Clause 4 - Personal medical services, personal dental services and local pharmaceutical services
NHS Reform and Health Care Professions Bill
4:30 pm
Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)
I am always happy to talk about clause 4, which is a familiar friend of mine. As we have discussed, the Bill will transfer almost all primary care functions of existing health authorities to PCTs. That lies at the heart of the initiative to shift the balance of power. However, there is a technical and legal tension between the principle of shifting the balance of power in the NHS and the legal architecture of the National Health Service (Primary Care) Act 1997, with which the hon. Gentleman may have had some involvement.
We do not need to look today at the origins of that Act, but the underlying principles of PMS and PDS are correct. The architecture of the 1997 Act has not prevented the Government from using PMS to extend the reach of primary care services through a range of important and innovative ideas to many parts of the country, including run-down council estates where residents never had access to primary care services.
As I implied earlier, the legal structure of the 1997 Act prevents us from using the Bill to transfer all the functions in respect of PMS and PDS to primary care trusts. Of course, we could have chosen to do that, but only by requiring Parliament to scrap the 1997 Act and by rewriting the entire legal framework around the delivery of personal medical services. That would have diverted Parliament from discussing more important issues, but there is another way of doing it; the way that we have chosen in clause 4.
The heart of the problem is that the 1997Act requires a distinction to be made between the commissioner and the provider of PMS or PDS. For example, in the majority of PMS pilots, the commissioner is the primary care trust and the provider a GP, a group of GPs or a nurse-led organisation. In some pilots, the primary care trust itself is the PMS pilot provider and the health authority is the commissioning organisation. To transfer all the local authority PMS functions directly to a primary care trust would, in such cases, result in a primary care trust commissioning PMS from itself. Obviously, we cannot accept that. It would not comply with the 1997 Act, and would go directly against the grain of that legislation. The options are either to rewrite the Act or to confer limited functions in respect of PMS or PDS on strategic health authorities.