Health and Social Care Bill

My Lords, this group of amendments is complex. I declare an interest as I chaired the commission on medical generalism, whose report is currently being consulted across the general practice community in the UK. I am also a fellow of the Royal College of General Practitioners, having worked as a GP myself. Having said that, our report highlighted the wide variation in training of general practitioners, and the need for general practitioners to develop new pathways of working with secondary care, to be gate-openers at appropriate times, and not to keep the gate closed inappropriately. I would also draw your Lordships’ attention to an article in this week’s British Medical Journal which asked whether general practitioners are being adequately monitored, and quotes a senior general practitioner as saying: "““If you asked me, ‘Do you know how safe general practice is?’, I would say, ‘I have no idea’””." The article, sadly, highlights the fact that, in a snapshot of GPs referred to and subsequently disciplined by the General Medical Council, GPs are overrepresented in comparison to hospital doctors. That is partly because hospital doctors are employed in NHS trusts, working in teams where they are overseen by other people, whereas GPs are, typically, independent contractors, sometimes working in isolation, despite the recommendations from people like Dame Janet Smith. That makes it harder for those with responsibility for primary care to access the information that could alert them to poorly performing doctors. That was the background to my amendment about NICE, which I unfortunately missed in the order—I realise that I can do nothing about that now; it was, anyway, a probing amendment—but it came out of evidence given to us in the commission. One of the pathfinder groups was clear that it did not feel under any obligation to adhere to or observe NICE guidance in the way in which it commissions services. I suggest that it will be very important to put in place adequate monitoring systems. It will be impossible for the Commissioning Board, at such a distance from individual general practitioners, to develop the intelligence to know what quality of care is being provided and how they are behaving and being monitored, given that the current structures will be disbanded. Against that background I suggest that the amendments around standards of primary care are particularly important. It was also against that background that I tabled Amendment 248B in the group. It is intended to ensure that there is an overview of general practice. Again, it is a probing amendment that will apply to Part 4 of the Bill on medical services. I look forward to the Minister’s reply on how the quality of general practice will be driven up under the new arrangements.