My Lords, in the short time available to me, I propose to speak about the role of general practitioners, who are regarded widely as the jewel in the crown of the National Health Service.
Your Lordships will be aware that throughout 2012 there were tortuous negotiations with the Department of Health about the GP contract. Agreement was reached at the start of 2013. I intend to touch on one aspect of this agreement today: doctors’ out-of-hours service. Of course, there is no question of GPs going back to the situation before 2003, when doctors in general practice were effectively on call on a 24/7 basis. Since then, a number of arrangements have evolved for dealing with out-of-hours work; some are run by the former primary care trusts, some by co-operatives of GPs and some by independent contractors. With any of these structures there must inevitably be a degree of patient dissatisfaction—perhaps I should say unease—since the patient will not be seen by a member of a GP practice familiar to him or her. This must be accepted and the challenge is to make these out-of-hours services as efficient and patient-friendly as possible.
I am advised that some of the doctors engaged in out-of-hours work will have had no experience of the particular skills it demands during the 10 years that the current out-of-hours regime has been in place. While out-of-hours doctors have to have the minimum qualifications to be a GP, and it is not a speciality as generally understood, nevertheless particular skills are required in assessing acutely unwell people; by the very nature of this work, there will be limited or no documentary back-up. Undoubtedly there are many able practitioners engaged in this work, where they may find the flexibility of out-of-hours work attractive and they may not want the responsibilities of a GP partnership—or indeed simply for the extra money. Nevertheless, it is a widely held view in the profession that there are many doctors in out-of-hours work who would have difficulty getting mainstream GP jobs.
Added to this is the media interest in this subject, including a particularly critical article in the Daily Mail yesterday, which that newspaper has followed up today. Now that responsibility for out-of-hours work has been passed back to GPs, does the Minister envisage an expansion in terms of numbers in the out-of-hours work service? Is he able to confirm that provision has been made for the costs of training? Fundamentally, what degree of monitoring does he envisage for the contractors and the qualifications of their personnel, bearing in mind media reports that cite instances of specialised nurses taking the place of doctors due to shortages of the latter?
I have the privilege of speaking after the noble Lord, Lord MacKenzie of Culkein, who has unrivalled knowledge of the nursing profession. I will address one particular aspect that affects nurses. Attention has been drawn previously in your Lordships’ House to the matter of language testing of nurses from the EU who have the right under the freedom of movement directive to practise in the UK. Significantly, there are different procedures for doctors and nurses. The GMC may register doctors from the EU. It can assure itself inter alia of the candidate’s English skills and only then issue a fitness to practise certificate; in other words, it is a perfectly workable and effective arrangement.
The nurses’ regulating body, the Nursing and Midwifery Council, is constituted under different legislation from the GMC and, crucially, does not at present have the freedom to monitor the competence in English of EU nurses before releasing them into nursing in Great Britain. I know from previous dialogues with the Minister that his department is aware of and sympathetic to concerns about the problem and so, in its more measured pace, is the Commission. However, the latest proposal for discussion coming out of Brussels seems to suggest that registration and fitness to practise should continue to come simultaneously. The effect of this is fundamental. It means that, once an EU nurse is registered, the Nursing and Midwifery Council still has no control over that nurse’s fitness to practise. The Government’s position on testing for English language competency appears to be set out in a Commons Written Answer of
“Post registration it is for employers and contracting bodies to ensure that any nurses or midwives they employ or contract with have the necessary skills and competencies (including language competence) for the job”.—[Hansard, Commons, 25/10/10; col. 126W.]
I appreciate that, as the directive now stands, that is the only course open to the Government, but I strongly suggest to your Lordships that it is not satisfactory and detracts from the authority of the NMC, the regulatory body.
The current proposal from the commission does nothing to alter the position and it is certainly of concern to the NMC. I would welcome an assurance from the Minister that his department will continue to press Brussels for an English language proficiency regime for nurses from the EU to be effectively the same as for doctors, so that there is a period during which the NMC can assess the English language skills of a registered nurse from the EU before issuing the appropriate authorisation to practise.
In March 2012, the Law Commission launched a consultation on the regulation of healthcare professionals in the United Kingdom, and it is due to present its final report and draft Bill in early 2014. I understand that this is likely to recommend the streamlining of fitness-to-practise legislation regarding health professionals across the UK. If this assists in resolving the problems of regulation and fitness to practise for nurses posed by the freedom of movement directive to which I have referred, it will be very welcome, as indeed will any reassurance that the Minister is able to give the House today.