Mr Desmond Swayne (New Forest West, Conservative)

Were we still labouring under the ancien regime and had we decided, under the procedures that until 6 December governed these Committees, properly to scrutinise the Bill and subject clause 23 to a thorough examination, this would be a stretching process.

Yesterday, I sought a briefing from the British Dental Association, which replied to me in an e-mail message, saying that it

does not object to the amendment—

by which it means the clause—

to allow dental corporate bodies/companies to provide General Dental Services and to contract with Health Authorities for services. Some questions remain about the practical application of this, particularly in relation to discipline within the GDS Regulations, and these will be discussed with the Department of Health.

The Minister will no doubt look forward to those discussions, because they will be had with him, rather than in Committee. However, I have a couple of questions about the clause. Why is there no provision for ophthalmology or pharmacies similar to the arrangements that we are making for corporate bodies in respect of dentists?

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Or doctors.

Mr Desmond Swayne (New Forest West, Conservative)

The hon. Gentleman is correct. I was prompted to ask that question by a representation that I received from Lloyds Pharmacy, which is worried about clause 26 and the provisions for disqualifying practitioners. It says:

While we welcome any measure which enables individual misconduct to be dealt with effectively, we are concerned that this Clause could enable entire pharmacies or chains of pharmacies to be prevented from operating as a result of the misconduct of an individual pharmacist. Our concern hinges on what the Government means by ``person'' in the Clause.

It is referring to clause 26 and goes on to say:

If a ``person'' is defined as being a single individual only, the Clause has our full support.

If a ``person'' is defined as being a corporate body, it seems to us this could mean that, should a single employee misbehave (ie an individual pharmacist within the corporate pharmacy ``person''), an entire company could end up being removed from a Health Authority's list.

That would be highly inequitable. That confusion could be avoided if there were a provision for pharmacists and ophthalmologists similar to that in clause 23.

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

Clause 23 deals with dental corporations. Most dental practices are owned by individual dentists or partnerships, but a limited number are owned by corporate bodies that employ the dentists. Boots has recently acquired a corporate body, and the largest, Integrated Dental Holdings Ltd., has a multi-million pound turnover.

Experience shows that limited liability status helps such bodies to raise capital for investment in building and equipping new dental surgeries, so we want to encourage their growth while ensuring that patients have the same protection that we provide for patients of practices directly owned by dentists.

It may not be commonly known that the number of corporate bodies is currently limited by restrictions in the Dentists Act 1984. Some trading is possible, and new bodies have recently entered the field by buying shell companies, which have ceased to trade. The restriction dates back to the Dentists Act 1921, when the number of corporate bodies was frozen because of concerns that clinical and ethical requirements might be overridden by commercial interests. However, there have been major improvements in the safeguards provided by company law and, with the introduction of the NHS, by the disciplinary controls that we are discussing and enhancing today.

We have positive experience of the widespread involvement of corporate bodies in providing pharmaceutical and optical services for NHS patients. The hon. Member for New Forest, West asked why there was a provision about dental corporate bodies and not others. It is because there is an existing provision for the ophthalmic profession, and there are pharmaceutical regulations that list corporate bodies, but dental corporate bodies are not covered. The proposal corrects that anomaly.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

For completeness, will bodies providing medical services under PMS be mentioned?

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

The contracts that are held for PMS are not analogous to those held by the commercial trading organisations referred to in respect of pharmacies, opticians and dentistry. I am not sure that it is the same issue.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

There is a move towards one-stop shops, especially within large chemist chains, which provide ophthalmic, dental and medical services in walk-in clinics. Thus there must be parallel arrangements for corporate bodies that may want to move into that market.

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

I am not convinced that that is so. People provide PMS either under a GMS contract or a PMS contract under the National Health Service (Primary Care) Act 1997. The arrangements that are allowed for the provision of medical services are fully and adequately covered.

The hon. Gentleman may be suggesting that some time in the future there will be a rise of corporate medical organisations contracting commercially to the NHS, but that is not the case now, nor is it on the horizon. It is not something that the Bill will encourage.

Mr Philip Hammond (Runnymede & Weybridge, Conservative)

Will the hon. Gentleman give way?

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

No, as I want to make some progress.

We plan to remove the restriction in the Dentists Act 1921 through enabling powers included in the Regulatory Reform Bill currently before Parliament. The extensive consultations and parliamentary scrutiny proposed in that Bill mean that it will be the end of the year before the change comes into effect.

First, however, we must guarantee NHS patients the same protection whoever treats them. The clause will protect patients who receive dental care from corporate bodies by enabling health authorities to contract with a corporate body for the provision of general dental services in the same way as they contract with individual general dental practitioners. As a result, health authorities will be able to remove from their lists all dental providers, including corporate bodies and/or the dentists they employ, if there is evidence that they are unsuitable. For example, directors of a corporate body who are not dentists may be involved in fraudulent abuses of the fee regulations or they may fail to provide adequately equipped surgery premises. In such cases, the health authority could remove the company from its list. I hope to table amendments on Report that will prevent the same directors reappearing as a new company and going on to the list. I hope that that will allay the hon. Gentleman's concerns.

Any response should be proportionate. The failure of a dentist in a corporate body to provide an adequate service in one part of the country should not usually lead to the entire organisation being shut down or deemed unsuitable, and the measure's appeal provisions will prevent that. However, if there were wrongdoing at the top, that option would be borne in mind.

Question put and agreed to.

Clause 23 ordered to stand part of the Bill.