Second Standing Committee on Delegated Legislation
Tuesday 19 October 2004
[Miss Anne Begg in the Chair]
Draft Primary Medical Services (Northern Ireland) Order 20048.55 am
Miss Melanie Johnson: I beg to move,
That the Committee has considered the draft Primary Medical Services (Northern Ireland) Order 2004.
I welcome you to the Chair, Miss Begg. This is the first time that I have had the pleasure of serving under your chairmanship.
The order introduces a range of measures required to implement the new general practice contract and associated changes in Northern Ireland which have been agreed for the whole of the United Kingdom between the general practitioners committee of the British Medical Association and the NHS Confederation. Similar measures were made in England and Wales under the Health and Social Care (Community Health and Standards) Act 2003, and in Scotland by the Primary Medical Services (Scotland) Order 2004.
Amendments to UK secondary legislation consequential on the Health and Social Care (Community Health and Standards) Act were made by the General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004, and the General Medical Services Transitional and Consequential Provisions (Wales) (No.2) Order 2004.
Similar amendments have been made in consequence of Scottish primary care legislation by the Primary Medical Services (Scotland) Act 2004 (Consequential Modifications) Order 2004, which was approved by both Houses of Parliament before being made by a Minister in the Scotland Office; and by the Primary Medical Services (Scotland) Act 2004 (Consequential Amendments) Order 2004, which was laid before Parliament on 8 September and was subject to the negative resolution procedure.
Following implementation of the Primary Medical Services (Northern Ireland) Order, some consequential amendments needed only for Northern Ireland have been made by Northern Ireland statutory rules. It has also been necessary to make a number of amendments to UK-wide legislation to reflect the changes made in Northern Ireland. However, owing to restrictions on the competence of Northern Ireland's Department of Health, Social Services and Personal Safety, any amendments that need to extend beyond Northern Ireland must be made by Order in Council following approval of the draft order by both Houses of Parliament. That is why this short and, I hope, uncontentious order is before the committee today.
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The order makes a number of necessarily technical but relatively minor amendments to the Medical Act 1983 and to three statutory instruments. Those are the Medicines (Pharmacy and General Sale -Exemption) Order 1980, the Prescription Only Medicines (Human Use) Order 1997, and the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003.
Most of the amendments simply replace references to the pre-April 2004 general medical services in part VI of the Health and Personal Social Services (Northern Ireland) Order 1991 with references to the new wider term ''primary medical services''. The one exception is the amendments found at paragraphs 4(2)(b) and (4)(b) of the schedule to the draft order. They remove two paragraphs that imposed restrictions on the right to practice of certain categories of GPs to be included in the GP register by virtue of an acquired right to practice. Those restrictions in the 2003 order are no longer necessary as they have been replaced, as appropriate, by restrictions in the legislation relating to the GP contract that deals with conditions for contractors, and the qualifications required by performers.
The Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), has made the following statement on the compatibility of the order with the convention on human rights:
''In my view, the provisions of the Primary Medical Services (Northern Ireland) Order 2004 are compatible with the convention rights.''
I commend the order to the Committee; I hope that I have already answered questions on the details.
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Dr. Andrew Murrison (Westbury) (Con): I echo the Minister's pleasure, Miss Begg, at serving under your chairmanship, for what I hope will be an extremely brief sitting.
My response to the Minister's remarks is to say, ''Well, that's clear then.''
I have now sat through quite a few of these proceedings, and I commend the Minister for rattling off her opening remarks on this extremely technical matter. I also confess that I am none the wiser, and although I am happy to accept that this is largely a technical matter that should not detain us for too long, I shall, if I may, do a bit of drilling down just to satisfy myself that the order is essentially the transposition of the Health and Social Care (Community Health and Standards) Act 2003 into Northern Ireland legislation, particularly in respect of the GP contract. That might be a little simplistic, but I understand that that is essentially what we are trying to achieve today.
Will the Minister say how the health and social care boards equate with primary care trusts, because that is fundamental to the order? PCTs on the mainland will, of course, run primary care, and I understand from the material with which we have been provided that health and social care boards will assume that function. The constitution of those boards is, I understand, quite different from that of PCTs, so merely transposing the
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2003 Act from UK legislation into Northern Ireland legislation might be more complicated than it seems on first examination.
I very much suspect that we are straying into devolved matters, but this is a complex area and I am one member of the Committee who is a little baffled and bewildered by the reason for our considering the order at all. It would help me to get my head around the matter if the Minister could say a little about health and social care boards and their equivalence with PCTs. Perhaps he will do so for my edification and that of the Committee.
Given that Northern Ireland is slightly behind England and Wales in transposing the effects 2003 Act, or its equivalent, into work at the coal face, this is an opportunity to learn from the difficulties that we have already had with the GP contract in England. The Minister will be well aware of the difficulties that we have had particularly with the staffing of community hospitals, of which there are a large number in Northern Ireland, with Saturday morning surgeries, which will be as important in Northern Ireland as they are on the mainland, and with the pressure on acute hospital casualty departments because of the disappearance in many areas of GPs' out-of- hours cover. It would be interesting to know how the Minister sees those problems being surmounted in Northern Ireland by the order.
The global sum adjustment is a very important part of GPs' remuneration, and it would be interesting to know from the Minister what allowance she intends there to be, or would like there to be, from her colleagues in Northern Ireland to address issues such as rurality and transient populations, which are not reflected in GPs' remuneration under the new GP contract in England.
The headlines on the NHS are very much dominated by the national programme for IT in the NHS and, again, it would be a good opportunity for the Minister to describe what impact the programme will have on Northern Ireland. We understand that it will be a UK-wide system, although it is already running into some difficulties, particularly in relation to its finance, and some comment on how the programme will be rolled out in Northern Ireland would be extremely useful.
There is the risk—indeed, it is probably part of the devolved settlement—that health care systems in Northern Ireland will diverge from those in the rest of the UK, but the contract was negotiated nationally between the British Medical Association, a UK-wide body, and the NHS Confederation. It would be interesting to know how the Minister sees primary care in Northern Ireland diverging from that in the UK as a result of the measure. I very much suspect that very different models of primary care provision will emerge under the devolved Administration, and it is interesting that there was a need for this new contract to be negotiated at a UK level, given the likelihood that the systems will diverge in the fullness of time.
Will the powers under the regulations—we see a lot of reference to regulations in the measure—be more or less the same on the mainland as in Northern Ireland, or has the Minister a different philosophy with regard
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to the progress of regulations in Northern Ireland? That touches on a number of sensitive issues, particularly the handling of patients whom GPs do not particularly want, and who might be excluded from primary care. That will be decided by regulation—[Interruption]. I hope that the Minister is listening; I am expecting some answers.
I think that I will end there. I have put several questions to the Minister, several of which, I accept, she may not be able to answer immediately. However, I would appreciate it if she would give it a shot.
9.6 am
Lembit Öpik (Montgomeryshire) (LD): I am delighted to serve under you, Miss Begg. I have no doubt that, when I look at my diary, this Committee will prove to have been the high point of my day.
The Parliamentary Under-Secretary of State for Northern Ireland (Angela Smith): I hope that the hon. Gentleman is taking the matter seriously.
Lembit Öpik: I certainly take the matter seriously, but I feel that the Minister needs to lighten up a bit. That brings me to my second point. It reminds me of the last time I discussed this very matter with the Minister—we debated primary medical services on this Corridor, if not in this Room, in January.
One issue relating to out-of-hours services continues to bother me. I understand that the out-of-hours responsibilities will be transferred to the boards as part of their new statutory duties. We still do not know, therefore, how that will work. No doubt the Minister has read the report of the previous debate, so she will be aware that I and others were concerned that in those places where out-of-hours provision has been changed, including my area, there have been problems, partly because of the large areas that have been covered and partly because the change itself caused some disruption. How does the Minister envisage implementing the change in a way that will not damage the out-of-hours service provision for patients? I need not tell the Minister that Northern Ireland, being quite rural, will experience the same difficulties as have places such as mid-Wales and the west Midlands, for the same reasons, unless she can give us an assurance that she will avoid the problems that occurred in the roll out in those areas, and outline how she intends to do it.
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