much more closely reflects the clinical quality of patient service than in the GMS contract, is attractive to them.

The BMA rightly has formal negotiating powers on the national contract, and we are seeking to agree a new contract with more emphasis on quality and outcomes. PMS is enabling innovative GPs throughout the country to find new ways of working and providing services that are popular with their patients. I have given assurances about the effect of the amendments on the regulations. We want uniformity across the list, and the Bill provides for consultation on GMS. I ask the Committee to resist the amendments.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I listened carefully to what the Minister said, and I was thinking particularly about an earlier commitment that he made. He said that PMS was a voluntary arrangement and there would always be the opportunity to opt out of it and return to GMS. Can we have an assurance from the Minister that should that option no longer exist—and I believe that it could be extinguished without primary legislation—he will not extinguish the option of either staying in or returning to GMS without bringing in the necessary consultation powers, which are not unreasonable, proposed by the hon. Member for New Forest, West?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The hon. Gentleman has made a fair point. There is a stage at which PMS pilots may become permanent in the future, and that is set out in the Bill. I would need to refer back to the 1977 Act to see whether it has the consequential effect of eliminating the possibility of removing GMS. I will look at that issue and write to the hon. Gentleman.

Mr Desmond Swayne (New Forest West, Conservative)

I accept what the Minister says about having taken the unusual step of putting the requirement to consult in the Bill. He has done that in 24 in respect of general medical services, but not respect of personal medical services. Precisely that omission gives rise to the suspicion that has always existed about the Government's motives for PMS.

I can understand the Minister saying that a different kind of negotiation and consultation would be appropriate for PMS, although I disagree—for precisely the reasons that I set out in respect of the national infrastructure to which the national plan refers. I can understand the Minster deciding that the consultation on PMS should be different from the consultation in clause 24, but clause 27 contains no requirement for consultation. If the Minister has ideas about a different type of consultation before the regulations are made, perhaps he should have put something in the Bill. We have not found what the Minister has said reassuring, but because of the drafting errors in our own amendments, we will not press them. However, I give notice that we will seek to return to the matter on Report. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 165 in page 26, line 12, leave out `8A' and insert `8ZA'

No. 111, in page 26, line 40, leave out from beginning to end of line 41.

No. 166, in page 26, line 46, leave out `by Health Authorities'.

No. 112, in page 27, line 9, at end insert—

`( ) circumstances in which a person included in a services list may not withdraw from it,'

No. 167, in page 27, line 31, leave out `49k(1)' and insert `49k'.—[Mr. Denham].

Clause 27, as amended, ordered to stand part of the Bill.