Employment of Pre-Registration House Officers in Medical Practices

Orders of the Day — National Health Service (Primary Care) Bill [Lords] – in the House of Commons at 6:15 pm on 12th March 1997.

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'.—(1) The Medical Act 1983 is amended as follows.

(2) In subsection (2) of section 10 (experience required for full registration as a medical practitioner), for "approved hospitals or approved institutions," substitute "—

  1. (a)approved hospitals,
  2. (b)approved institutions, or
  3. (c) approved medical practices,".

(3) In subsection (3) of section 11 (construction of section 10, etc), after the first "where" insert "—

  1. (3)in the case of an approved hospital or an approved institution,",
    • and at the end insert "; or
    • (b)in the case of an approved medical practice, the person employed satisfies such conditions as to residence as may be prescribed".
  2. (4) In subsection (4) of section 11—
    1. (a) insert in the appropriate place—
    2. "medical practice" means a prescribed description of practice in which one or more medical practitioners—
      1. (i)provide general medical services under Part II of the National Health Service Act 1977, Part II of the National Health Service (Scotland) Act 1978 or Part VI of the Health and Personal Social Services (Northern Ireland) Order 1972; or
      2. (ii)perform personal medical services in accordance with arrangements made under section 28C of the 1977 Act, section 17C of the 1978 Act or the corresponding provisions of the law in force in Northern Ireland;";
  3. (b) in the definition of "prescribed", after "means" insert "—
    1. (a)in subsection (3)(b) and in the definition of "medical practice", prescribed by regulations made by the Secretary of State; and
    2. (b)in the other provisions of this Part,".
  4. (5) After subsection (4) of section 11 insert—
    1. "(4A) The Education Committee may by regulations provide that the period of employment in a medical practice which may be reckoned towards the completion of any of the periods mentioned in section 10(3)(a) above shall not exceed such period as may be specified in the regulations.
  5. (6) In subsection (5) of section 11, after "under subsection (2) of section 10 above" insert "or under subsection (4A) of this section".
  6. (7) After subsection (6) of section 11 insert—
    1. "(7) Regulations made by the Secretary of State under this section must be made by statutory instrument; and such a statutory instrument shall be subject to annulment in pursuance of a resolution of either House of Parliament." '.—[Mr. Malone.]

Brought up, and read the First time.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

I beg to move, That the clause be read a Second time.

Photo of Miss Janet Fookes Miss Janet Fookes , Plymouth Drake

>: With this, it will be convenient to discuss the following: amendment (a) to the proposed clause, in line 40, at end add— '(8) Section 12 is omitted.'. Government amendments Nos. 59, 60, 62, 63, 65, 67 to 72, 74 and 75.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

During the Second Reading debate I gave an undertaking to meet the concerns of several hon. Members about the limitations in the Medical Act 1983 that prevented pre-registration house officers from taking placements in general practice except in health centres. In Committee, I explained that that was clearly an anomaly that we were happy to address. I am therefore pleased to move new clause 8 and to discuss amendment No. 75, which deliver on my undertaking to the Committee. With those, I want also to speak to the related amendments to clauses 11 and 22 and schedule 2.

New clause 8 and amendment No. 75 are designed to enable more young doctors in their final year of basic training—the pre-registration house officer year—to undertake part of that training in general practices. The case for the change has been made for many years and it is now quite timely, given that the Bill provides opportunities for more flexible ways of working and providing services. Much of a primary care-led national health service has to do with the training provided in the context of primary care.

It is important that I should set out a number of practical issues that will have to be carefully considered before those placements in general practice are fully introduced. I want there to be no misunderstanding among hon. Members: the measure before the House is an enabling measure and there is considerably more work to be done. We are considering encouraging carefully evaluated pilot schemes in health centres, which will enable us to assess whether any constraints should be placed on the activities of pre-registration house officers in general practice. For example, concerns were raised in Committee about the prescribing of medicines and unaccompanied visits to very young children or, indeed, to any patient.

Those are important issues and we must balance young doctors' training needs with the protection of patients' interests and safety. The education committee of the General Medical Council will need some time for the careful development of regulations and guidance to cover those issues and will need to consult widely. Regulations made by the education committee will be approved in the normal way by the Privy Council. We therefore do not expect the new arrangements in general practices to be in place for some time.

I now turn to amendment (a) to new clause 8. There must have been some misunderstanding that has led to the amendment being tabled, because it removes entirely section 12 of the Medical Act which provides that a health centre cannot be an approved institution for the purpose of pre-registration house officer training, unless it is an NHS centre provided under the National Health Service Act 1977 or the Scotland or Northern Ireland equivalents. Where it is so and if other conditions are satisfied, PRHO training can take place in health centres. In other words, if that part of the Medical Act were removed, it would cast doubt on whether PRHO placements—including some that are now in operation—could take place in health centres. I am sure that that was not what was intended.

I turn finally to the amendments to clauses 11 and 22 and schedule 2. In brief, those replicate provisions that currently exist in general medical services and give the Secretary of State powers to replicate those that operate in the general dental services. They will enable us to ensure that training can take place in the different environments and service settings for which the Bill provides. I assure hon. Members that all the controls that currently underpin training within general medical and dental services will equally be applied to personal medical and dental services, so that training activities can be undertaken with no effect on the quality of the services provided. I commend the amendments to the House.

Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Health)

The new clause has been introduced with cross-party support and is also, as the Minister made clear, supported by the General Medical Council, which is responsible for overseeing the pre-registration year for medical graduates. As part of that pre-registration year, medical graduates can spend up to four months in general practice.

The need for the new clause is created by section 12 of the Medical Act 1983, which restricts the experience of general practice that may be counted towards the 12 months of general clinical training needed for full registration to that obtained in practices based in publicly owned premises. However, general practitioners are increasingly practising in buildings that are not publicly owned and that fact prevents medical schools from incorporating a training period in the pre-registration year.

Currently, of 3,800 new doctor graduates each year, only three spend part of their pre-registration time in general practice. The new clause, therefore, would amend the 1983 Act to broaden the scope for employment of pre-registration house officers to an approved hospital or approved institution.

Opposition Members believe that to be a practical way of starting to tackle the crippling shortages of GPs in many of our inner cities and of coping with the long-term recruitment crisis confronting general practice. We believe that, if medical students in training have more exposure to general practice and more opportunity to train in general practice, general practice and the opportunities offered by general practice as part of primary care will become more appealing. We cannot envisage the proper and well-grounded development of the health service with the shift from secondary to primary care without the ability to tackle the acute shortage of general practitioners.

We regard the measure as a way of improving standards in the long run and ensuring a better gender balance in the availability of general practitioners, which was mentioned by my hon. Friend the Member for Cannock and Burntwood (Dr. Wright) on Second Reading.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

As I said on Second Reading, this measure is welcome. There was lobbying from both sides of the House, and the Minister undertook to consider the matter. I am grateful for that. This welcome measure will allow further development of general practitioner opportunities. I am grateful to colleagues—one of whom I believe is about to seek to catch your eye, Madam Deputy Speaker—for the fact that they, on behalf of the General Medical Council, have ensured that we are aware of the strong view held by the General Medical Council on this subject.

Photo of Mr Gareth Wardell Mr Gareth Wardell , Gower

I have great pleasure in welcoming what the Minister has said, and I am delighted to discover that this anomaly in the Medical Act 1983 will now be put right. Madam Deputy Speaker, as a lay member of the General Medical Council, I was pleased to catch your eye on Second Reading, and I was pleased that the hon. Member for Chislehurst (Sir R. Sims), who also sits as a lay member of the General Medical Council, made a valuable contribution to that debate.

Although I shall not press the new clause to a vote, I have one concern: I do not quite follow the logic of the new clause that the Government have tabled, because it does not seek to remove section 12 from the 1983 Act. Although the amendment contains three lines referring to an order or regulation to be made by the Secretary of State to accomplish the objective that is sought, I do not understand why section 12 of the 1983 Act will remain on the statute book, given that it appears to be in conflict with the section that is sought to be amended.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

It might be helpful if I spell it out for the hon. Gentleman. Such regulations will not be in place for some time and several people are already undertaking training in such health centres. If we simply removed that section of the legislation, their future placements, some of which start in August 1997, might be in doubt. Section 12 remains merely to ensure certitude.

The GMC was seeking to enable future training arrangements to take place in a wider context, and that is what the new clause enables them to do. It would be ironic if, while opening up the prospects for training in primary care in general, allowing scope for substantial discussion about how that is introduced, we were to agree a provision that prevented the training that is already taking place under what, once the Bill is through the House, we could probably safely describe as "the old arrangements."

Photo of Mr Gareth Wardell Mr Gareth Wardell , Gower

I am grateful to the Minister for that explanation. I now understand his rationale for seeking to proceed in this way; otherwise it would be a great disservice to the, albeit few, people who are currently in training.

Once again, I thank the Minister for the fact that he listened carefully to this point on Second Reading. I am very grateful to him, to Labour Front Bench Members and to the hon. Member for Southwark and Bermondsey (Mr. Hughes) for the fact that we have been able, on this occasion, through an all-party system, to agree on something that will benefit the national health service so much.

Question put and agreed to.

Clause read a Second time.

Photo of Mr Gareth Wardell Mr Gareth Wardell , Gower

No, not to be moved.

Clause added to the Bill.